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‘Just say yes, Mr President’

Mbeki and AIDS

___________________________

ANTHONY BRINK

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If ever there was in the world a warranted and proven history, it is that of vampires. Nothing is lacking; official reports, testimonials of persons of standing, of surgeons, of clergymen, of judges; the evidence is all embracing.

Jean Jacques Rousseau

Later we will realize many times how mistaken we were in concepts that were so familiar they became part of us and were an automatic part of our thinking. Often we need to change our concepts, not only the general concepts, the social or philosophical ones, but also sometimes our medical concepts.

Ernesto Che Guevara

‘Just say yes, Mr President’: Mbeki and AIDS

The success of our constitutional venture depends upon robust criticism of the exercise of power. This requires alert and critical citizens. ... [The South African] Constitution places particular store upon free and fair political activity. And it gives constitutional recognition to the fact that freedom of speech and expression ... is an indispensable adjunct to free and fair political activity. The overall structure of our Constitution, thus, lays an emphasis on the effective and inclusive functioning of democracy, and highlights this in the special protection it gives to the aspects of free speech and expression which safeguards political activity. It is in this context, too, that ... the fundamental rights chapter grants every citizen the right ‘freely to make political choices’. This freedom could scarcely be enjoyed unless there is vigorous, free and informed political debate. ... The ambit of political activity ... spans a broad and encompassing area.

Cameron J (now JA) in Holomisa v Argus Newspapers 1996 (2) SA 588 WLD.

The SABC television evening news on Friday, 9 October 1998, opened with a dramatic announcement by newsreader Nadia Levin:

The HIV/AIDS crisis facing South Africa was highlighted today in an historic live address to the nation by Deputy President Thabo Mbeki. President Mandela did not give the address as previously planned, because he’s been ordered to rest by his doctors. Mbeki’s speech spearheaded an initiative for greater partnership between government and society. There are 1 500 new HIV infections each day in this country.

Cut to a clip of some black toddlers. Apart from one blubbing, as kids sometimes do, which he stops when he begin sucking his thumb, as kids usually do, all look healthy and content. No, says reporter Robyn Curnow: ‘These are the faces of HIV/AIDS, faces that tell a story that many South Africans don’t want to hear, but today Deputy President Mbeki came to this children’s home and made South Africa listen. At midday he urged everybody to change “the way we live and how we love”.’ Cut next to a cutesy staged set that has Mbeki sitting in an armchair surrounded by more black children (‘the faces of HIV/AIDS’) placed all around him, one resting his head on his left knee. Looking straight ahead into the camera, with his hands together in his lap, Mbeki commences an awful proclamation: the country was in the grip of a terrible plague; it might not be visible but it was everywhere; those of us who could not or would not see it were vainly denying the magnitude and horror of it; and unless we changed our sexual habits South Africa would soon be laid waste. So went his speech, broadcast in full earlier in the day – ‘10 Minutes to Save the Nation’, as the National HIV/AIDS and STD Directorate called it – and printed on a banner behind him:

Partnership Against AIDS

DECLARATION

HIV/AIDS is among us.

It is real. It is spreading.

We can only win against HIV/AIDS if we join hands to save our nation.

For too long we have closed our eyes as a nation, hoping the truth was not so real.

For many years, we have allowed the H-I-Virus to spread, and at a rate in our country which is one of the fastest in the world.

Every single day a further 1 500 people in South Africa get infected. To date, more than 3 million people have been infected.

THE DANGER IS REAL

Many more face the danger of being affected by HIV/AIDS.

Because it is carried and transmitted by human beings, it is with us in our workplaces, in our classrooms and our lecture halls.

It is there in our church gatherings and other religious functions.

HIV/AIDS walks with us. It travels with us wherever we go. It is there when we play sport. It is there when we sing and dance.

Many of us have grieved for orphans left with no one to fend for them. We have experienced AIDS in the groans of wasting lives. We have carried it in small and big coffins to many grave yards.

At times we did not know that we were burying people who had died from AIDS. At other times we knew, but chose to remain silent.

And when the time comes for each one of us to make a personal precautionary decision, we fall prey to doubt and false confidence. We hope that HIV/AIDS is someone else’s problem.

CHANGING OUR WAY OF LIFE

HIV/AIDS is not someone else’s problem. It is my problem. It is your problem.

By allowing it to spread, we face the danger that half of our youth will not reach adulthood. Their education will be wasted. The economy will shrink. There will be a large number of sick people whom the healthy will not be able to maintain. Our dreams as a people will be shattered.

HIV spreads mainly through sex.

You have the right to live your life the way you want to.

But I appeal to the young people, who represent our country’s future, to abstain from sex for as long as possible. If you decide to engage in sex, use a condom.

In the same way I appeal to both men and women to be faithful to each other, but otherwise to use condoms.

PARTNERSHIP

The power to defeat the spread of HIV and AIDS lies in our Partnership: as youth, as women and men, as business people, as workers, as religious people, as parents and teachers, as students, as healers, as farmers and farm-workers, as the unemployed and the professionals, as the rich and the poor – in fact, all of us.

Today, we join hands in this Partnership Against HIV/AIDS, united in our resolve to save the nation.

As Partners Against AIDS, together we pledge to spread the message!

Every day, every night – wherever we are – we shall let our families, friends and peers know that they can save themselves and save the nation, by changing the way we live and how we love. We shall use every opportunity openly to discuss the issue of HIV/AIDS.

As Partners Against AIDS together we pledge to care!

We shall work together to care for those living with HIV/AIDS and for the children orphaned through AIDS. They must not be subjected to discrimination of any kind. They can live productive lives for many years.

They are human beings like you and me. When we lend a hand, we build our own humanity, and we remind ourselves that, like them, each one of us can become infected.

As Partners Against AIDS together we pledge to pool our resources and to commit our brain power!

There is still no cure for HIV and AIDS. Nothing can prevent infection except our own behaviour.

We shall work together to support medical institutions to search for a vaccine and a cure.

We shall mobilise all possible resources to spread the message of prevention, to offer support to those infected and affected, and to destigmatise HIV and AIDS and to continue our search for a medical solution.

And so today we join hands in the Partnership, fully aware that our unity is our strength. The simple but practical action that we take today is tomorrow’s insurance for our nation.

Accordingly, we pledge that whenever we meet and study, work and sing, play and enjoy one another’s company, we will protect ourselves and our partners against HIV and AIDS.

Together, as Partners Against HIV/AIDS, we can and shall win.

I have asked for your time to listen to this urgent message because there is no other moment, but the present, to take action!

I thank you for your attention and urge you to ACT NOW!

In the excerpt of Mbeki’s address broadcast on the eight o’ clock news, the news editors zoomed in on its central idea, his call for mass behaviour change:

By allowing it to spread we face the danger that half of our youth will not reach adulthood. Their education will be wasted. The economy will shrink there will be a large number of sick people whom the healthy will not be able to maintain. Our dreams as a people will be shattered. But I appeal to the young people, who represent our country’s future, to abstain from sex for as long as possible. If you decide to engage in sex use a condom. In the same way I appeal to both men and women to be faithful to one another, but otherwise to use condoms.

‘In Cape Town workers listened to one of this country’s most important speeches, while in Bloemfontein hundreds of people marched in support of the Deputy President’s call for action,’ says Curnow speaking again. ‘And around the country flags flew at half-mast, a sad reminder for the nation that has one of the fastest HIV growth rates in the world.’ The visuals now move to Parliament with Table Mountain in the background, where indeed the flags hang low as if to mark some terrible national tragedy. ‘Representatives from business, sports and entertainment, religion, trade unions, people living with AIDS, women’s groups and the youth all pledged to do something.’ A series of whom then appear making promises. To do something. ‘It’s believed that almost a million people in KZN [KwaZulu-Natal province] are HIV-positive,’ laments reporter Fauzia Moodley. ‘About 29% of pregnant women are HIV-positive and more than a third of their babies will be born with the AIDS virus.’ A hospital doctor and a university virology professor come up next to spin their scary stories. Moodley concludes the evening’s drama: ‘At the moment there is no cure for AIDS, but treatment is available to prolong life and to reduce the amount of virus in the body. Unfortunately it is too expensive to be widely offered at state hospitals.’ It’s called AZT.

With Mbeki as visionary commander-in-chief, the country was going to war against HIV, the frightening menace that threatened it with oblivion. Under our flies.

Until then almost completely overshadowed by the sparkle of Mandela’s personal magic, Mbeki’s televised Partnership Against AIDS declaration was his first big appearance in the public eye. What was ironic was that the subject in which he made his earnest and faithful début would be one for which he would be universally attacked as the world’s most scrofulous modern heretic just a year later. Month after month, throughout the five years of Mbeki’s first term as President himself, and into his second, the fire beneath him would be tended and fed, slow-roasting him mercilessly for his sins, like a medieval non-conformist spread-eagled on an iron grate.

This is the story of the apostate’s progress.

Debating AZT reached Minister of Health Dr Mantombazane Edmie Tshabalala-Msimang in just the nick of time. Two articles in the Sunday Times in May 1999 spurred me to send my manuscript to her predecessor, Dr Nkosazana Dlamini-Zuma. The first, on the 2nd, reported: Zuma rejects cheap AZT:

The government has refused to provide AZT treatment to pregnant women infected with HIV despite being offered the drug at the cheapest price in the world for the past two years – 70 percent of the price charged in the US and Britain. In that time, 120 000 babies have been infected with HIV. The lives of half these babies could have been saved by the drug. The Department of Health has said the costs of the treatment are too high, but it has not made the drug’s manufacturer, Glaxo Wellcome, a counter offer.

It was par with the kind of tendentious media coverage of the controversy that had shaped a unanimous public consensus in favour of the drug. What the report omitted was that Dlamini-Zuma had a friend in UNAIDS executive director Peter Piot: AZT programs for HIV-infected pregnant women were difficult to implement, he said, even at the level of pilot studies; it was a ‘very complex issue’. Hoosen (‘Jerry’) Coovadia, then professor of paediatrics at the University of Natal, agreed: ‘I fear even beyond the price of the drugs, there are many problems to be solved before the treatment can become widely available.’

The following week, in the same style and tone, the newspaper claimed: Zuma in dramatic AZT about-turn: Hospital’s go-ahead to distribute drug to pregnant women with HIV signals shift in health policy. Actually no policy reversal had taken place; the Gauteng Department of Health had simply given the nod to UNAIDS supplying some donated AZT to the Chris Hani-Baragwanath Hospital in Soweto. And her special advisor Ian Roberts pointed out that Dlamini-Zuma hadn’t even been consulted. As her spokesman Khangelani Hlongwane made clear in the report, the government’s reservations about AZT were soley financial at that stage.

‘The problem lies not with the government,’ Mbeki had shrugged in answer to the government’s critics regarding the non-delivery of AIDS drugs. ‘The problem lies with pharmaceutical companies’ exorbitant prices … making it impossible for the government to make them available.’ Commenting on a protest over the price of AZT by AIDS drug activists on 28 April, Mbeki’s spokesman Ronnie Mamoepa reiterated the President’s view:

If the price is reduced we will have no problem with the treatment. But it is for the pharmaceutical company to act. As long as AZT is only available at exorbitant prices it makes it impossible for the government to make it available to ordinary people. It is incumbent on the pharmaceutical companies to reduce the cost and price of AZT, and therefore the calls for AZT to be made available should be directed at the pharmaceutical companies.

To which AIDS Law project director Mark Heywood reacted: ‘We are not the government’s friend on this issue, but GlaxoWellcome could be doing more to make AZT available at cost price. We are fighting for people living with HIV and those HIV-positive women who are pregnant.’

My revelations about the dangerous toxicity of the drug in the Citizen a few weeks earlier in the course of my debate with South Africa’s top AIDS treatment expert, Dr Desmond Martin, president of the Southern African HIV/AIDS Clinicians Society, evidently hadn’t yet been officially noted.

I reacted to the Sunday Times reports by emailing Roberts on 19 May, asking him for ‘a postal address for the submission of some materials I believe the Minister will find invaluable in staving off her critics regarding her decision on AZT. I support her 100%!’ Roberts replied the same day: ‘Thank you for your expression of support. At this time around elections it is best sent to [my home address]. I await your data with interest and will send a copy to the Minister.’ Opting to use email instead, I sent Roberts an amplified version of my AZT debate, then subtitled Questions of safety and utility, including further citations from the medical literature concerning the drug’s toxicity and carcinogenicity.

Roberts acknowledged receipt on the 27th:

Thank you for sending me the email and the attachment. I will pass it on to the Minister of Health after the elections and the [new post-Mandela] Cabinet appointments have been made [by President Mbeki].It will then get the attention it deserves. You have clearly researched this topic in great detail and I guess you have read more than anyone I have come across so far in South Africa. I share many of your concerns regarding the risk benefit ratio of zidovudine in therapy particularly in the therapy that involves non-HIV infected individuals where, in my view, information is so scant that such an assessment is impossible to make. I also share your concerns that it appears that too freely in this country of ours, people have come to a conclusion on this topic without much scientific evidence to back these conclusions.

On 23 July Roberts confirmed: ‘I have now sent your document to the Minister of Health.’ On the same day, Howard Barrell on the Mail&Guardian (later its editor) reported, Ban on AZT to pregnant women under review:

New Minister of Health Dr Manto Tshabalala-Msimang is reviewing the ban on the use of the antiretroviral drug AZT by HIV-positive pregnant women to prevent infection of their unborn children. … Curbing the rate of new HIV infections was her ‘number one priority for this year’ so ‘the time has arrived to review the decision’ not to supply AZT to HIV-positive pregnant women ... taken by her predecessor, Dr Nkosazana Dlamini-Zuma, on the grounds that AZT was too expensive and its benefits to the unborn children of HIV-positive women were not clear enough. One of Tshabalala-Msimang’s first acts after her appointment as health minister was to call a meeting of people and groups working to curb the HIV/Aids pandemic. Activists spoke of a new sense of purpose after the meeting. One HIV/Aids worker praised the ‘sense of urgency she brought to the meeting, the questions she asked and her willingness to listen. It was a breath of fresh air’. Next week, the interministerial committee on HIV/Aids, usually chaired by President Thabo Mbeki, is due to meet, and her suggestion for a review of her predecessor’s ban on AZT treatment for HIV-positive pregnant women is likely to come under discussion.

The pressure on me at the time is indescribable. I was working after-hours quite alone in the country – supported by a small network of concerned scientists and dissident activists scattered thinly around the world – with the pealing of salaried professional AIDS treatment activists and drug-pushing journalists mesmerizing a spellbound public, and drumming against my ears like the exhortations of those rabbis in the Warsaw Ghetto, who’d bought the promises announced through German officers’ bullhorns and, unable to imagine the evil lying ahead, urged their flock to pack their things for voluntary relocation in the East: ‘We’re going to a better place. We’re going to a better place.’

The first sparks in the AZT controversy had flown on the same day that Mbeki announced his Partnership Against AIDS, when Dlamini-Zuma cancelled a five-site pilot trial in which AZT was being given to HIV-positive pregnant women – all black – at Chris Hani-Baragwanath Hospital and Zola Clinic, Coronation Hospital, Witkoppen, Empilisweni and Sebokeng. Her spokesman gave the reason:

Our problem is with the economic viability of the intervention, not with the long-term cost-effectiveness of the project. People can advance all sorts of arguments but the government won’t make a commitment that it can’t sustain. The bottom line is that the government does not have the money. If there is a windfall from somewhere, then the government might reconsider its decision. Governments have to take difficult decisions and this is one of them.

Anyway, said Dlamini-Zuma, ‘AZT treatment will have a limited effect on the epidemic as we are targeting individuals already infected. ... The only cure is to prevent infection in the first place.’ It was an economic decision: ‘If you have limited resources, you may decide to put your resources into

preventing mothers getting infected in the first place.’ Roberts summed up matter of factly: ‘There is not much point in running a pilot study unless you can implement its findings.’

Hearing which, Professor Nicoli Nattrass at UCT’s School of Economics scolded: ‘It is economically illiterate and shockingly ill-informed to argue that we cannot afford to give pregnant women AZT.’ Glenda Gray, co-director of the Perinatal HIV Research Unit at Chris Hani-Baragwanath Hospital in Soweto, fumed likewise: the government ‘preferred incoherent campaigns instead of things that will really turn the tide against AIDS … South African politicians must know that the whole world is watching them.’ Knowing better than the Minister did, Heywood decided that ‘Dr Zuma does not understand the issues. These drugs should be given during birth and in the week post-birth.’ And he intended taking the government to court to force it to provide AZT to all HIV-positive pregnant women as a constitutional right, he said. He repeated his plans in the March 2000 issue of Focus: ‘I believe there is a very strong legal case under the Constitution for giving AZT to pregnant women, both as regards the rights of children to health care and the reproductive rights of women. AZT can be shown to be cost effective and affordable. The government knows it’s on weak ground when it comes to AZT for pregnant women.’ Why, Mbeki himself had declared that ‘people with AIDS had a “moral entitlement” to mercy treatment,’ Heywood pointed out in the Sowetan on 1 December 1999. ‘[In a piece he’d written and sent to the Sunday newspapers for publication on 7 March 1998, Mbeki] wrote that the cruel games of those who do not care should not be allowed to set the national agenda.’ The cruel drug industry executives pricing life-saving AZT out of reach. ‘Save our babies, Dr Zuma’, pleaded Carol Paton’s headline in the Sunday Times in the weekend. Your Decision against drug treatment puts thousands at risk.

The decision to call off the AZT pilot study, however, had the backing of the Ministerial Task Force on AIDS, which Mbeki, still Deputy President, had established and chaired. None of the private sector members of his new Partnership Against AIDS had been consulted before the decision to cancel the study was taken – perhaps because the strenuous opposition of its dominantly white private sector members was predictable. As Morna Cornell’s was: the director of the AIDS Consortium, a network of virtually every local AIDS organisation around, condemned it as ‘unacceptable … The decision has a huge impact on the people we work with. We want to know that the concerns we’ve raised have been heard. A partnership implies the possibility of influencing a decision, being involved in a process.’

Touting AZT for sale at ‘preferential pricing’ for administration to HIV-positive pregnant women in South Africa, GlaxoWellcome had first approached Dlamini-Zuma in 1996, but she wouldn’t bite. The company’s next trick was described with a straight face by the Mail&Guardian on 22 August 1997 as ‘a bouquet of assistance … While Glaxo would sell the drug to the government at its usual price to avoid it being re-exported, the difference in cost between the actual and the discounted price would be ploughed back to fund training for AIDS counsellors and building private consulting rooms at clinics, among other options’. Needless to say, Dlamini-Zuma wasn’t impressed by that offer either. When the results of Schaffer’s short-course AZT mother-to-child transmission study in Thailand came through in early 1998, the company tried again, this time offering a 30% discount. The Department of Health Exploratory set up pilot studies at five sites, but, as just mentioned, Dlamini-Zuma pulled the plug on government funding a few months later, even though, so eager was GlaxoWellcome for the business that it had now reduced its price by three quarters.

Condemnation of Dlamini-Zuma’s rejection of GlaxoWellcome’s solicitations to bulk-buy its AZT and to supply it across the board to HIV-positive pregnant women in South Africa had been universal. Top science journal Nature had been carping about it since October, the month before she cancelled the perinatal AZT pilot trial. On 4 March 1999 the journal groused further: ‘South Africa’s minister of health, Nkosazana Zuma, has refused to alter her decision not to pay for a pilot programme administering the antiviral agent AZT to HIV-positive pregnant mothers. This is despite increased threats of a boycott of the World AIDS Congress in Durban next year’ and notwithstanding a special visit by the ‘president of the International AIDS Society, Mark Wainberg ... to persuade Zuma to reverse her earlier decision’ on AZT – ‘mildly toxic’ he would later describe it. Determined he was too, also lobbying Mandela, his deputy Mbeki and Finance Minister Trevor Manuel.

In its 5 February issue, the Mail&Guardian quoted Wainberg saying they should ‘support Zuma in recognizing that perinatal treatment is a cost-effective way forward, and in making funds available for this. South Africa must consider itself to be at war. Its number-one enemy … is not some neighbouring country threatening its borders. It is HIV.’ Although he claimed that his meeting with Dlamini-Zuma had left him ‘encouraged and confident’, her spokesman Vincent Hlongwane made clear that the government would not reconsider its decision: ‘What we are saying is that we don’t have the budget for it. That position has not changed. It has not been influenced by the research findings coming from Chicago or anywhere else’ – referring to a meeting of Wainberg’s society a few days earlier in Chicago, where data in support of short-course AZT treatment had been presented. The meeting, also attended by South African AIDS experts, had been held to discuss the boycott calls in regard to the impending International AIDS Conference in Durban, including the proposal that Dlamini-Zuma be barred from attending if she didn’t change her mind. But Hlongwane emphasized that her decision was not just her’s but the entire government’s, which was ‘fully briefed’, he said: ‘The Cabinet’s position is to rather use the money we have for prevention. The majority of south Africans do not have AIDS now, but that could change if we don’t focus on prevention.’

‘Ludicrous’, ‘autocratic’, ‘extraordinary’, was the furious response of unnamed AIDS activists quoted by the M&G. It was ‘unacceptable’, said AIDS Law Project attorney Fatima Hassan, and ‘if the government has not significantly shifted its position on mother-to-child transmission and other AIDS policy issues … by September’, Heywood warned that he and his fellow AIDS activists would ‘not rule out’ a boycott. They’d show the government who was in charge of AIDS policy.

Nature deplored Dlamini-Zuma’s obstinacy, given that ‘Glaxo-Wellcome is offering AZT to the South African government at 75 per cent below the price for developed countries, and has offered to hold that price for five years’. The journal went on to make all the familiar noises, concluding in blinking incomprehension that the African National Congress didn’t think Dlamini-Zuma quite as useless as it did – ranking third on the party election list, right after ANC president Mbeki, and her former husband, party deputy president Jacob Zuma. And better esteemed even than Zulu strongman Mangosuthu Gatsha Buthelezi, the Inkatha Freedom Party boss (and political gigolo of Margaret ‘The ANC is a typical terrorist organisation’ Thatcher). Although what any of this was doing in a science journal it’s hard to say. Unless you appreciate that Nature is all about a very Tory kind of science.

Sometime in October 1999 Tshabalala-Msimang read the manuscript of Debating AZT, which Roberts had given her in July. It took her like a cold shower. She changed her mind about the drug completely, let Mbeki in on what she’d discovered, and passed the manuscript on to him after copying it for some of her top officials and aides. ‘That was the first time that I became aware of this alternative viewpoint,’ Mbeki told Allister Sparks, during his research for Beyond the Miracle: Inside the New South Africa (Jonathan Ball Publishers, 2003): ‘Mbeki himself confirmed that the first person to draw his attention to [dissident criticism of AIDS causation and treatment orthodoxy] was a lawyer and part-time jazz musician named Anthony Brink, then practising in the provincial city of Pietermaritzburg. … It must be said in Mbeki’s defence that Brink ... is an able lawyer who makes his case with persuasive force.’ Mbeki was appalled. With the entire South African medical establishment crooning ignorantly about the virtues of AZT, he decided to take matters in hand personally: he went online, and looked up and printed the toxicity papers cited in Debating AZT, many of which had been posted there by the medical journals in which they had originally appeared, if not in full then summarised in the researchers’ abstracts. Given the gravity of the issue and its vast implications, the master strategist then picked his moment – and his place, as he explained through his spokesman Parks Mankahlana afterwards: ‘There is no other forum that is as widely representative as a parliament of any democracy where citizens can exchange their views.’ It’s ‘the highest organ of public debate’.

On 28 October Mbeki addressed Parliament’s second chamber, the National Council of Provinces:

To close, let me make a few remarks about two issues that are at the very heart of our quest for the humane and caring society of which we have spoken before. I refer here to the issues of rape and HIV/AIDS. Very correctly, just over a month ago, this House debated the question of violence against and the rape of women and children. We noted the resolution that emerged from that discussion, supported by all the provinces, political parties and all members of the Council, condemning these completely unacceptable acts of violence and calling for consistent and severe sentences against all perpetrators of such heinous crimes. The approach adopted by the NCOP [National Council of Provinces] on this and other matters is constructive and in keeping with the sense of outrage that violent crimes invoke in our communities. As a people whose struggle and sacrifice defeated one of the most pernicious systems of our time, we can and must wipe out of our communities this scourge of violence and abuse of our people. One rape that occurs is a rape too many. Through our concerted action, we must make this clear to all who carry out this terrible crime. Accordingly, it is unnecessary and counter-productive for anybody to propagate untruth about the incidence of this crime in our country. For example, in 1997 the South African Police Service published statistics alleging than only 1 rape out of 36 was reported. Whereas the number of rapes actually reported that year was just over 52 000, an extrapolation was then made that on the basis of the estimate of the extent of under-reporting, over 1,8 million rapes had in fact occurred. You will be as surprised as I was to learn that in the fact the SAPS itself does not know what the estimate of 1 out of 36 was based upon. They can offer no explanation as to how they decided to publish figures which they cannot substantiate in any way whatsoever. The tragedy is that many of us have taken these purely speculative figures as fact. Clearly, this will not help us properly to fight against the terrible crime of rape as we cannot base our actions on untruths. Similarly, we are confronted with the scourge of HIV/AIDS against which we must leave no stone unturned to save ourselves from the catastrophe which this disease poses. Concerned to respond appropriately to this threat, many in our country have called on the government to make the drug AZT available in our public health system. Two matters in this regard have been brought to our attention. One of these is that there are legal cases pending in this country, the United Kingdom and the United States against AZT on the basis that this drug is harmful to health. There also exists a large volume of scientific literature alleging that, among other things, the toxicity of this drug is such that it is in fact a danger to health. These are matters of great concern to the government as it would be irresponsible for us not to heed the dire warnings which medical researchers have been making. I have therefore asked the Minister of Health, as a matter of urgency, to go into all these matters so that, to the extent that is possible, we ourselves, including our country’s medical authorities, are certain of where the truth lies. To understand this matter better, I would urge the Honourable Members of the National Council [of Provinces] to access the huge volume of literature on this matter available on the Internet, so that all of us can approach this issue from the same base of information. … Thank you.

Mbeki’s media liaison officer, Tasneem Carrim, confirmed he had done so himself. Three days later, the Sunday Independent quoted her telling that he had acquired a ‘thick set of documents’ about the dangers of AZT from the Internet: ‘The President goes into the Net all the time.’

Since the media-instilled notions that AZT saves babies and that South Africa had the highest rape rate in the world had taken deep root in the mind of white South Africa, Mbeki’s speech provoked outrage. As he stabbed its holy cows successively, the liberal Sunday Independent bellowed in the weekend: ‘For a leader who has shown such statesmanship in the vital task of making Africa a prosperous continent, it is surprising that President Thabo Mbeki has not shown the same dedication to the most injured citizens in our own country.’ To its credit, Reuters immediately reported Mbeki’s statements about AZT without deprecating comment of the kind that had followed every news report about Dlamini-Zuma’s disinclination to buy the drug from GlaxoWellcome (formerly Burroughs Wellcome, now GlaxoSmithKline, and from now on referred to by the company’s current name) for dispensing in hospitals and clinics, and it made an unusually impartial mention of AZT’s ‘supposed’ benefits. The South African Press Association’s idea of a news report about Mbeki’s extraordinary initiative, on the other hand, was to release the drug merchant’s wounded reaction as news, just as the South African Broadcasting Corporation used to headline apartheid politicians’ responses to criticism by the civilised world. In an article under the title, Mbeki Has Been Misinformed About AZT: Glaxo Wellcome, the company complained about being taken by surprise, repeated all the usual lies about what great stuff AZT is, and boasted about all the countries it had penetrated, all the regulatory authorities it had screwed.

The company’s full statement went like this:

Press Release: Glaxo Wellcome Response To AZT Safety Allegations: Glaxo Wellcome refutes the statements questioning the safety of the anti-HIV medication, AZT, that were made by President Thabo Mbeki to the National Council of Provinces in Cape Town today. Following extensive international and local trials carried out on AZT, the medicine has been approved for use in numerous countries including those with the most stringent regulations, such as the United States and members of the European Community. Over ten years ago, South Africa’s Medicines Control Council (MCC) joined the US Food and Drug Administration (FDA) and other regulatory authorities around the world in giving AZT its stamp of approval. The MCC has not indicated any current concerns to Glaxo Wellcome about the use of AZT. For more than a decade, AZT has extended and improved the quality of life of millions of people living with HIV/AIDS around the globe, said Dr Peter Moore, Medical Director of Glaxo Wellcome South Africa, adding that hundreds of healthcare workers who have been exposed to the virus in the work situation have also benefited. There are no court cases against Glaxo Wellcome, regarding the safety of AZT in South Africa or abroad. In fact, AZT has been authorised by the FDA and the MCC in South Africa, as well as the Centers for Disease Control in Atlanta – the worldwide authority on communicable disease control and management – for use in pregnant women after their first trimester, to prevent mother-to-child transmission of the virus, he said. We are concerned that the President is encouraging NCOP delegates to access information on the Internet – which is not routinely medically reviewed and should therefore not be taken as an authoritative or necessarily correct source of information. Glaxo Wellcome said the President’s remarks would potentially raise unwarranted concerns among patients currently using the medication, who as a result may decide to stop the treatment without consulting their doctors, and so endanger their health. Glaxo Wellcome applauds the President’s commitment to fighting this scourge in South Africa and welcomes the opportunity to discuss with him any concerns he may have regarding the safety of AZT, as the company honestly believes that in this case the President has been misinformed, concluded Moore. Issued on behalf of Glaxo Wellcome. Contact person: Dr Peter Moore.

Moore’s statement, ‘Following extensive international and local trials carried out on AZT, the medicine has been approved for use in numerous countries including those with the most stringent regulations’, was false on all scores, except ‘approved for use in numerous countries’. In truth, AZT hit the market internationally after a single small clinical trial, conducted not internationally but in the US, namely, the Phase II trial preceding US Food and Drug Administration approval. In licensing AZT, the rest of the world just followed the FDA’s lead without independently investigating the drug’s efficacy and toxicity. Drug regulators in other countries took it on trust that the Americans knew what they were doing and did it properly, and that the clinical trial data were sound. In reality, as we’ll read in Licensing AZT in the appendices, they were rotten to the core. Certainly, as Moore claimed, scores of AZT trials have been conducted since the Phase II trial – but not for licensing purposes. The American Phase II study was the pivotal, decisive one. GlaxoSmithKline relies on it in all its literature in support of the life-saving claims it makes for AZT, and other drug regulatory authorities rely upon it in turn. For instance, immediately after the Phase II trial, AZT was licensed in Britain on the strength of it – even before the US. As far as Moore’s other studies are concerned, Tim Hand, an associate professor teaching behavioural pharmacology, neuroscience and endocrinology at Oglethorpe University at Atlanta (himself HIV-positive, drug-free and healthy) commented in an analysis in the Reappraising AIDS newsletter in September 1996, Why Antiviral Drugs Cannot Resolve AIDS:

Nearly all ... large, randomized, controlled studies yielding skeptical or frankly negative conclusions about AZT’s therapeutic or prophylactic efficacy [several studies cited] were funded by sources other than Wellcome. So were studies showing that AZT is immune suppressive [ibid], has no enduring ability to suppress HIV levels [ibid], and has pharmacokinetic properties that preclude the possibility that it will work in HIV-positive patients as intended [ibid].’ On the other hand, ‘Glaxo-Wellcome continues to promote AZT with misleading studies that trivialize toxicity. For example, the European-Australian Collaborative Group [Cooper et al. in New England Journal of Medicine, 1993] claimed that AZT benefits healthy HIV carriers, and that “severe haematologic or clinical side effects were rare”. Supported by the Wellcome Foundation, this paper contained some of the most breathtaking procedural and statistical blunders ... exposed in a series of hostile letters to the editor of the New England Journal of Medicine (329:1895 and 330:1758).

Brian Deer reported in the London Sunday Times in August 1994 that a panel of experts convened by the FDA in June had discussed Cooper’s paper, and that ‘its broad conclusions had been rejected’. That’s how bad it was – a study sponsored by the manufacturer, conducted by a ‘familiar face on the company-sponsored conference circuit ... provided with media services by its public relations firm’.

Concerning Moore’s familiar assertion that ‘AZT has extended [the lives of] people living with HIV/AIDS’, Licensing AZT in the appendices will take a look at the key Phase II study that gave rise to this foul lie. In the meanwhile, we recall mention in Debating AZT of a letter by Phillips et al. to the New England Journal of Medicine in 1997 reporting precisely the opposite: ‘Extended follow-up of patients in one [AZT] trial, the Concorde study, has shown a significantly increased risk of death among the patients treated early.’ Confronted with the outcome of the Concorde trial in the MNet Carte Blanche television documentary, The AZT Debate, broadcast by MNet on 7 November 1999, Moore retreated from his ebullient defence of AZT in the manner of a criminal accused caught out in cross-examination. It was put to him: ‘In 1994 the Concorde trial – the most comprehensive AZT trial yet undertaken – damned the drug. It concluded that the drug was too toxic for most people, did not prolong life, nor did it stave off AIDS in HIV-positive people. Nevertheless AZT continued to flourish worldwide.’ Moore responded: ‘The Concorde study is a classic study but we must realize that they used AZT as a monotherapy, meaning it was used on its own. The days of using AZT as a monotherapy are gone.’ Would it be reasonable to understand from his answer that administered alone without other drugs AZT doesn’t actually extend life after all? And that he was retracting his false claim in his press release? For which he would have been gaoled had it been uttered in a court of law. Being perjury on oath. Even if wrapped in virtue: ‘... the company honestly believes that in this case the President has been misinformed.’ Not the sort of guy Ralph Waldo Emerson would have had round to dinner, since, ‘The louder he talked of his honour, the faster we counted our spoons.’

As for Moore’s claim that ‘AZT has improved the quality of life of millions of people living with HIV/AIDS around the globe’, his first fib was in the price. Limiting it to the rich in the First World at the time, and not around the globe in any meaningful sense at all. The second is that millions have taken it. That isn’t true either. There are no records, but critics fear that a few hundred thousand could have been exposed. Thirdly, it would surprise any oncologist to hear a drug manufacturer claiming chemotherapy improves the quality of patients’ lives. AZT being just that. The opposite is notorious – something to bear with courage and strength. For instance, Keith Kroebbel was asked how he felt taking AZT in the 1994 BBC Panorama television documentary, A Ray of Hope: ‘As if I had been poisoned. Very, very seasick. It wasn’t a throwing up kind of nausea, it was a seasickness that was in my bones, and headaches, inability to concentrate or respond.’ And on stopping: ‘I felt great. I felt so much better.’ Studies by Wu, and by Lenderking et al. pertinently looking into what AZT does for the ‘quality of life’ of people taking it found precisely the opposite of what Moore alleged. We’ll be dealing with the studies soon. A new one by Bechtl et al. confirms them too. Moore’s lies are so flagrant, you’re left shaking your head. But then again kids, this is a pharmaceutical executive talking.

After SAPA’s loan of its news service to GlaxoSmithKline for free propaganda airtime, it reported a statement by Tshabalala-Msimang made directly after the parliamentary session in which Mbeki ordered AZT investigated. Supporting him, she confirmed that there was indeed

a body of scientific research and information which indicated that AZT was a dangerous drug, and had not been designed for the treatment of HIV/AIDS. Because it was unable to target only the human immunodeficiency virus when it went to work in the body, it further weakened the immune system. There was also a danger that ... mothers taking the drug might produce children with disabilities. Tshabalala-Msimang said her ministry would not like to look back ten or fifteen years down the line and find it had exposed the vast majority of historically disadvantaged people in South Africa to a dangerous drug. … there was no data proving that AZT was of any use to rape victims.

And as she added in a statement to the SABC, she was considering how best to investigate the matter ‘so that we really have concrete information in our hands’. All spot on.

But quoting from the company press release, SAPA gave Moore the last word: Mbeki was irresponsibly encouraging parliamentarians to research the drug on the Internet for themselves, Moore said, because they might come across materials that doctors had not vetted. But the literature to which Mbeki was referring came straight out of the medical press, all of it peer-reviewed. Published on the Internet for professionals to read. In line with one of the Internet’s original purposes: the rapid communication of scientific information. But eventually serving an unintended function: democratizing it. So that it’s accessible in the contemporary electronic age by lay people too. To anyone who just takes the trouble to look for it. Mbeki was raising ‘unwarranted concerns’ about AZT’s safety, Moore added; patients might even ‘stop the treatment without consulting their doctors’. Having regard to all the direly negative medical literature published about AZT, much of it recent – crucially Papadopulos-Eleopulos’s et al. damning A critical analysis of the pharmacology of AZT and its use in AIDS, their monumental analysis and critique published a few months before as a special supplement to Current Medical Research and Opinion – one must assume that Moore finds browsing through Fortune more interesting than Lancet or Biochemical Pharmacology. But Moore and his local CEO John Kearney were later to concede privately that Mbeki wasn’t so wide of the mark after all.

Working over the weekend in a frantic damage-control exercise – one can imagine the international faxes flying – Moore amplified his company’s not guilty plea with a new adjective. The Sunday Independent quoted the company’s chinless wonder saying: ‘It appears that the President has been gravely misinformed about the safety aspects of AZT.’ If Moore intended the public to understand from this further Nixonian asseveration that his company’s drug was safe, the grave misinformation was his. Grave because as a statement for and on behalf of his company it was fraudulent. Even if he assured the rattled public on television a week later: ‘Glaxo Wellcome are a reputable company. We do not lie to people.’ But as the offal bubbled, lots more prevarication from the reputable company would follow.

The Sunday Independent article also quoted Moore repeating his complaint: ‘We have never been made aware by the MCC [Medicines Control Council] that there are any safety issues around the drug.’ This is not surprising: Debating AZT, expanded to include some of the political heat following Mbeki’s AZT talk in the National Council of Provinces, described how after Nature’s local correspondent, Stellenbosch University zoologist Michael Cherry, had criticised him in ‘Mbeki’s Claims on AZT are Problematic’ in Business Day on 18 January 2000, Mbeki sent him a copy of just-published review of AZT’s molecular pharmacology the following day, suggested that he ‘contact the Perth scientists ... directly’ (the authors, Papadopulos-Eleopulos et al.) and reproached Cherry for his slovenly journalese – stating that the ‘question we must all answer, including the scientists, is whether we should continue to harm the health of the women of our country to avoid “causing public confusion”’. On receiving the paper, Cherry asked Mbeki for a couple of weeks to consult a colleague about it, because he didn’t ‘know very much about this subject’. Finding two leading ‘AIDS experts’, Professor Gary Maartens and Dr Carolynn Williamson of the University of Cape Town, equally clueless, Cherry next approached South Africa’s top pharmacologist Peter Folb, formerly head of the Medicines Control Council for seventeen years. How Folb disgraced himself in lazily hashing a review of the paper was described in Debating AZT. Folb’s successor as director of the Medicines Control Council, Helen Rees, in charge at the time the controversy broke, and whom I directed to Current Medical Research and Opinion’s Internet archive at which the paper was posted, evidently didn’t understand it either. And so had no idea what the authors were talking about when discussing AZT’s ‘IC50’ or ‘inhibition concentration’, and the issue of its ‘intracellular triphosphorylation’. Didn’t bother finding out, before reporting to Tshabalala-Msimang that AZT was just fine. Or maybe she asked Folb. Which would have been about as much use as asking the dustman. But in any event, the first duty to keep abreast of the literature, and to react to it responsibly by pulling the drug, was that of the manufacturer and not of any licensing board. Particularly after the publication of Papadopulos-Eleopulos’s et al. exposé, blowing the whistle for game over. It was admittedly published in a high-class specialist academic medical journal, out of sight of the general scientific masses, but the company couldn’t have missed it: On 12 May 2000, a few months after it came out, Nature broadcast its publication in a dedicated feature article: [Current Medical Research and Opinion] editor defends publishing key AZT paper – after extensive fine-tooth combing peer-review over ‘many months … an extended period of time’. In short, because of its enormous implications, the paper was given the third degree treatment by its pre-publication reviewers, but they couldn’t fault it. After which there could be no defence of AZT. Except by the scientifically illiterate. Any more than mercurous cyanide for hosing down the female slipway. For ‘disinfection’. Or concentrated carbolic acid – alternating with the scalpel – for containing rowdy impudence in wives and daughters. Nipping it in the bud. Curing their ‘hysteria’. Which, believe it or not, they used to. One day we’ll be wondering with equal incredulity how it was ever possible that doctors gave people AZT, raped and pregnant women especially.

Stung by Mbeki’s disparagement of its goods, the mother company in Britain issued a public statement decrying the government’s investigation of AZT: ‘Our stance is that we do not regard the review as necessary or justified but we will in no way interfere with the review.’ Perhaps the company was still savouring the stink caused when the BBC documentary, A Ray of Hope, exposed its attempt to suppress negative findings about the drug, urgently conveyed ahead of the main report, by the overseers of the Concorde trials in a special preliminary letter to Lancet in April 1993, which concluded: ‘Concorde has not shown any significant benefit from the immediate use of zidovudine compared with deferred therapy in symptom-free individuals in terms of survival or disease progression, irrespective of their initial CD4 count.’ Findings negative enough for leading ‘AIDS expert’ consultant immunologist Professor Anthony Pinching in London to recommend, HIV carriers advised to stop their treatment, as the Daily Telegraph reported him saying on 3 April 1993: ‘It is now clear that AZT is not the answer and people should hang around until other [drug] trials are concluded. … [Concorde] brought us back to earth.’ And likewise, sufficiently cogent to inspire a one hundred-and-eighty degree about-turn in Dr Deborah Cotton of the Harvard School of Public Health, a member of the FDA advisory board that had recommended the licensing of AZT for prescription to asymptomatic HIV-positive people. Science quoted her three weeks later: ‘In my own practice, this sways me towards waiting before recommending AZT.’ But not Phase II trial leader Margaret Fischl, who told medical journalist Joan Shenton that she’d be continuing to give AZT to anyone with CD4 cell counts of less than eight hundred.

In AZT is Death, published in Spin in August 1993, Celia Farber reported Concorde trial overseer Dr Ian Weller’s comment to her: ‘I think it’s very hard, if you’ve been giving AZT to large numbers of patients, to swallow this result.’ Probed about whether there’d been pressure to massage the negative results, he responded affirmatively. ‘A woman standing next to him, also on the Concorde team, nodded emphatically and finally burst out: “Yes, there has been pressure, and it has been placed at the very highest level. … The most frustrating thing is that I can’t tell you about it.”’ Weller concluded, ‘We’ve carried out this study against incredible adversity, but we are not going to cave in to any pressure. We’ll win the battle in the end. We show the science; that’s all that matters.’

A couple of days after AZT’s big day in Parliament, I received a telephone call from Smuts Ngonyama, Head of Presidency and Communications in the African National Congress, asking me for details of the local and foreign AZT litigation to which I’d alluded in Debating AZT, and to which Mbeki had referred in Parliament. I filled him in about the Hayman case in preparation here (subsequently launched by the widow of an attorney killed by AZT), the Threakall case leading several others brought in England, and the Nagel, McDonnell and Emerson cases in the US – unaware at that point that the Threakall action had been withdrawn a month earlier, and the Nagel and McDonnell cases had stalled before take-off. He was pleased to hear about the triumphant Emerson judgment in September (to be discussed later), confirmed on appeal in a unanimous decision of the Maine Supreme Court a couple of weeks after our conversation.

A day or two later, Dr Kgalema Motlanthe, ANC Secretary-General, urgently requested a copy of my manuscript. If he had harboured any doubts about Mbeki’s judgment in the matter before that, Debating AZT swung it for him. His office immediately prepared a supportive press release, ANC Speaks on AZT / ANC Statement on the Outcome of the SADC Health Ministers on HIV/AIDS and the Usage of AZT, and sent it to me for preview and comment. That the AZT controversy just ignited by Mbeki was apprehended by the highest echelons of the governing party to represent a political hot potato with dangerously divisive potential among the party’s leadership cadres, to say nothing of the rank and file, was suggested by the fact that its first official public reaction – due for release, I was told, the following day – had not been shown to anyone else, apart from Presidential Spokesman the late Parks Mankahlana and Joel Netshitenzhe, director of the Government Communications and Information Service. At its core it read:

In the light of many uncertainties regarding the AZT drug, the South African Government needs to exercise utmost care and responsibility in taking a decision on whether the drug should be distributed on a massive scale to the public. The directive of President Thabo Mbeki to the Health Minister with regard to investigating these matters will effectively contribute to establishing these necessary facts. We express our support for ongoing research into the effects of exposure of children and mothers to these drugs.

As the ANC was busy settling the language of its press release in its final form, the South African Human Rights Commission issued a statement on 7 November asserting that Tshabalala-Msimang could be charged with human rights violations for denying AZT to pregnant women. Two days later the Medicines Control Council’s chairperson Helen Rees issued a ‘preliminary report’ assuring Tshabalala-Msimang that AZT was safe for such women. ‘The drug being out there is justified,’ said Rees eloquently. Yes, AZT had known side effects, some of them potentially serious, but the potential benefits outweighed the risks, she said. ‘Just remember that all medicines must be treated with respect. There is virtually no medicine that’s totally free of side effects’ especially ‘heavyweight’ drugs used to save people from life-threatening illnesses. ‘We always, always, look into it’ when people like Mbeki question drug safety. The safety of AZT was ‘not a static situation’, Rees said, and qualified the MCC’s hasty imprimatur by saying that another more detailed report was in the pipe for release in about two months time as the first was ‘fairly superficial’.

It certainly was, Helen. Faithful recitations of all the stock myths about the value of the drug, neither report dealt pertinently with recent foetal toxicity reports and the crucial triphosphorylation problem, notwithstanding that I had provided Rees with a copy of Debating AZT, which canvassed the toxicity literature, and had given her Librapharm’s Internet address at which Papadopulos-Eleopulos’s et al. recently published epitaph on AZT was archived, exhaustively reviewing the molecular pharmacology of AZT and concluding that not only is the drug very poisonous, it’s completely useless as an anti-HIV agent. In fact, that Rees hadn’t taken Mbeki’s concerns seriously emerged from a patronising statement she later made to Newsday in New York on 11 July 2000:

most researchers ... concluded long ago that the HIV-fighting value of antiretroviral drugs (such as AZT) were worth the awful side-effects they can trigger. … case closed. So what gives with South Africa? You can’t just view this matter as a health issue, South Africans wearily explain. You also must see it as a political issue. It’s all wrapped up in the South African liberation movement, observed Dr. Helen Rees, who chairs South Africa’s Medicines Control Council. Today, nothing is beyond debate – and that is a heady thing for this long-repressed nation. ‘I don’t have a problem with someone who says, “Go back and look at this again”,’ Rees said, because people need room to learn and grow.

The pity of it was that she felt above taking her own advice.

The final draft of the ANC’s press release, issued on 9 November put it this way:

The ANC is further encouraged by the preliminary report of the Medicines Control Council restating what President Mbeki and the Minister of Health had articulated about the known side effects related to AZT use as strengthening the call to ensure that maximum caution with regards to the safety of the drug is arrived at first, before further action is taken. In the light of many uncertainties regarding the AZT drug, the South African government needs to exercise the utmost care and responsibility in taking a decision to avail this drug on a massive scale, with regards to long-term safety and cost implications.

In its annual report for the year, the ANC took a stronger line, recording categorically that AZT would not be made available by the government because of ‘unanswered questions regarding efficacy and toxicity’.

I had single-handedly stymied an aggressive marketing initiative by the world’s largest multinational pharmaceutical conglomerate at the time, peddling a useless and extremely toxic drug for wide-scale administration to pregnant women, overwhelmingly poor and black. It was an immense relief to me. A thrill too, even as I worried daily about retaliation, given the gargantuan stakes. A friend told me that GlaxoSmithKline ‘hated’ me – and throughout the ranks too: his conversation in a bar with two of its street-level sales representatives had suddenly gone very sour at mention of my name. Retaliate the company later did, but luckily the bullet, so to speak, missed.

On 3 November Associated Press reported the medical establishment’s backlash to Mbeki’s AZT safety inquiry directive. Casting him as misinformed and irresponsible, the article went: ‘... his claim that a widely used AIDS drug is dangerous has set off an uproar, producing bafflement and shock among physicians and advocates who say AZT is safe. … The controversy threatens to set back efforts to fight the disease.’ The report scoffed at Mbeki’s statement that there is a ‘large volume of scientific evidence alleging that, among other things, the toxicity of this drug is such that it is in fact a danger to health’, and his allusion to ‘dire warnings’ – issued by the likes of Hayakawa et al. in 1991: ‘... it is urgently necessary to develop a remedy substituting this toxic substance, AZT’; Lewis and Dalakas in 1995: ‘... the prevalent and at times serious ... mitochondrial toxic side effects are particularly broad ranging with respect to their tissue target and mechanisms of toxicity: Haematological; Myopathy; Cardiotoxicity; Hepatic toxicity; Peripheral neuropathy’; Papadopulos-Eleopulos et al. in May 1999: ‘... the scientific literature [elucidates] a number of biochemical mechanisms which predicate the likelihood of widespread, serious toxicity from use of this drug’; and Brinkman a month before his speech: AZT and similar drugs ‘are much more toxic than we considered previously’.

Without ascertaining what studies he had in mind, the news service countered reflexively, jumping to take sides with Mbeki’s detractors: ‘Reputable scientists have issued no such warnings, and it was unclear what he was referring to.’ No doubt the scientists just-mentioned would marvel at learning that they had all been cast as disreputable. AP then trotted out some ‘reputable scientists’ to straighten Mbeki out: Joseph Perriens, head of the care and support division of the UN AIDS program in Geneva, said AZT was ‘perfectly acceptable. … It causes slight side effects ... but ... so do many medicines.’ In fact, the research reports of real scientists, as opposed to fat-butted medical bureaucrats in soft jobs bouncing drug company sales propaganda, told a different story. ‘Worries about AZT’s safety surfaced in the early 1990s but have long faded,’ he said. Actually, not faded, but not acted on. Perriens urged Mbeki to ‘inform himself better about the toxicity of [AZT], which is not really as serious as he thinks, and he should probably recast the debate in terms of cost. [He’s] not doing his people a service.’ Had the UN guy kept abreast of the literature, current in particular, he might have rendered a better one himself. Saul Johnson, a paediatrician giving pregnant black women AZT at Chris Hani-Baragwanath Hospital, found Mbeki’s statements ‘very distressing because it sets back the whole agenda [and raises] the issue of where he gets advice’. The Medical Research Council’s director of AIDS research, Salim (‘Slim’) Abdool Karim remonstrated: ‘I think if the President doesn’t want to provide AZT, he should find an excuse based on fact.’ As if Karim had the facts, and Mbeki didn’t. ‘It’s the standard of care in many countries,’ he said. Which is not saying much, when one considers that most useless and poisonous medicaments, universally popular in their heyday but now abandoned and unthinkable, once wore the same epithet. ‘I can only assume that he has been given this information and accepted it in good faith. I don’t think the President would deliberately try to mislead us.’ Karim clearly didn’t consider the amazing possibility that the head of the country was actually much better informed than the roly-poly ignoramus heading the country’s AIDS research programme. Telling us at about the same time that there was ‘no new evidence in the medical literature in the last year on the adverse effects of AZT’. After a whole lot.

The experts all sounded like John Moore at the Aaron Diamond AIDS Research Centre at New York’s Rockefeller University (now at Cornell University) – perhaps the loose equivalent in rank as an AIDS prelate to the Vatican’s Cardinal Ratzinger (before his ascension) – in his letters to me before my excommunication. (The terse warrant he issued is contained in Debating AZT):

Mr Brink, I have read your articles on AZT published in the Citizen. It is sad that you are uncritically championing the view that AZT is a poison, since what you say is substantially incorrect scientifically, and you potentially could cause great damage to public health in South Africa if politicians listen to you. The absurdities of the Duesberg/Horowitz arguments were long ago revealed, and their cases destroyed, in the USA; they do not deserve to be thrust down the throats of the people of South Africa. … think before trying to damage the unborn children of South Africa in the future.

Actually I hadn’t made any ‘Duesberg argument’. Peter Duesberg, Professor of Molecular Biology at the University of California, Berkeley, and the best-known AIDS dissident, contends that the extreme toxicity of AZT arises from its indiscriminate and random termination of human DNA synthesis. I disagree, as we’ll see in Is AZT a DNA chain terminator? in the appendices. And Horwitz doesn’t have any arguments; he’s just wrongly thought by everyone to have first synthesized the drug – about which we’ll read in the scoop story that the true inventor told me, recounted in Inventing AZT at the end of this book.

Moore went on in a second endless plea to me under the heading, Why AZT is not poison. It’s an entertaining vignette, fabulously illustrating how constipated the medical mind can get. Substitute mercury or arsenic compounds for AZT as you read it – the big drugs a few decades ago, for which doctors would be struck off were they to prescribe them today – and you’ll get the idea:

Let me tell you why I found your articles so potentially damaging. At a time when AIDS researchers in the USA are trying very hard to persuade the South African health ministry to reverse Zuma’s absurd decisions on the provision of AZT to pregnant women, anything that plays into her hands and adds false credibility to her arguments is very dangerous. Granted, Zuma’s objections to AZT are based more on the fact that it is made by a Western company than on scientific grounds, but she is already poorly advised and does not need to be further confused. Perhaps her successor will show a more enlightened attitude to the health and wellbeing and her country’s children. … Nobody pretends that AZT is a miracle drug. In the context of established HIV infection, it does very little. It’s not powerful enough, and the virus can readily mutate to escape from it. But it’s a useful addition to some cocktails that include protease and other reverse transcriptase inhibitors. However, whatever AZT’s limitations in the context of preventing disease progression, there is rock-solid evidence from multiple trials in several countries that AZT reduces the rate of maternal-fetal HIV transmission.

The illogic of this latter contention never jars the ‘AIDS experts’. That AZT alone has been found ineffective to knock down all those mutating viruses infecting people ‘living with HIV’, but it works a dream they say, when fed to pregnant women. Especially given that AZT has no significant effect on what ‘AIDS experts’ call their ‘viral load’. And that the administration of AZT towards the end of a pregnancy to prevent the mother infecting her baby is going to be like closing the stable door after the horse has bolted – several months having preceded the treatment within which the virus will have had the opportunity to jump the gap via all that shared blood, and to ‘reverse transcribe’ itself, as the ‘AIDS experts’ explain it, indelibly into the baby’s DNA.

‘Put simply, for most children, acquiring HIV infection at birth is a death sentence, and the mode of death is pretty miserable. Stopping these, substantially avoidable, infections, even with a drug as weak as AZT, is the only sensible course of action.’ Though widely believed, like so many other medical superstitions, there is no epidemiological support for Moore’s claim by way of any controlled study: this idea that HIV-positive babies are doomed to die young. It’s a subject to which we will return. And as we read in Debating AZT, several recent studies have found that children exposed to AZT in the womb have a much higher mortality rate and incidence of serious disease and birth defects than unexposed children. Suffering ‘pretty miserable’ deaths – thanks to the pills their mothers were given.

‘Like all drugs, overdosing with AZT is ill-advised. If one takes too much of any drug, there will be toxicities. But the “AZT is incompatible with life” argument holds no water from the practical, clinical perspective.’ A study we’re still to discuss by Lenderking et al. found AZT to be life-threatening even at the lowest dose recommended by GlaxoSmithKline. And whatever one’s ‘perspective’, it’s hard to come up with any meaning for the skull and crossbones decal embossed on a broad orange stripe (industrial code for extremely dangerous chemical toxin) on bottles of AZT manufactured by Sigma Chemical Company for research use other than that AZT is a deadly poisonous substance.

‘You could use your writing to do good here, by helping persuade the South African government to save the lives of some of its unborn children by providing a useful, although not perfect, drug to HIV-infected pregnant women. The alternative is far, far worse.’ To which the recently late radical social critic Ivan Illich had a general retort: ‘The compulsion to do good is an innate American trait. Only North Americans seem to believe that they always should, may, and actually can choose somebody with whom to share their blessings. Ultimately this attitude leads to bombing people into the acceptance of gifts.’ Socrates had another angle: ‘The only good is knowledge and the only evil is ignorance.’

In a graduation ceremony speech at the University of the Witwatersrand on 1 December, UCT Vice Chancellor and World Bank director Mamphela Ramphele contended that the government’s sudden loss of enthusiasm for AZT evidenced a ‘lack of respect for a scientific base for health care planning’; that there was a ‘subtle but visible anti-intellectualism seeping into the body politic which discounts the value that experts can, and do, add to human development’; and that ‘the bitter fruits’ of this ‘anti-intellectualism’ were most evident in national AIDS policy. The absence of any ‘coherent management strategy yet developed by the government … results not from lack of expertise in South Africa, but in its disregard by those in government, with tragic consequences’. It was ‘nothing short of irresponsibility, for which history will judge it severely’. By real intellectual doctors like me, she meant. Who go for drugs like AZT. After reading the advertisements in our journals.

On the same day, World AIDS Day, visiting professional AIDS activist VIP, Cleve Jones, thought he would give the government what for, as he unrolled bits of his AIDS Memorial Quilt in Cape Town, the famous one that he’d started, and which he was carrying around the world on permanent holiday: ‘I have been asked to say to President Mbeki and the Parliament that this decision [to withhold AZT until shown safe] is contrary to the principles of the African National Congress and the constitution of South Africa.’ As if the American dropping in knew better than they did. ‘It is scientifically misinformed. It is economically unsound and it is morally bankrupt.’ Yeah, yeah, yeah. When’s your plane?

Mbeki’s indication in Parliament that he’d personally researched the literature on AZT published online – explicitly confirmed by his media liaison officer two days later – ricocheted around the world, with journalists adding a negative gloss to their reports in order to discredit his concerns about the drug. For instance, Financial Mail editor Peter Bruce wrote on 5 November: ‘It was, I think, Newsweek that alerted us to the fact that our President is an Internet junkie. Apparently he spends hours on the Web late at night, trawling for useful speech material he can’t find in the local media. So when he was pounced on the other day for daring to question ... the efficacy of AZT as an anti-Aids drug, I did a quick Web search of my own.’

Bruce hit an archive of lay articles about AZT posted by Dutch AIDS dissident activist Robert Laarhoven at – ‘denigrating AZT as a danger to human life’, Bruce said – but he admitted that he was struck by the sinister sight of Sigma’s orange Jolly Roger label for AZT. (It’s no hoax – I have a 25 mg phial of AZT bearing the famous insignia.) The equivalent of that yellow badge for nuclear hazard – stand back. Who in their right mind wouldn’t be startled? That the stuff is lethal is the very point of the label’s Zyklon-B warning, thrice announcing ‘Toxic’ in English and several other languages, with the message driven home by it’s funereal decal set against the deadly colour. Bruce advised however that Mbeki desist from searching the Internet for information on anything because ‘there is a lot of rubbish’ there. Thanks for that, Pete. Presumably you weren’t referring to the US National Libarary of Medicine with its fifteen million papers archived online.

‘Most times, coming up with something new works for him and makes him seem learned and deep.’ Bruce’s facile comment captured perfectly white reaction to Mbeki’s announcement. In common with white journalists and commentators in South Africa and elsewhere, Bruce was unable to conceive of the possibility that on the subject of AZT Mbeki was indeed ‘learned’, that he really was onto something ‘deep’: an enormous public health issue that everybody else had missed, and that his intervention, sparing thousands of African babies the effects of exposure to the drug in the womb, might in time be judged visionary, heroic.

Bruce went on: ‘Sometimes he may, just may, bump into something truly nutty and repeat it. … it is worth musing on the capacity of some powerful people to become intrigued by things they do not fully understand or cannot fully explain.’ Particularly the non-Europeans. Not so hot at science and mathematics, as the old government said. With such deficits, Mbeki must have battled to ‘fully understand’ the ‘truly nutty’ conclusion of Papadopulos-Eleopulos’s et al. thirty-thousand word analysis and critique of the bio-chemistry of AZT – the one he’d sent to Nature’s South African correspondent, asking whether he’d read it, as he himself had done:

AZT underwent clinical trials and was introduced as a specific anti-HIV drug many years before there were any data proving that the cells of patients are able to triphosphorylate the parent compound to a level considered sufficient for its putative pharmacological action. Notwithstanding, from the evidence published since 1991 it has become apparent that no such phosphorylation takes place and thus AZT cannot possess an anti-HIV effect. [Mbeki is alive to the triphosphorylation problem, and has twice been reported mentioning it.] However, the scientific literature does elucidate ... a number of biochemical mechanisms which predicate the likelihood of widespread, serious toxicity from use of this drug … Based on all these data it is difficult if not impossible to explain why AZT was introduced and still remains the most widely recommended and used anti-HIV drug. [The continued administration of AZT] either alone or in combination ... to HIV sero-positive or AIDS patients warrants urgent revision.

Parliamentary Opposition reaction to Mbeki’s revelations about AZT was as dull as the media’s. The Inkatha Freedom Party’s AIDS spokesperson Ruth Rabinowitz MP expostulated: ‘AZT is the cornerstone of AIDS treatment ... Anyone questioning these facts, questions the integrity of the entire body of 20th century science and of the scientific and medical fraternity, and suggests a conspiracy of vast unprecedented proportions.’ Only, mercury and arsenic were the cornerstones of syphilis treatment until a few decades ago. Without any conspiracy. And that AIDS looks a rerun of an old history movie. With a fearsome sex disease burned out best, said the doctors – and now again – with some of the deadliest poisons imaginable. Paraphrasing Democratic Alliance MP Mike Ellis, the Natal Witness report described him tipping his hat to the party’s masters in the marble halls of Johannesburg: ‘By directly questioning the operations of one of the world’s largest pharmaceutical companies, the government is sending the wrong signal to other multinationals seeking to set up operations in South Africa.’ DA leader Tony Leon instinctively took GlaxoSmithKline’s side in the Daily News on 22 December: ‘President Thabo Mbeki muddied the waters ... by quoting dubious sources on the supposed “toxicity” of this drug. Closer to the truth is that the government simply does not want to pay for it.’

I was the ‘dubious source’. After a telephone call to Ellis, I’d sent him Debating AZT to give Leon to read, ahead of a meeting Ellis told me they had imminently scheduled with Moore. To pat his feathers down. A chicken struck on the head with a stone. Clucking indignantly. Apparently the attorney wasn’t much impressed by the content’s of the advocate’s brief. As we aren’t by Leon’s habit of impugning the integrity of those with whom he disagrees (more to follow).

And it didn’t come as too much of a surprise reading a view of the matter taken by ‘Dr Des Martin, president of the HIV/AIDS Clinicians Society, which represents the country’s expertise in antiretroviral therapy’, as the Sunday Independent billed him on 14 November in Mbeki ‘out of step’ over AZT safety fears: ‘It works, it is a godsend, it is preventing thousands of children being born HIV-positive.’ The MRC’s Karim, to whom I’d sent Debating AZT earlier in the year, said in another article in the same newspaper, The denigration of AZT outdated and irresponsible: ‘I think well-meaning individuals like that fail to draw the distinction between therapy and prophylaxis. All the evidence they quote from is from old therapy studies and largely therapy for adults.’ The ‘individual’ was I, described in the report as a ‘sceptic apparently engaged in a crusade to discredit AZT [who] declined to be named or quoted’ (as Roberts had requested, asking me to keep my head down). Karim told me on the phone that he’d received Debating AZT but not read it. Which, no doubt, is why he misrepresented it. ‘Therapeutic doses are different from prophylactic doses used for mother-to-child prevention, so they’re missing the point. They’re making a counter-argument against an argument we’re not making.’ Karim’s contention seemed to be that therapeutic doses might be unacceptably toxic but not prophylactic ones. (In fact the doses are the same.) To this weary lawyer, his wordplay had the familiar rhythm of a fraud accused tap-dancing around the point. That my main concern was precisely the grave harm to which babies in the womb are exposed via so-called AZT prophylaxis was reflected in my detailed piece in the Citizen two days later: Is AZT safe for babies? It was an excerpt from my much-expanded Debating AZT manuscript. Which Mbeki and Tshabalala-Msimang had taken the trouble to read. The country’s AIDS research boss hadn’t bothered.

An isolated call in South African journalism for a reasoned response to Mbeki’s AZT safety inquiry directive, out of tune with all the angry shouting, was by Citizen managing editor Martin Williams. The day after Mbeki’s initiative, Williams’s editorial, Mbeki right about AZT, commented that he had

behaved impeccably in this matter ... sensibly taking cognisance of a substantial body of medical ... data. … In doing so he has opened up the debate rather than trying to stifle it, as Glaxo Wellcome seems to prefer. The drug company expressed concern that Mbeki was encouraging parliamentarians to access information about AZT on the Internet. Why shouldn’t decision-makers, or anyone else, read whatever is available in order to make up their own minds?

A week later, responding to the furious local and international condemnation that Mbeki had drawn, Williams’s editorial, Mbeki is not misinformed, displayed Sigma’s skull and cross bones AZT label, and, providing some addresses of Internet databases for readers to look at, urged them to research and think the issues through themselves and draw their own conclusions – a distinctly thoughtful suggestion from the journalist responsible for getting the ball rolling by publishing my essay, AZT: A Medicine from Hell, earlier in the year. And University of California African history professor Charles Geshekter’s wet blanket on the African AIDS scare a couple of months before that.

Nature, the world’s loftiest scientific journal, was not amused by the unprecedented intervention of the unruly politician from the colonies. Bridling at Mbeki’s meddling intrusion into the hallowed preserve of the medical and scientific establishment, it published a critical report by its local correspondent Cherry on 4 November. Under the title, South Africa says AIDS drug ‘toxic’ (with inverted commas to pooh-pooh the worry), it blithely discredited Mbeki’s concern that ‘our country [should not] take the irresponsible step of supplying AZT ... until the drug’s safety was established’ by insinuating that he was a heartless phoney: ‘The statement was being seen as an attempt to justify the government’s tardiness in making AZT available in state hospitals even to rape victims and pregnant women.’

Cherry’s article was endorsed by a derisory covering editorial, written with the inimitably imperious hauteur of an Englishman talking to his wayward wog: Keeping the record straight on AIDS: Recent statements by South Africa’s president on the hazards of AZT need a sympathetic but firm response. A highlight of the lesson was its repeated use of the word ‘firm’ – the right thing to be when dealing with the natives. Not toeing the line. And the sentiment ‘sympathetic’: these easily baffled sambos need to be shown the way.

Firmly. Like at Amritsar in 1919. After which, General Dyer mentioned the gratification he fetched from watching his men firing for a solid ten minutes into ‘that seething mass of sweating niggers’ trapped inside the walls of the enclosed city square. Delivering a ‘moral lesson’, he told the subsequent inquiry. In how to behave. Likewise, closer to home, after Colonel Graham ‘cleared’ the Eastern Cape Zuurveld a century earlier, by dispatching with powder and ball just about every Xhosa man, woman and child encountered, Cape Governor Cradock assured Lord Liverpool, Secretary of State for the Colonies, that ‘The whole of the Kaffir tribes have been expelled from His Majesty’s territories ... and I am very happy to add that in the course of this service there has not been shed more Kaffir blood than would seem to be necessary to impress on the minds of these savages a proper degree of terror and respect.’ And in a precursor eighty years ago to Bush’s recent sport, Churchill, then Colonial Secretary, scorned the ‘squeamishness’ of those horrified by his use of English poison gas against the ‘uncivilized tribes’ of Afghanistan. Right after the atrocities of the First World War. It was the ‘application of modern science to modern warfare’, he said, to ‘spread a lively terror’ in order to ‘procure a speedy termination of the disorder which prevails on the frontier’. From the same firm guy, risen to Prime Minister two decades later, to deliver the Germans a lesson at Dresden and Cologne. Doing his duty.

Assuring us, despite the abundant contrary evidence, that ‘AZT and its successor treatments [are] the most effective weapons against the disease’, the editorial chided Mbeki incoherently, huffing and puffing pompously:

raising questions about the desirability of treatment using AZT [notwithstanding] its acknowledged toxicity [on the basis that] taking such concerns seriously is one thing; endorsing policy statements that appear to be based on an incomplete understanding of the scientific principles involved, with potentially tragic consequences, is a different matter. The criticisms currently being voiced in South Africa, where the disease has a stronger hold than anywhere else in the world, are familiar. But they have also been carefully assessed, and in most cases firmly rejected, by those best placed to make such judgements, namely the world’s leading scientific experts. … The positions already taken by the Medicines Control Council and the Medical Research Council give optimism that sound reason will eventually prevail. Hopefully, the government will choose to listen to them rather than to others whose glib appeal masks an obscure agenda.

A clever playwright writing a burlesque parodying an English doctor with a public school tie couldn’t have come up with better lines.

The guy with the ‘glib appeal’ and ‘obscure agenda’ to whom Mbeki was listening was revealed in Nature two weeks later. Pointing an indignant prosecutorial finger in an article, AZT critics swayed South African president, it charged that there is ‘evidence that the president may have been influenced by a Pietermaritzburg-based lawyer, Anthony Brink’. The lawyer’s writs had annoyed Medical Research Council president William Makgoba too: ‘... remember that I am the scientist and not you.’ But Einstein anticipated the complaints fifty years earlier: ‘We should be on our guard not to overestimate science and scientific methods when it is a question of human problems; and we should not assume that experts are the only ones who have a right to express themselves.’

A fortnight later another article in Nature, entitled Concern at cheap AIDS drug fears, bewailed a joint statement ‘issued by the health ministers of South Africa, Botswana, Zambia, Namibia, Mozambique, Swaziland, Lesotho, Zimbabwe, Malawi, Tanzania, Angola and Rwanda at a meeting in Johannesburg this month’ in which the ministers stated their ‘grave concern over possible side effects as a result of their toxicity’ and called for research into the effects of ‘unnecessary exposure of children and mothers to these drugs’. Stating the terribly obvious, Cherry wrote: ‘This action is understood to have been heavily influenced by the South African government’s position.’ The lead theme of his piece was that the US Elizabeth Glazer Paediatric AIDS Foundation had been miffed by Mbeki’s statements because they threatened to derail its plan to spend the million dollars that it had allocated to buy AIDS drugs. (The Wall Street Journal told us on 12 July 2000 that the foundation had panhandled $15 million more from the Bill and Melinda Gates Foundation for the same purpose.) Heck Lizzie, we can’t have these Negroes in Africa deciding for themselves what’s good for them and their kids. (And thereby messing with the corporate agenda that our philanthropy actually serves). They must be helped. By Americans, who know what’s best.

The Star noted on 9 November that Mbeki’s startling parliamentary announcement had resulted in GlaxoSmithKline being ‘inundated with calls from concerned patients and medical professionals on whether they should continue using AZT’. This called for damage control, and pronto. The company’s top local officers, Kearney and Moore, requested an urgent meeting with Tshabalala-Msimang, their purpose announced in the same article, which reported that they were ‘scheduled to hold talks today with the Health Ministry to clarify Mbeki’s claim that the widely used drug is dangerous’. In other words pretend that it isn’t. Although the company had persistently denied Mbeki’s claim in Parliament that there was a large body of medical literature on AZT’s dangerous toxicity, Health Director General Ayanda Ntsaluba said after the meeting that ‘Glaxo acknowledged, in response to a comment from the Minister that the concerns raised by Mbeki were not new’, that ‘it was fair to say there was no consensus among scientists on the safety of AZT’, and that the company had accepted the view expressed at the meeting by Tshabalala-Msimang that ‘there was nothing irresponsible in Mbeki raising these concerns’. Ntsaluba added that the company had promised its co-operation in the safety enquiry by delivering all available relevant data. The promise was broken. None of the published papers reviewed in Debating AZT, which reported the profound cellular toxicity of the drug, were passed on to the MCC for consideration. That much emerged from a further false statement by Moore, made to the press immediately after the meeting, and reported by the Natal Witness the following day: ‘The review ordered by President Mbeki of the anti-AIDS drug is neither necessary nor justified … there is no new data [sic] that will raise legitimate concerns about AZT’s safety.’

In point of fact, two months earlier in September, Brinkman noted in Lancet that AZT and similar drugs

are much more toxic than we considered previously. … The layer of fat-storing cells directly beneath the skin, which wastes away ... is loaded with mitochondria [intracellular organelles crucial to energy metabolism] … other common side effects of [AZT and related drugs are] nerve and muscle damage, pancreatitis and decreased production of blood cells … all resemble conditions caused by inherited mitochondrial diseases.

And Blanche et al. noted in the same issue: ‘Our findings support the hypothesis of a link between mitochondrial dysfunction [in babies] and the perinatal administration of prophylactic nucleoside analogues’ – their findings being eight children born with mitochondrial dysfunction, that is, seriously impaired energy metabolism and corresponding muscle and other cell damage, resulting in cardiomyopathy and muscle weakness. Five children, of whom two died, presented with delayed neurological symptoms (severe brain damage in the form of massive cortical necrosis, cortical blindness, epilepsy and spastic tetraplegia) and three were symptom-free but had severe biological or neurological abnormalities. Four of the children had been exposed in utero to AZT and 3TC (a similar drug) combined, and four to AZT alone. None were HIV-positive. In advance of publication of Blanche’s et al. findings, the UK Committee on Safety of Medicines had issued a warning to doctors on 7 July 1999 about ‘the risk of mitochondrial dysfunction in infants born to HIV infected mothers treated with zidovudine (AZT) to prevent vertical transmission.’ But reporting this, in a sparkling illustration of the AIDS activist mindset at work, (an online clearing-house for AIDS drug propaganda, like our own industry-supporting Health-e) added its own advice: ‘... it is important that women do not stop their treatment in an unplanned way due to scare stories about the effects of antiretrovirals on unborn children.’ Scare stories.

On 16 November, a little over two weeks after Mbeki’s address on AZT in Parliament, Tshabalala-Msimang backed Mbeki on the toxicity of AZT in an extensive, closely reasoned statement to the House. What was clear from it was that she was well on top of the research literature on the drug. Her main points were that AZT remained much too expensive for the government to buy for mass distribution whatever its merits; but moreover, it was a failed chemotherapy too poisonous for cancer treatment, and was itself a proven carcinogen in rodent studies – all as reported in the literature reviewed in Debating AZT. Some highlights:

AZT is a drug that was developed for use in chemotherapy for cancer patients. It was, however, never used in cancer patients because it was regarded as too toxic to use. Tests have clearly shown that rats that were exposed to high levels of AZT for prolonged periods of time, developed vaginal cancer. [In fact, at human equivalent doses during pregnancy.] This is a very serious finding. Other toxicological data exists with respect to AZT, including damage to nerves, muscles and bone marrow. All of this data needs to be assessed very thoroughly. … As the Minister of Health I have a responsibility for ensuring that South Africans get appropriate and affordable healthcare. This responsibility extends to ensuring that no healthcare intervention has a long-term negative effect on people. With the evidence before me, I believe that the proper thing to do is to invite both the South African Medicines Control Council and a group of independent scientists, approved by Southern African Development Community health ministers, to review the use of AZT, and to inform me and other SADC health ministers of their position.

Although studies had been published supporting the use of AZT, she said, ‘there are other scientists who say that not enough is yet known about the effects of the toxic profile of the drug, that the risks might well outweigh the benefits, and that the drug should not be used.’

After canvassing the most obvious shortcomings of each and every research report published to date on the claimed benefits of using AZT in pregnancy to prevent mother to child transmission of HIV (MTCT), Tshabalala-Msimang emphasized that

there is evidence of the toxicity of AZT that has been published in scientific literature. For example, baby mice that were exposed to AZT through the placenta of their mothers, developed tumours. Over the past two years additional toxicological data has been published in the scientific literature raising similar toxicological concerns regarding MTCT exposure in studies performed in monkeys and in humans. … [The] toxicity debates around the various drugs are particularly marked in the issue of MTCT. The toxic effects of the drugs in babies is doubled because they get their own dose of the drug, plus they get a dose from their mothers during labour and delivery.

And, more importantly, during gestation.

Tshabalala-Msimang cited the warning from history that I sounded in Debating AZT:

We have to bear in mind that drug-related horrors do occur. This is all too apparent when we remember that a drug called Stilboestrol, which was given to pregnant women and which for years was considered perfectly safe, was later found to cause vaginal cancer in young girls whose mothers had taken the drug. We have to be very, very careful. And so, from time to time, drugs that were considered to be safe, do get withdrawn from the shelves when side-effects are discovered. This is normal. It happens all the time.

She concluded by pointing out: ‘This is a very difficult question that we are trying to answer as more research data becomes available to us. … We simply do not have enough information ... on the appropriateness of the drugs to make any decisions that might have long-term health effects on the lives of children born to HIV-positive mothers.’ As for the other use for the drug that the activists were clamouring for: ‘AZT was not registered in South Africa or anywhere else in the world for use by women who were raped … We have absolutely no idea of what the effects are, either short-term or long-term, of using AZT, a known carcinogen, on healthy people. The use of AZT [for HIV prophylaxis after rape] is, at the present time, illegal, aside from it being dangerous.’ And she was struck by the fact that ‘it is only in South Africa, and nowhere else in the world, that AZT has been registered … to treat health care workers following needle-stick injuries. This concerns me.’ Especially since there was no good clinical trial evidence that it actually worked for ‘this purpose’, she said.

Tshabalala-Msimang’s scepticism of the ability of the industry-friendly drones on the MCC to come up with anything but pusillanimous whitewash was evident from her proposal that independent scientists be engaged to assist in the investigation. Her gloomy apprehensions about the incompetence of the MCC were soon to be realised. But even the outside help she got proved useless.

The South African Cohrane Centre in Cape Town, to which she turned, is part of an international network of study groups advising governments on the value of medical interventions and treatments. Which should be ‘evidence-based’, they sensibly say. Tshabalala-Msimang may have been encouraged to learn that one of the founders of the Cochrane Centre group, clinical pharmacologist Andrew Herxheimer, Emeritus Fellow of the Cochrane Centre in the UK, and WHO advisor on essential drugs for developing countries, considered that AZT ‘was never really evaluated properly and that its efficacy has never been proved, but its toxicity certainly is important. And I think it has killed a lot of people, especially at the high doses. I personally think it not worth using alone or in combination at all.’

But if Tshabalala-Msimang was hoping for the same sort of independent, critical intelligence from the Cochrane Centre down here in Cape Town, she would soon be disappointed. For a start, the local centre was funded by and nested in the Medical Research Council, full of people feeding off the virus/chemotherapy line – which blew any possibility of an impartial take on the subject. And one of the two Cochrane staffers who reported to her on Benefits and risks of interventions aimed at reducing mother-to-child transmission of HIV infection. South African Minister of Health, Dr ME Tshabalala-Msimang, December 1999 was Patrice Matchaba, a gynaecologist, who, in the South African Medical Journal in April the same year, had just said hooray for AZT: Providing AZT in pregnancy – if not now then when? In fact, so enthralled was he by the chemical fight against AIDS that he was writing a novel about it, Deadly Profit (David Philip, 2000), all about how greedy the pharmaceutical industry is when it comes to pricing its life-saving miracle drugs out of reach. And then, when the book flopped, he took a job as director of the pharmaceutical giant Novartis. Just like that. Which all goes to show. His colleague Jimmy Volmink, it emerged from several papers he published afterwards, was a big fan of AZT for pregnant women too. And what he, as a specialist in Primary Health, knew about the toxic pharmacology of AZT was also zero, as Tshabalala-Msimang was soon to discover. No wonder she contemptuously chucked their report into the bottom drawer and ignored their requests to meet with her. What was the point?

Having thought, apparently, that if it simply ignored the uncomfortable story it would just go away, the US press now gave the South African AZT rumpus a belated note. On 25 November, tucked away on page thirteen, an article in the New York Times sought to discredit Mbeki and Tshabalala-Msimang’s concerns:

‘There is toxicity, but this is not a sweet, this is a drug,’ said Dr. Joseph Perriens, who heads the care and support program of the United Nations AIDS program in Geneva. ‘To combat a fatal disease, it is perfectly acceptable to use drugs slightly more toxic than an aspirin … AZT is a valuable therapeutic drug. Its efficacy is a very important consideration and needs to be taken into account.’ … Stirring a furor among doctors and researchers who treat patients infected with the virus that causes AIDS, government officials here have been questioning the safety of the standard anti-AIDS drug AZT, saying they suspect it may be too dangerous to justify its use. … The statements have touched off a flurry of protests from doctors and others concerned about AIDS in this country, which has one of the world’s highest rates of infection with H.I.V., the virus that causes the disease.

The Mail&Guardian appears to have been tremendously wowed by Moore’s assertion during a television programme about the AZT controversy on Carte Blanche on 7 November 1999 that ‘Glaxo Wellcome is absolutely serious about the safety of its drugs – it is absolutely paramount to the company’, because the once radical newspaper packed off its visiting American journalist Aaron Nicodemus to supplicate the corporate high priest for an authoritative refutation of Mbeki and Tshabalala-Msimang’s stated worries about the drug. One the public could confidently rely on. Right out of the mouth of the accused. Fantastic!

Moore had frankly acknowledged the validity of the government’s concerns about the safety of AZT at his meeting with Tshabalala-Msimang. But no sooner was he out the door than he pretended that there weren’t any. In his article, Truth and lies about AZT, published on 1 December 1999, Nicodemus quoted him thus: ‘Moore said AZT’s toxicity has been well documented. In the 28-day treatment of pregnant mothers and for needle-stick injuries, Moore said several studies have found no evidence of permanent side effects.’ Blanche et al., reporting death, blindness, spasticity, epilepsy and muscle-atrophy among AZT-exposed babies three months earlier in Lancet, didn’t consider them temporary inconveniences. Plenty of studies have reported that AZT ingestion even for short periods causes serious toxic side effects, as we read in Debating AZT. And the late South African attorney James Hayman discovered to his mortal cost. ‘Long-term use of AZT does contain risks, including cancer, anaemia and a reduced white blood cell count. These side effects develop in about five percent of patients who use the drug for more than six months.’ The percentage and the term that Moore claimed were childish inventions, the glib lies of a doctor unaccustomed to challenge from his patients or anyone else, contradicted inter alia by the results of the licensing study that preceded FDA approval of AZT in the US, and, notably, by the first formal investigation (to be discussed below) of the frequency of serious side effects from antiretroviral drugs reported for the first time two years later in 2001. ‘One has to look very carefully at the possible effects and benefits of any drug. Why is AZT being singled out? [Mbeki’s concern that AZT is dangerous, and Tshabalala-Msimang’s claim that it was shelved as an experimental anti-cancer drug because it is so toxic] is nothing new. If AZT is not safe, why has it been allowed on the market in South Africa for 10 years?’ You tell us, guv.

It was remarkable reading Moore, both a pharmacologist and a medical doctor with a veritable scrabble set of letters after his name, openly concede in the Mail&Guardian that AZT can cause cancer in people taking it. Because GlaxoSmithKline had never done so before. On top of those cited in Debating AZT, some more recent papers back him up.

Down to Earth, India’s leading science and environment magazine, ran an article, Role reversal: Anti-HIV drugs can mutate the genes of an embryo, in its March 2001 issue, citing a study by Walker et al.:

NRTIs [nucleoside reverse transcriptase inhibitors], such as AZT ... used for preventing the transmission of the AIDS virus from an expectant mother to her child may cause genetic mutation in the offspring. … Currently women are warned only of a theoretical risk. But studies conducted on rats show that offspring exposed to NRTIs as embryos can develop NRTI-induced cancers after middle age ( February 20, 2001).

As Walker put it, ‘We have confirmed that the risk is more than theoretical.’ The article explained: ‘During their study, the researchers compared 71 new-born rats which had been exposed to AZT alone or in combination with the drug with 3TC, another kind of NRTI. … They found significantly higher genotoxic and mutagenic effects in the exposed babies.’ But ‘the findings should not be considered alarming’, Walker said, because AZT is good at preventing babies from getting HIV from their mothers. Better to get cancer.

Dorrucci et al. reported in the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology on 1 April 2001 that rates of invasive cervical cancer in women ‘with long-term HIV infection continue to rise in the HAART era’, and, after some random speculations to account for why, finally suggested that researchers should take a closer look at the role of ‘antiretroviral therapy in the development of this disease’. Three days later Frisch et al. published an investigation of the association of HIV seropositivity (treated with what drugs we can reliably guess) and cancer in the Journal of the American Medical Association. Irrespective of the degree of the patient’s ‘immunosuppression’, they found a higher incidence of both ‘AIDS-defining’ and ‘non-AIDS-defining’ cancers than occurred among HIV-negatives. The authors surmised that some of these cancers – of the lip, testes, lung, penis, and soft tissue and blood – were ‘probably attributable to lifestyle factors among persons with AIDS’ such as smoking and human papillomavirus infection (that mangy scapegoat again). They didn’t think to consider a role for the treatment in the development of these cancers, we see. As Walker, Dorrucci and their colleagues did, in company with GlaxoSmithKline’s surprisingly frank Peter Moore.

But not honest for long: interviewed for Vivienne Vermaak’s documentary, The Truth on AZT, broadcast on 12 December, Moore was asked: ‘How does Glaxo react to new research which claims the drug causes cancer, birth defects and deaths?’ His response: ‘I’m not aware of the data that you’ve just mentioned to me.’

The MCC provided Tshabalala-Msimang with a second shabbily drawn report on AZT in late January 2000. At a parliamentary press briefing on 8 February, she disclosed that she’d rejected it too:

You will recall that in his address to the NCOP, the President instructed us to investigate concerns around the toxicity of the antiretrovirals. We have commenced with this task. We asked the Medicines Control Council (MCC) to make available to us information that would assist in determining the risk benefit assessments of the use of the antiretrovirals for different indications. The initial reports we got were not to our satisfaction. I have now recently received the latest report from the MCC which I am studying.

In the course of a radio interview on 15 March, Tshabalala-Msimang restated her dissatisfaction with the failure of the MCC to address the issue of AZT’s long-term risks in its reports, and said that she had commissioned further investigation. But four days later the New York Times reported her announcement that the government had decided not to provide AZT in public hospitals, for the reason that ‘There is not enough information for me as the Minister of Health to expose women to a drug that we do not know about.’

Word about the toxic trouble with AZT spread north: Zimbabwe’s Minister for Health and Child Welfare, Timothy Stamps, told the Zimbabwe Mirror later in the year, on 24 November, that ‘the side effects of taking anti-retroviral drugs outweigh the benefits’. He added that ‘without “supplementary drugs” that inhibit other “opportune infections” [sic] like meningitis and tuberculosis, the use of anti-retroviral drugs would not help much’. Even the faraway Russians took heed of Mbeki’s alarm clarion concerning AZT. President Vladimir Putin was interviewed in the same month on Austrian state television. Taxed by a journalist for withholding the drug from pregnant women, Putin’s answer was that its efficacy was uncertain and that it was dangerous, and that he needed healthy babies for his growing country and economy. When the journalist responded that such a position was irresponsible, Putin angrily quit the show.

Mbeki and Tshabalala-Msimang’s parliamentary statements about the dangerous toxicity of AZT were paralleled in the British House of Commons some fifty years earlier. From the late eighteen-hundreds until the early 1950s, a dreadful disease epidemic blighted thousands of English babies entering their second year. As their faces flushed red they became inconsolably miserable, wouldn’t feed, couldn’t bear light, and grew autistically detached from their mothers. In some cases fingers and toes dropped off from gangrene. Countless died – about a quarter of those who developed the affliction. Doctors variously blamed acrodynia or ‘Pink disease’ on long winters, proximity to rivers, bad food, a ‘peculiar neurosis of the vegetative nervous system of young children’, and, inevitably, on a virus. In one medical paper, the popularly rumoured possibility that the babies were being poisoned by the deadly heavy metal mercury in their teething powder had only to be stated to be rejected. (What better way to sooth teething pains than by simply poisoning off nerve cells in babies’ tender gums with a potent neurotoxin.) But public disquiet about the suspect ingredient persisted, eventually surfacing during question time in Parliament in 1951. Anticipating the coming heat, the patent medicine manufacturers dropped mercury from their teething powders – and from deworming medicines popular in Germany, where it was killing older children – whereupon the epidemic disappeared.

The reaction of medical experts fifty years ago to the impertinent implication by politicians of one of their medicines as the cause of the Pink disease epidemic exactly matched their later reception of Mbeki’s public statements about AZT. The Oxford Illustrated Companion to Medicine (3rd ed., 2001) tells that ‘Even when faced with strong evidence, powerful paediatricians refused to believe it or even test the evidence’ – their scepticism surely redoubled by the affirmations of contemporary tomes, such as their drug handbook, the 24th edition of Hale-White’s Materia Medica: Pharmacy, Pharmacology and Therapeutics in 1939, which described mercury as ‘one of the most valuable medicines we have. … Children take mercury very well.’ Except that doctors have rather different ideas now: Dreisbach and Robertson’s standard reference Handbook of Poisoning (Appleton & Lange, 12th ed., 1987) now advises that ‘The administration of mercury in any form to children should be avoided.’ Never mind swallow it, don’t even inhale stray atoms vaporising from spills lying in tiny floor cracks: ‘The exposure limit must be observed at all times; frequent air sampling is necessary.’ Other reasons for medical scepticism were the infrequency of Pink disease – identified in only about one in every few hundred cases of children soothed with mercurial teething powder, and the fact that mercury had been an established drug with a centuries-long history of use in Western medicine. Like AZT it was a ‘standard of care’. A great antiseptic, no doubt about it. Killing everything. Like an American search and destroy mission, shooting anything that moved, with possibly a couple of Vietcong among the dead. But within a couple of years of public and political identification of mercury as the cause of Pink Disease, the doctors came round. The 23rd edition of Martindale: The Extra Pharmacopoeia, published in 1953 noted: ‘It is suggested that pink disease is due to an idiosyncrasy to mercury. In Manchester, where the condition is common, there is a history in almost every case to the ingestion of mercury, usually as calomel [mercurous chloride] in teething powders, and in the urines of affected infants an excess of mercury has been found in three-quarters of the cases.’

The difference between the British and South African parliamentary involvements was that unlike those British MPs, Mbeki was not merely asking worried questions; he spoke of ‘a large volume’ of peer-reviewed clinical and research literature on the exceptional toxicity of AZT reviewed in Debating AZT – and still the ‘AIDS experts’ weren’t interested. No one wondered: ‘What’s he actually referring to?’ Because they didn’t want to. They’d made up their minds, and, as is universally known, there’s nothing as uncomfortable as having to change one’s mind about a passionately held conviction. Such as that AZT saves lives. It’s why Ofelia Olivero, a research scientist on the staff of the US National Cancer Institute, who has published several papers reporting the carcinogenicity of AZT in animal models, told me she finds so little interest in the implications of her findings for humans exposed to AZT in the womb. No one wants to know. Especially not the ‘AIDS experts’, AIDS activists and AIDS journalists who’ve irrevocably staked their reputations on it.

CHAPTER

Three days after Mbeki set off the siren about AZT, a former science journalist on the Star, Anita Allen, personally handed him some critiques of the HIV/AIDS model written by dissident scientists, which she’d downloaded off the Internet. She’d become aware of its problems in April 1999 on reading the AIDS chapter in Nobel laureate biochemist Kary Mullis’s book, Dancing Naked in the Mind Field (Pantheon, 1998). Her interest piqued, she ran an online search and hit an archive of critical papers, thereafter compiling a dossier of about a hundred pages worth and sending them to scientists she thought would be interested. But weren’t. So she sent them them to Mbeki under a covering letter, pointing out that contemporary AIDS science was all wrong. Three months later a handwritten note from Mbeki himself rolled off Allen’s telefax machine late at night, inviting her to meet the next morning. There she handed him four discs containing a huge collection of dissident papers. At the end of an hour-long discussion Mbeki asked her: ‘What exactly do you want me to do?’

Allen conveyed a proposal just made in an article for lay readers that had appeared in three parts in the Australian magazine, Nexus, commencing in June 1999, under the title A Great Future Behind It: The Yin and Yang of HIV. At the end of which, authors Valendar Turner (of the AIDS dissident ‘Perth Group’) and journalist Andrew McIntyre suggested that

it is inexorably drawing nearer to the time when world governments will convene an international, adjudicated debate on this subject. In contrast to the 13,775 participants from 177 countries who attended the June [1998] Geneva AIDS Conference, this should be a small gathering where a dozen or so experts from each side put their respective cases to a disinterested group of scientists of the utmost stature, for example, another dozen made up largely of Nobel laureates. There is a precedent [discussed by Glover in Nature 394:4] for such a ‘consensus conference’ or ‘conference de citoyens’ in common sense and ‘along the lines of a model invented in Scandinavia and since applied in the United Kingdom and elsewhere’. A ‘jury’ of 14 people ‘screened for independence from interested parties’ have issues ‘debated in front of them by scientists, non-governmental organizations, industrialists and other bodies.’

Mbeki agreed, anticipating big trouble coming: ‘I’m going to be slaughtered, you know.’ He was on the point of changing his mind about AIDS completely, and it would be quite a turnaround. In common with every other top member of the ANC, he had been taken for the ride, spooked by the claims of the ‘AIDS experts’ along with everyone else. Everyone but an initially unimpressed Mandela.

‘By 1989 we could see AIDS all around us in the countries where we were in exile and we were already seeing some HIV-positive comrades,’ said Ralph Mgijima, then ANC Secretary for Health based in Lusaka, Zambia, and later Superintendent-General of Health for Gauteng. Tshabalala-Msimang, who’d completed a spell as registrar in the gynaecology and obstetrics section of Muhimbili Hospital in Dar es Salaam, and earlier as superintendent of Lobatse Hospital in Botswana, shared the exiled ANC leadership’s rising alarm. Recounting in June 1992, she said: ‘I worked in Tanzania and I saw cases of HIV and AIDS in the early 1980s, and have been continually attending workshops and courses on HIV and AIDS since then.’ With a medical degree taken in Russian from the First Leningrad Medical Institute, a master’s degree in public health from the University of Antwerp in Belgium and a certificate in Health Care Systems Planning from the UK (on top of a Bachelor of Arts from Fort Hare before she left the country in 1962, and several English and American public health diplomas too), she founded the ANC’s health department in exile and got involved in the fight against AIDS early on, ensuring that it was put on the ANC’s policy agenda by the late 1980s.

In early 1989 the ANC convened a health workshop in Lusaka, at which AIDS topped the agenda. It was followed by another a year later in Maputo, a few months after Mandela was released from prison by the apartheid regime. Mkhonto weSizwe Commander-in-Chief the late Chris Hani worried there:

Some of us might regard this as a diversion from the important task of transfer of power to the people, [but it was imperative that we] learn to tackle these problems head on … Those of us in exile are especially in the unfortunate situation of being in the areas where the incidence of this disease is high. … We cannot afford to allow the AIDS epidemic to ruin the realization of our dreams. Existing statistics indicate that we are still at the beginning of the AIDS epidemic in our country. Unattended, however, this will result in untold damage and suffering by the end of the century.

Tshabalala-Msimang presented a paper at the Maputo conference, in which she argued the white feminist wisdom that ‘In a situation where women have no control over their fertility and the sexual behaviour of their partners, the prevention of AIDS becomes difficult’, and the white medical wisdom that prostitution among Africans, engendered by the migrant labour system, was the main vector for the spread of AIDS. Just as local virologist Barry Schoub and others had contended in the South African Medical Journal (74(4):153-7) the year before, offering wise advice for a radical social control programme: ‘Serious consideration will have to be given to efforts to shrink the promiscuous core of prostitution, irrespective of the guise under which it is practised. The role of legislative control of prostitution needs to be investigated, but what is more important is addressing the social and societal conditions which lead to prostitution.’ Meaning sweeping the streets and throwing all the black bitches in prison for a start, and then maybe relaxing apartheid a bit. (Not to be put off by the hobgoblin of consistency, or maybe he’d forgotten, just the previous year Schoub had reported in Transactions of the Royal Society of Tropical Medicine and Hygiene (1987;81(5):874-5) his finding: Absence of HIV infection in prostitutes and women attending sexually-transmitted disease clinics in South Africa . But then he’s the AIDS expert.)

As Mbeki would later point out, the idea that HIV spread during intimacy between the sexes was a new development, because the experts had all agreed at first that it was something only gays got. In 1983 the Director General of the Department of Health, Coen Slabber, stated that AIDS posed a threat to homosexuals only. But there would be no public health campaign about this, he said, because ‘Homosexuality is not accepted by the majority of the population and certainly not by the Afrikaans speaking population. To advocate that homosexuals use the condom is therefore very difficult.’ AIDS as the lot of gay men exclusively was the newspaper story too: ‘Homosexual’ disease kills SAA Staff reported the Argus on 4 January 1983, followed five days later by ‘Gay’ plague: More victims? in the Sunday Times. Well, this was after all what the American experts said, the New York Times reported on 11 May 1982: New homosexual disorder worries officials, and they’re clever.

A couple of years down the track, however, the medical and popular understanding that AIDS was a gay thing had been supplanted by the idea that AIDS was something for heterosexuals to fret about too. Whenever they met someone new. The government accordingly appointed an AIDS Advisory Group in 1985; but among heterosexuals an epidemic of AIDS was still regarded by government as a distant spectre: Willie van Niekerk, Minister of Health and Population Development, said in 1987 that ‘Although a relatively small number of cases has been diagnosed so far in South Africa, the disease certainly has the potential to become a major problem.’ Caused by South Africans having getting down too much: ‘Promiscuity is the greatest danger, whether one likes it or not,’ he warned the nation the following year. ‘We have to say that. It is a fact. There is no way one can say, “I still want to sleep around but I don’t want to get AIDS.”’ He added the year after that: ‘It has the potential to lead to chaos in Africa and South Africa, not only destroying the social and political structures but to lead to economic chaos.’ Ruben Sher, an immunologist on the AIDS Advisory Group, warned around the same time in similar vein that AIDS could become a ‘biological holocaust’, his popeyes bulging. Adopting her sort of Calvanist sexual morality was the only way to head it off, adjured van Niekerk’s successor as Minister of Health, Rina Venter, in 1990: ‘Everyone must strive for themselves and those closest to them to change their risky sexual behaviour and settle for a single sex partner, preferably within a marriage.’ Soon government sponsored AIDS Training and Information Centre (ATIC) branches were operating in every major city to spread the new message, nearly all run by young whites, and a special AIDS research programme was established by the Medical Research Council.

AIDS as a new idea didn’t spread naturally, even if the post-94 ideological climate was conducive – for reasons to be examined ahead. Like Nazi ideology in the thirties, the notion among the public that a newly mutated virus was jumping between genitals was implanted, germinated and watered by means of an intense propaganda campaign – more intense, extensive and sustained in South Africa than anywhere else in the world. Following on the apartheid government’s basic AIDS awareness initiatives, ‘Soul City’ was a private one founded in 1992 that sold its package of ideas about the new hazards of sex via ‘edutainment’ in print, radio and television media. ‘Soul Buddyz’ was a sub-project aimed specifically at preteens. ‘Beyond Awareness’ was launched in 1998: a multimedia project conducted by a consortium of non-governmental AIDS organizations on behalf of the National Department of Health’s HIV/AIDS and Sexually Transmitted Diseases Directorate. The project went beyond instilling the fear of AIDS; it was specifically contrived to dampen sexual activity, especially among the young. The following year an extraordinarily ambitious campaign called ‘loveLife’ was launched targeted at teenagers, applying slick commercial propaganda techniques to brand ‘safe sex’ as cool. Alleging on its website that ‘More than 5 million South Africans are living with HIV, more than in any other country in the world’, among other scare stories, it attracts its colossal corporate and government funding by claiming that ‘achieving carefully targeted reductions in high-risk sexual behaviour among young people – including delaying initiation of sex, reducing the number of sexual partners, managing STI’s, and increasing condom use – can dramatically change the course of South Africa’s HIV/AIDS epidemic. That’s the kind of change that loveLife is working to achieve.’ In 2001 the government assembled an AIDS Communication Team (ACT), a consortium of several organizations, to run the Health Department’s Khomanani AIDS information campaign – specifically to encourage people to ‘Get tested for HIV’, as a poster went, in order to ‘make healthy choices’, such as ‘Get early treatment’, right at the top of the list.

This propaganda drawing people into the pharmaceutical industry’s market for treatment with AZT and other AIDS drugs, with their poisoning symptoms seen as ‘progression to AIDS’, rechromed precisely the same medical leitmotifs founding the deadly Wassermann/Salvarsan syphilis con in the first half of last century. Health authorities urged the public to undergo the useless Wassermann test (legally mandatory before marriage in numerous American states) and, if they were positive, to submit to injections with arsenic – a patented compound of it called Salvarsan and its derivates, manufactured by Bayer in Germany. An American public health poster in the thirties claimed: ‘SYPHILIS…. SIX OUT OF TEN CURED BECAUSE THEY DID NOT WAIT TOO LONG’. In truth, on arsenic you can only go one way. (Doctors ascribed the consequent mental deterioration, other neurological impairment and other organ damage, heart especially, culminating in general paralysis, dementia and death, to tertiary- or neuro-syphilis.)

But there was a whole lot more to it than a burgeoning communications industry. In 1992 the AIDS sector really started taking off in South Africa. To address the declared new menace, the national budget for AIDS was quadrupled from R5.4 million the previous year to R20 million (that sum quintupled to R100 million two years after that, and climbing almost exponentially since). A tollfree national AIDS helpline was set up for the worried public to be worried even more by telephone counsellors talking about ‘window periods’ and the right strong American medicine to take and so on. In a joint intiative, the apartheid health ministry and the ANC established a collaborative of NGOs, local, provincial and national government, the ANC Health Secretariat, business, labour and clergy, and other interested individuals to draw a grand National AIDS Plan. Tshabalala-Msimang and Dlamini-Zuma, both ANC doctors in line for Cabinet positions, were prominently part of it. The National AIDS Coordinating Committee of South Africa (NACOSA) as it was called convened a conference in Johannesburg in October under the title ‘South Africa United Against AIDS’. United in the view that a new virus was ripping through the country, and nothing less than a national defence mobilized at the highest level of state would be able to stop it.

The whole project concerning the strange new disease identified a decade earlier by American doctors, for which Anglo-American multinational drug companies had just the cure, was financed by the American National Institutes of Health and several hugely wealthy American corporate philanthropies: the Carnegie Corporation, Atlantic Philanthropies, the Rockefeller Brothers Fund and the Ford Foundation, some of whom would become the backers of the the professional AIDS drug lobby group, the Treatment Action Campaign later on.

In 1993, with the ANC poised to sweep South Africa’s first democratic election set for the following year, NACOSA convoked a meeting of forty health experts to discuss how best to ensure that AIDS was put at the top of the ANC government’s agenda as a special project of the first importance. As Dlamini-Zuma, head of NACOSA’s strategy subcommittee later put it, ‘it was obvious that AIDS was going to be one of this countr’'s greatest crises – in terms of health and the economy – and that the government was not going to get around to doing anything unless prompted’. Cross-cultural fault-lines appeared in approaches aired there. When white delegates emphasized what they considered to be the primary role of migrant labour in the spread of AIDS – alleging that black miners consorting with city prostitutes were bringing HIV home to their rural wives – Health Minister in-waiting Dlamini-Zuma sighed: ‘White people just don’t understand the issues.’ But they dominated AIDS policy throughout the Mandela era nonetheless. The conference resolved to set up an independent advisory panel chaired by Dlamini-Zuma, to be called the National AIDS Council (NAC), and proposed a substantial governmental budget for an extensive media campaign, wide-scale education and support programmes, free condoms, and a standing national AIDS commission to operate out of the President’s office, to be headed by a deputy minister with executive clout over other departments.

But in April 1994 newly inaugurated President Mandela couldn’t see what the fuss was all about. He slashed the proposed budget by three quarters, and refused to be crowded by AIDS chatterboxes with long faces, talking about people having too much sex all the time. Other people. The National HIV/AIDS and STD Programme was situated in the Health Department instead. Tshabalala-Msimang was tucked away in Mandela’s Cabinet as Deputy Minister of Justice, although did take the chair of the parliamentary Health Committee. Years would pass before Mandela as President gave AIDS a public mention in South Africa. On 7 August 1998, addressing the National Council of Provinces in Parliament, Mandela warned at last:

There is another killer that haunts our land. The Department of Health reports that the provinces have introduced a wide range of initiatives to address the HIV/AIDS epidemic, as part of the national effort. And yet the reality is that we are as a nation not doing nearly enough if we are to avoid the situation towards which present trends are taking us – of some two million AIDS orphans in a matter of years, and a loss of 1% of our potential GDP. In order to harness the resources of our society more effectively in this critical battle, the government is working towards building an active partnership, across all sectors and communities, around practical programmes to avert this disaster.

Mandela’s initial coolness to the AIDS craze infuriated Nthato Motlana, his personal physician and prominent apartheid resistance activist: ‘I get so angry. I go to Mandela … and I give him hell. The response by the previous apartheid government was a national disgrace. The response by my government ... has also been disgraceful.’

Not as if Mandela was oblivious to all the enthusiasm. He’d delivered the opening address at NACOSA’s first conference. Quarraisha Abdool-Karim, later to be the first director of the National HIV/AIDS Programme, followed him to the podium as the next speaker, but he’d said it all, she said, and ‘there was very little to add. He knew all the issues, everything that had to be done.’ Indeed, he was full of how social conditions made ‘the black community even more susceptible to the sex related virus’, and the pressing need ‘to convince the majority of black South Africans to change their sexual behaviour’ to avoid ‘this scourge’. Sexually disciplined whites in the suburbs didn’t need such tutoring, his speech implied. But from Mandela’s subsequent lack of interest in AIDS when he took power, it was obvious that he hadn’t yet bought the whole spiel, and that what he’d been spouting were the fantasies of concerned white and Indian AIDS experts, who were running the AIDS show here, and who had written every word for him. Mandela would be reborn as a believer much later on, following an evangelical visit to his home by Judge Edwin Cameron.

Mandela unconvincingly explained his indifference to the festivities to David Dimbleby in the documentary Nelson Mandela: The Living Legend, broadcast on BBC One on 5 and 12 March 2003:

Africans are very conservative on questions of sex. They don’t want you to talk about it. I told them we have got this epidemic which is going to wipe out our nation if we don’t take precautions. ‘Advise your children that they must delay as much as possible before they have sex. When they do, let them have one partner and condoms.’ I could see I was offending my audience. They were looking at each other horrified.

So he took his advisors’ advice to drop the subject, he said: ‘I wanted to win and I didn’t talk about AIDS.’ Why didn’t he start jabbering about AIDS after winning, then? Because he ‘had not [had] time to concentrate on the issue’. In any case: ‘It’s no use crying over spilt milk.’ About which Cameron remarked: ‘He more than anyone else could through his enormous stature have reached into the minds and behaviour of young people. A message from this man of saint-like, in some ways almost god-like stature would have been effective. He didn’t do it. In 199 ways he was our country’s saviour. In the 200th way he was not.’ He didn’t go around telling his people that they needed to control themselves so they wouldn’t get sick and die about ten years later.

But in any case, the ANC’s 1994 National Health Plan for South Africa, drawn with helpful input of experts from the WHO and UNICEF, took AIDS very seriously, prophesying fearsomely:

Forecasts to the year 2000 predict that there will be between 4 and 7 million HIV-positive cases, with about 60 per cent of total deaths due to AIDS, if HIV prevention and control measures remain unaddressed. Similarly, credible predictions indicate that by the year 2005, between 18 per cent and 24 per cent of the adult population will be infected with HIV, and that the cumulative death toll will be 2.3 million, and that there will be about 1.5 million orphans. … In view of the devastating implications of the HIV/AIDS epidemic for South Africa, it is mandatory to define prevention and control interventions plus comprehensive care for those already infected, within the context of the Bill of Rights.

And on 21 July, soon after taking office as Minister of Health, Dlamini-Zuma announced that the Cabinet had considered NACOSA’s National AIDS Plan, and that ‘In principle, the government accepts the plan, but that doesn’t mean we’ll implement it word for word.’ Everyone was pleased.

At the ANC’s 49th National Conference in Bloemfontein in December, on the other hand, AIDS got nary a mention, aside from a single passing reference in a resolution concerning the ‘problems of youth’.

In 1995, without consulting the NAC, and with her officials circumventing conventional tender procedures, Dlamini-Zuma assigned R14.2 million of a European Union grant to the production of a AIDS awareness play, Sarafina II, inspired by an earlier musical of the same name that had been a hit in the US. When white AIDS activists and journalists slammed the show as a waste of money, both Mandela and Deputy President Mbeki spoke out in Dlamini-Zuma’s support. Mandela suggested that the pounding Dlamini-Zuma was taking over the play arose from pharmaceutical corporation antagonism on account of her unprofitable emphasis on prevention rather than treatment. Under persistent media and activist pressure, however, Dlamini-Zuma eventually called the play off, fairly questioning whether it would have been so savaged had its writer and producer, Mbongeni Ngema, been white. A further round of controversy was generated by the anonymous donation of R10 million to the Department of Health as a contribution to what was considered by critics as the wasted cost of the play. The donor was determined by the Public Protector to be ‘a white South African businessman’ with no stake in the affair, who was concerned that AIDS awareness should be kept up and who didn’t want to see the foreign donor pool drying up.

As far as Dlamini-Zuma was concerned, the NAC’s objection to the project marked the end of its relevance in formulating AIDS policy. She might also have grown tired of whites continuing to tell blacks what to do. A deal that emancipation in 1994 was supposed to have ended. Zweli Mkhize, ANC health MEC for KwaZulu-Natal explained the sentiment: ‘There is in this country a long history of whites telling us what do with our bodies and you’ll find some resentment of that still. There has always been this debate about Africans determining what is right for Africans, not whites.’ A point totally lost on AIDS Consortium director Morna Cornell: ‘I don’t think anyone can give a simple explanation for why our AIDS program has failed. But the race issue is huge. It’s like we eliminated apartheid but it left behind this huge wall that none of us knew how to tear down or get around.’ When the NAC’s members were put out again, this time by Dlamini-Zuma’s proposal that AIDS be made a notifiable disease, they sought a meeting. Dlamini-Zuma’s answer came in the form of a letter signed by Health Director General Olive Shisana telling their chairperson that their council was no more, and that they could all go home now. Thanks.

Shisana herself was off next, to take a job mid-year with the WHO in Geneva. In the fallout over the the procedural irregularities involved in the allocation of funding to the Sarafina project, Shisana blamed Dlamini-Zuma. But Mbeki stood by the latter, and had his office issue a statement in her support.

Cameron, gay founder and first director of the AIDS Law Project, co-founder of the AIDS Consortium and a member of the NAC from the start, was upset by all this. In February 1996 he approached Mandela for a powwow to discuss government AIDS policy. You people are messing it up.

At the time I chaired a national convention on AIDS, my co-chair and I made every effort we could to get an audience with President Mandela, and we didn’t succeed. … Our efforts, which were sustained and determined and insistent, to get President Mandela to involve himself personally in the epidemic were unsuccessful. … The fact is that President Mandela had a huge job. He saved our country. He didn’t do what we what we would have wanted on AIDS. Whether history will fault him, I’m not clear.

Mandela dismissively delegated Deputy President FW de Klerk to meet with him instead. Who listened indulgently but without much interest. In the flapping judge. In the middle of the meeting, de Klerk’s co-deputy unexpectedly strode in. On his arrival he gave Cameron a caring hug. Unlike Mandela and de Klerk, Mbeki took it all very seriously. He expressed his grave concern about the epidemic. He engaged animatedly with Cameron, and sought his advice on strategies and policy options. Recalling his tête-à-tête with Mbeki, Cameron told the New Yorker on 13 May 2003: ‘He really, really cared.’ A couple of years later, in Cameron’s view, he’d suddenly stop caring. Really.

Unlike Mbeki at the time, though, Parliament still didn’t care: when NACOSA held a seminar later in 1996 to brief parliamentarians on the alleged AIDS crisis, only fourteen MPs pitched up.

In January 1997 Dlamini-Zuma told Mbeki that she’d been approached by the promoters of a locally developed drug they called Virodene P058, based on a chemical called dimethylformamide, claiming that skin patches impregnated with it had helped AIDS sufferers. Mbeki was interested. The originator of this idea, Pretoria cardiothoracic surgeon Carl Landuaer, backed by cardiology professor Dirk du Plessis of the University of Pretoria, were invited to present their claims directly to a meeting of Cabinet on the 22nd. People claiming to have been cured by Virodene appeared before it. After a lengthy and moving presentation, there was clapping and cheering.

Medicines Control Council president Peter Folb heard what was going down and marched in to put a stop to it. This was not how one goes about getting a drug approved. It was irregular. Worse still, as boss of the MCC for seventeen years, he’d been left out. Virodene’s pluggers should have applied directly to the proper licensing authorities. To him. They weren’t doing it the right way, the way GlaxoSmithKline gets its drugs approved, for example. Now there’s a model of probity to follow. In how to go about getting your prescription drugs licensed. ‘Ethicals’ they call them in the trade – AZT, Lotronex and Relenza, for instance. About all three we’re still to read. And are sure to be amazed. And afterwards even more by the company’s repeated protestations that it’s an ‘ethical’ company. Odd, it is. Because weapons and automobile manufacturers and the like don’t go on so. Shakespeare called it protesting too much. Especially since the lesson from the approval of GlaxoSmithKline’s aforesaid drugs is that you just do whatever it takes. As long as you get that official stamp. Best from the big guys first, the American FDA. Because once you’ve got it from them, you won’t have to worry about small fry like Peter Folb and his MCC. They’ll fall in line, no questions asked. Every time. But fair’s fair. It’s the way of the world in the drug business. All over.

On 21 November Folb put out a statement alleging that people had suffered ‘severe adverse toxic reactions’ to Virodene, and warning:

The MCC has serious concerns, based on the best available scientific knowledge and advice, that Virodene is unsafe and potentially dangerous to humans when given as a medicine for HIV infection and AIDS. Virodene has not been shown to be of any benefit for this purpose. … Virodene is an impure industrial solvent and toxic substance, used in the plastics industry, and it is quite inappropriate for medicinal use in humans in the form and manner in which it is being distributed.

Folb went on to threaten every kind of criminal and civil plague on anyone ignoring him. Folb’s statement was no more that the most ignorant and vulgar negative propaganda, but it was predicatably adopted by newspaper journalists as the scandalous truth. In fact, the compound has has long been known to have highly unusual chemical properties….

In a statement, ANC has no financial stake in Virodene, published in Mayibuye in March 1998, and in the Sunday newspapers on the 8th, under the title, The War on Virodene, repudiating false allegations made by the DA that the ANC stood to score financially from the approval of Virodene, Mbeki revealed that Folb and the MCC had eventually agreed to allow the drug to go to clinical trials, ‘but later changed their mind’, unmoved by the submission by the researchers of

at least four versions of their research proposal, the Protocol, in response to the critical appraisals of the MCC. As it became more and more difficult to understand the attitude adopted by the MCC, the Minister of Health and I held meetings with both the researchers and the Chairperson of the MCC, to help facilitate the resolution of any outstanding problems.

Mbeki explained the reason he and Dlamini-Zuma had intervened – in their respective leadership capacities on the Inter-Ministerial Committee on HIV/AIDS – in terms of the pressing need for a treatment solution to ‘the pressing crisis of an escalating pandemic of HIV/AIDS’ affecting ‘2,8 million infected South Africans’, and concerns that the disputes between the developers of the drug might lead to a situation where ‘the intellectual property represented by Virodene could fall into the hands of people who could shut down the research effort or sell Virodene at unaffordable prices, should it be licensed as efficacious medication’. He went on to list a number of estimable medical experts from Portugal, France, Great Britain, the Czech Republic and Canada, who’d examined the clinical trial protocol, and furnished unamimously favourable comments. But

Alas, … the MCC, still refuses to accept the application, despite its knowledge of the unanimous opinion of these “learned and highly qualified professionals” [as one expert described them], and whose credentials it is perfectly aware of. To confirm its determined stance against Virodene, and contrary to previous practice, the MCC has, with powers to decide who shall live or die, also denied dying AIDS sufferers the possibility of “mercy treatment” to which they are morally entitled. I, and many others, will not rest until Virodene’s efficacy or otherwise is established scientifically.

But Peter Folb and his MCC were just as adamant that Virodene wasn’t going to be tested in any kind of approved trial under any circumstances. Mbeki could jump in the lake.

Asked why the government had got involved in the Virodene licensing bid, ANC Secretary-General Kgalema Motlanthe explained: ‘Because this is a major issue, it confronts all of humanity. If society is on the brink of a major breakthrough on the scourge of AIDS, [there should be the] will and readiness to bring this work to a conclusion.’ The MCC was ‘playing God,’ he said. ‘Given the devastating effects of AIDS, the research must be brought to its logical conclusions.’ The researchers were being ‘hounded like criminals’, he noted, referring to Mbeki’s revelation that the MCC had conducted midnight raids on the researchers’ homes, ostensibly looking for evidence of wrongdoing. But finding nothing. ‘The rationale of the MCC should be questioned,’ he suggested. ‘I surmise that the MCC is driven by other interests than concern for proper control of medicines.’ To which Folb responded: ‘This is not something which a responsible person should be hinting at. He should be called on to clarify his statements, which are seriously damaging and utterly untrue.’

The AIDS establishment saw funny psychological reasons motivating Mbeki and Dlamini-Zuma’s concern to see Virodene tried out. ‘There was this sense that this drug would be the thing that offset the perception ... of Africans as substandard and less than capable,’ explained Quarraisha Karim sweetly. ‘All eyes were upon [the ANC] and the expectations were very high and they were really trying to find their feet but they didn’t want to exercise caution. This was driven by this need to show the world: “Yes, Africans can do this. We can do this. Virodene became our redemption.”’ Their redemption. Her husband Salim Karim voiced similar thoughts: the Cabinet imagined that its discovery of Virodene would somehow give the new government a boost in the same way that Chris Barnard’s world-first successful human heart transplant had been a winner for the old order, he thought.

Medical academics and professionals rallied to support Folb and his MCC. On 23 March the heads of medical schools at the universities of Cape Town, Stellenbosch, Natal, Witwatersrand and MEDUNSA protested at what they described as Mbeki’s political interference, and called for a commission of inquiry: ‘This council [the MCC] has an admirable record in its dealing with many complex issues over many decades. Its concern for the health of individuals and the health of the public is beyond question and it has served the South African public with the highest degree of integrity under the leadership of its chairman, Professor Peter Folb.’ Folb agreed; his council ‘must be left to do its work according to proper standards that will offer reasonable prospects to patients and prevent their being exploited’. So did the Medical Association of South Africa: the politicians should butt out, they said, because they were undermining the autonomy of the MCC:

Medicine is not an exact science and over the years the practice of finding scientifically and ethically justifiable answers in the quest for curing diseases has assured patients of our first obligation: to do no harm.’ There was a way to find out if a drug such as Virodene worked, the doctors said: ‘This can be achieved by way of acceptable scientific protocols, entrenching ethical principles. It is important not to raise expectations that may not be fulfilled, especially when people living with Aids are particularly vulnerable to the sort of harm that follows on grave disappointment.

But unlike the clubby doctors, Mbeki and Dlamini-Zuma were thoroughly unimpressed by Folb’s showing in the affair, and began doubting his competence and the health of his organization generally. An independent panel of top-drawer overseas experts was hired to assess the MCC’s performance under his leadership. This was no hatchet job: Graham Dukes, Emeritus Professor of Drug Policy Studies at the University of Groningen in The Netherlands was actually a friend of Folb’s, who had invited him to contribute two chapters to, and edit a section of, the 13th edition of the standard reference Meyler’s Side Effects of Drugs that he had edited in 1996. Dukes was assisted by Dr Suzanne Hill of the University of Newcastle, New South Wales, Australia.

Dukes and Hill were appalled by what they found – bearing out Mbeki and Dlamini-Zuma’s worst suspicions. Their report released on 24 March 1998 recommended that ‘the present MCC should cease to exist’ immediately, and urged the ‘suspension of [its] work’ on the spot. Folb’s head rolled soon thereafter: he was notified that his contract, up for renewal in April, wouldn’t be. His deputy, and the MCC Registrar got the chop too, in circumstances a labour tribunal later declared unfair, but by then Helen Rees had taken over, with Peter Eagles, a pharmacology professor at the University of the Western Cape, as deputy president. Precious Matsotso was appointed new Registrar.

I met and had dinner with Carl Landauer at his invitation in late 2005. I was curious to find out why he imagined the administration of the diethyformamide might have a therapeutic action when administered to AIDS patients. Though instinctively averse to the use of synthetic chemicals in medicine, as a general principle, I already knew that dimethylformamide is a reducing agent that counteracts the damaging effects of cellular oxidation – the real cause of AIDS. (We’ll get there later.) Landauer promptly confirmed that this was exactly the pharmacological action intended; it nothing to do with any ‘antiretroviral’ action. As for the virus: well, what virus? With that he had me listening. He whipped out a pen and paper and began explaining with series of molecular schematics and other notes and diagrams that diethylformamide is a thoroughly researched compound long known to chemists for its singular, most unusual properties, which inter alia make it ideal for infusing into tissues destined for transplant, preserving them without harming them.

Landauer impressed me at our meeting as a genuine, selfless pioneer of a novel treatment modality, thoroughly frustrated by the usual medical prejudice against novelty and the institutional inertia that he’d run into, about which he told me the whole story: his contacts with Mbeki and government, the entire fascinating history from start to finish. At the end of which, it was not difficult for me to understand why he had impressed Mbeki and how it came to be that government had come to associate itself so closely with Landauer’s appeal for his invention to be tried out in formal controlled clinical experiments. But happy dealing AIDS drugs, the medical establishment wanted none of it.

Towards the end of Mandela’s tenure, Mbeki increasingly took command. By 1997, still pepped by Cameron’s AIDS talk early the previous year, Mbeki had become concerned about Mandela’s blasé attitude to AIDS and he worried that the Department of Health would not be able to manage the threatened crisis alone. His first step in November was to establish a Ministerial Task Force on AIDS, whose monthly meetings he chaired. Tshabalala-Msimang was appointed to head its secretariat, and it promptly got to setting battle plans.

Mbeki was surprisingly silent about AIDS in his closing speech at the ANC’s 50th National Conference in Mafikeng on 20 December, on succeeding Mandela as party president, but the conference did resolve that since AIDS would ‘massively impact on the economy, will impact socially with more orphans and the loss of breadwinners, and on the health service with additional new users’, the education campaign to prevent it from spreading should ‘be led by the President of our organisation who must direct that the NEC, Branches, the Youth League, the Women’s League throughout our Provinces … place the campaign against AIDS on their day to day agendas’. The nine-point programme included included the party’s resolution that ‘The message about Aids awareness be included in political speeches of our entire leadership, with a pledge to fight the disease; The ANC co-operates with all organisations, groups, individuals, and agencies engaged in the campaign.’

‘It frightens me and makes me feel anguished inside that we’re losing a population and nobody seems to be disturbed,’ said Virology Professor Alan Smith at the University of Natal’s medical school in the March 1998 issue of African Business. ‘We’re going to depopulate an entire continent.’ But in his landmark African Renaissance speech given at the United Nations University in Tokyo on 9 April, Mbeki, now formally leading the country’s forces, emphasized the government’s resolve to fight what was making Professor Smith frightened: ‘We must take decisive steps to challenge the spread of HIV/AIDS, of which Africa accounts for two thirds of the world total of those infected. Our government has taken the necessary decisions directed at launching and sustaining a big campaign to confront this scourge.’

At a conference on the ethics of vaccine testing in South Africa, held in Durban in the first week of September that year and attended by about a hundred scientists, researchers, Health Department officials and NGOs, the scale of the ‘national emergency’ facing the country, to quote AIDS Law Project director Mark Heywood, was repeatedly emphasized: South Africa was said to have fifty thousand new HIV infections a month, seventy more every hour. It was noted that UNAIDS had warned in January that by June almost three million South Africans would be HIV-positive, and that the infection rate had leapt by seven-hundred thousand in 1997 alone. Referring to news that Mbeki was planning to launch a major AIDS awareness campaign, Heywood warned: ‘If South Africa wants to lead an African renaissance, it is not going to succeed with half its school-going population and twenty-five percent of its teachers HIV-positive and with the lowered morale that goes with one in every five adults having HIV or AIDS.’ And Mbeki was ‘going to have to go much further than investing in public awareness’, Heywood counselled; drugs were what we needed. But Peter Busse, founding director of the National Association of People Living With AIDS (NAPWA) took a different line. Conceding that AIDS drugs were very expensive, he urged that in countries unable to afford them the First World should put up cash for vaccine research instead. Words that would lead to a fateful rebellion in NAPWA’s ranks.

Even the tax collectors were scared: on 3 September, while the conference was still on the go, the fiscus released a press statement warning that up to thirty-five per cent of South Africans could be dead from AIDS within a decade. To educate civil servants about the danger, the Cabinet had resolved that the Department of Health should allocate funds to each and every government department, including the Revenue Service, to pay for an internal AIDS awareness campaign ‘to combat Aids and protect [government] employees and their families’.

Shortly after the vaccine conference ended, Mbeki rose to the sombre occasion, appearing at a press conference on 11 September, along with several Cabinet ministers, to announce the launch of the government’s Beyond Awareness campaign to about two hundred political and social leaders from just about every walk. But the name of the campaign notwithstanding, none of its R80 million budget was for the drugs that the activists craved; prioritised instead were ‘primary prevention’ strategies. Welfare Minister Geraldine Fraser-Moleketi explained the thinking behind this: only the development of a vaccine could provide a long-term solution to the epidemic in the country. Dlamini-Zuma suggested that in view of the role that that the country’s youth had played in resisting apartheid, they should adopt the fight against AIDS as ‘the new struggle’. Both Mbeki and Dlamini-Zuma stressed that AIDS was draining the economy, and said it would only get worse as the country’s estimated three million HIV-positive people began falling sick.

On 9 October Mbeki brought more hands on deck by establishing the ‘Partnership Against AIDS’, a ‘broad-based and multi-sectoral’ co-operative, made up of representatives from several government departments and private sector players with an annual budget of R80 million. Grandly launched it was too – at a soirée thrown at the Presidential guesthouse for eight hundred people. In so doing, Mbeki was addressing AIDS as the national emergency that local and foreign ‘AIDS experts’ and activists had sold it as. He never doubted them for a moment. On the contrary, he was never seen out without a red AIDS solidarity ribbon on his lapel. To show how much he cared. In fact he led the fashion, the badge on his coat presaged by the remarkably similar ‘narrow scarlet sash, emblem of the Junior Anti-Sex League’ in George Orwell’s 1984, the ‘aggressive symbol of chastity’; and again the bloody symbol glinted on his coat as Mbeki appeared on national television that day to warn that a deadly new sex plague was suddenly upon us. Why, the Department of Health’s Health Sector Strategic Framework 1999-2004 called for the government to ‘Declare HIV/AIDS a national emergency, if not a global emergency’. It was all very alarming.

Mbeki’s special television address to the nation to tell South Africans that a deadly new germ, although invisible, was actually everywhere had the unintended consequence of whipping up a maelstrom of plague hysteria in some parts – with tragic results. Whereas the theme of Mbeki’s speech had been the importance of sexual restraint for our national salvation, Mandela went further three weeks later. Delivering the keynote address on World AIDS Day on 1 December at a meeting in Matubabatuba in KwaZulu-Natal, attended by UN-AIDS boss Peter Piot, he urged:

It is time to break the silence. That is why we are here today as political leaders, following the lead given by Deputy President Thabo Mbeki. … We want our communities to be able to say to our country: Come and witness the reality of AIDS; see the devastation in our community; see the fresh graves; see the courage of those who live with the infection and of the children who have lost their parents. … It is the silence that leads us, when we see all the signs in our friend’s face, to speak of anything else rather than ask, ‘Do you have AIDS? How can we help?’ It is the silence that hangs over our cemeteries when we bury loved ones knowing they died of AIDS, but not speaking of it. It is the silence that is letting this disease sweep through our country, adding 1 500 people each day to more than 3 million already infected.

When NAPWA fieldworker Gugu Dlamini took Mandela’s advice and courageously broke the silence by announcing that she was HIV-positive during a radio programme on the same day, her neighbours in KwaMancinza near Durban were horrified. Alarm spread as the news of the demon among them did, and two weeks later, having decided that the threat needed a decisive fix, they proceeded at night in a posse to her home where they beat and stoned her to death. ‘It is a terrible story,’ Mbeki commented when he heard this. ‘We have to treat people who have HIV with care and support, and not as if they have an illness that is evil. This is a message that needs to be spread to as many people as possible.’ AIDS, he emphasized, was one of his greatest concerns for the future of our country.

And without the special medicine so many of us were going to die, said NAPWA member Zackie Achmat, at the public launch of the group’s special project that he’d conceived, the AIDS Treatment Action Campaign. Gathered on the steps of St George’s Cathedral in Cape Town on International Human Rights Day, 10 December 1998, he and a dozen other protesters fasted for the day and collected about a thousand signatures to demand that the government develop a programme to provide ‘AIDS medication’ to the sufferers:

The Treatment Action Campaign calls on the Minister of Health, Dr. Zuma and Trevor Manuel, the Minister of Finance to meet immediately with the National Association of Persons Living with HIV/AIDS (NAPWA) and HIV/AIDS NGOs to plan for resources to introduce free AZT for pregnant mothers with HIV/AIDS. The TAC also calls on the government to develop a comprehensive and affordable treatment plan for all people living with HIV/AIDS.

People like his gay friend Simon Nkoli, who’d just died an AIDS martyr on 30 November – having taken AZT alone and in combination with other AIDS drugs on and off since 1988, courtesy of friends abroad who’d been sending them over, one parcel after another, until he finally keeled over.

Achmat was no newcomer to the political scene, but a seasoned agitator from his teens during the late apartheid era. A founder member of the National Coalition for Gay and Lesbian Equality (NCGLE), he succeeded Cameron as director of the AIDS Law Project in 1994 and ran it for three years before Heywood took over in 1997. In October the following year, as leader of the NCGLE, Achmat demonstrated his political brio in getting buggery decriminalized by the Constitutional Court (on the same day, coincidentally, that Mbeki announced the Partnership Against AIDS on TV); and with this behind him Achmat knew he was born to lead. And that the country’s top judges in this newly established forum, eager to demonstrate how progressive they were, could be relied on to help him ram his next agenda through. By now Achmat’s ambitions had drawn him to another gay group, a special little sect of the chosen: the National Association of People Living with AIDS (later to transmogrify into a massive African heterosexual organization). There he’d find his road to really big fame. A month after winning his gay rights in court, he was on the steps of the Church with his supporters, demanding AZT for mothers and their unborn babies, and for HIV-positive people generally. But he would not take it himself, he told journalist William Gumede a week later: ‘On principle, I won’t take ARVs until they are freely available to the poorest.’

Mbeki, meanwhile, was busy leading the government’s fight against AIDS in his own way. Welfare and Population Development Minister Geraldine Fraser-Moleketi had come up with the idea that a good way for her ‘Women in Partnership Against AIDS’ to draw attention to how women were specially victimized by AIDS would be to have a railway train chuffing around around the country and providing mobile conference facilities for po-faced women to talk all day about how violent men are and how they just forced themselves on their women as they felt like it. The railway parastatal Spoornet ageed to go along with her scheme, and provided a train for it, throwing in a hundred million rand to fight AIDS too.

On 4 March 1999 Mbeki launched the Vusa-ifizwe (‘On the Right Track’) AIDS train at Pietersburg in the company of several top politicians, including Dlamini-Zuma and Mineral and Energy Affairs Minister Penuell Maduna. In his speech Mbeki delivered a stern admonition for his brothers, remarking on their poor turnout at the launch and how they needed to get more involved in AIDS awareness and prevention campaigns. ‘Woman are particularly vulnerable to this disease and to society’s reaction. We need to stand up and support their fight,’ he said. In her address Dlamini-Zuma provided frightening statistics: a fifth of women attending antenatal clinics were HIV-positive; 3.6 million South Africans had the deadly virus; and in KwaZulu-Natal almost a third of people living there were infected. ‘We have to begin encouraging women to break the silence and raise society’s levels of awareness. We need to demystify the taboos, expose the violence and propagate the hard facts about the impact of HIV/AIDS on women and children.’ After all was said and done, Northern Province Premier Ngoako Ramatlhodi (later to follow Mbeki’s intellectual flip-flop on AIDS) performed the customary AIDS ritual by lighting a candle.

On 17 March Achmat wrote to Dlamini-Zuma to ‘request an urgent meeting with yourself, the Minister of Finance and other HIV/AIDS NGOs to discuss and plan the implementation of free AZT and formula feeding for pregnant mothers with HIV/AIDS, and to explore other affordable treatment options. As partners in the fight against AIDS, we urge you to meet with us to explore alternative solutions that are fair and equitable to all South Africans.’

On Human Rights Day (the South African one) on the 21st , Achmat again led his supporters in bravely skipping lunch to raise the moral pressure on Dlamini-Zuma to change her mind about giving pregnant women AZT. Four days later, inflamed with righteousness outrage, Achmat and members of his NAPWA-TAC barged into her office at Parliament to press their demand – an ‘informal meeting’, they called it, at which she agreed to treat with them and fixed a date.

Before it arrived Dlamini-Zuma caused an uproar by announcing on 17 April that along with the Health Ministers of Zambia and Zimbabwe she intended making AIDS a notifiable disease, requiring doctors to tell intimate partners and families if their loved ones lit up the HIV test: ‘We want to know who is dying of AIDS, and relatives and partners must be notified. It is time we treated AIDS as a public health issue like tuberculosis. We don’t go about treating that with secrecy.’ But this common sense was opaque to the AIDS activists. Why should the partner or family of a person carrying a deadly unseen plague have to be told? It was ‘outrageous’, said NAPWA’s Peter Busse. It was ‘reinforcing oppression of women and undermining everything AIDS activists are trying to do’, said Heywood. In the event, Dlamini-Zuma decided not to push it.

Achmat and fellow NAPWA-TAC members met Dlamini-Zuma to discuss their demands on 30 April, after which a joint statement was released agreeing that reasonably priced AIDS drugs were a human right, and that the Minister would stipulate an affordable price for AZT to give pregnant women for the ‘prevention of mother-to-child transmission’. ‘If you want to fight for affordable treatment, then I will be with you all the way,’ she added. But it was not only AZT that Achmat was after; ‘pressure on’ formula milk producers ‘such as Nestlé’ to provide it cheaply was to be a key objective too. So on top of this profoundly toxic drug, Achmat wanted doctors pushing Nestlé factory milk on African mothers too. For a replay of the criminal Third World milk powder catastrophe. Jesus wept. Even Coovadia dimly remembered it, commenting later: ‘Formula food is a killer. It doesn’t provide babies with the protection against disease that breastmilk does. If it’s mixed with contaminated water, babies can die of diarrhoea or pneumonia. … I believe government is being badly informed by poor science. It shouldn’t be providing the formula.’ The WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality agreed, reporting in Lancet in February 2000 that giving formula milk to babies in ‘less developed countries’ trebled to quadrupled their death rate. Achmat hadn’t heard.

The next meeting with Achmat and his group was on 29 September – exactly a month before Mbeki’s stunning about-turn on AZT in Parliament. By now, though, lots had changed. Disagreement within NAPWA over Achmat’s demand that his drugs project be prioritised led him to walk out and set up the TAC as an independent group. Mbeki had succeeded Mandela as President, and soon condoms, which Mbeki thought the answer, because the experts said so, were everywhere: according to an article by Myer et al. in AIDS (15(6):789-793) in April 2001, no less than 198 million of them were distributed that year, up from six million in 1994. Free dispensaries were set up in government buildings and in every hallway and public loo in the Union Buildings in Pretoria – and, to set a good example, even in Mbeki’s official residence, Tuinhuys, in Cape Town. Mbeki replaced Dlamini-Zuma with AIDS go-getter Tshabalala-Msimang as his Health Minister, moving the former up to Foreign Affairs. From the feedback Achmat would have got from AIDS Consortium director Morna Cornell, then also a TAC executive member, he had every reason to be optimistic about his prospects of pushing his TAC drug agenda past the eager new Minister. Cornell had commented that ‘recent meetings with Tshabalala-Msimang have shown that the department’s top priority is women and children, so I would think they would regard this as a really key issue. I just hope that we can now quickly see if this is applicable here. It certainly does seem to represent an unbelievable opportunity for our country to save lives.’ With AZT. Unbelievable.

But at the September meeting, also attended by her special advisor Roberts, Health Director General Ntsaluba, and a stand-in for HIV/AIDS and STD Directorate director Nono Similela, Tshabalala-Msimang was much less enthusiastic about giving pregnant women AIDS drugs than the TAC had expected. She expressed concern about the cost of providing AZT to expectant mothers, and about the safety and efficacy of nevirapine as an alternative, a drug that had just hit news. According to a TAC report on the meeting, ‘The Minister stated her awareness of TAC activities and welcomed a partnership with us on the issues of health care costs.’ Asked to ‘outline a practical programme on implementing prevention programmes on MTCT’, Tshabalala-Msimang responded cagily that the government was ‘committed to implementing the programme’ (to quote the report). But first, she said, the government has ‘agreed that the pilot programme should go ahead and that it should examine the efficacy of AZT and nevirapine’.

Nonetheless, despite this annoying talk of pilot programmes for pregnant women, instead of a general rollout that Achmat wanted, things remained sweet between Tshabalala-Msimang and his TAC. She wrote after the meeting:

I thank you very much for a very productive meeting on a number of indeed very emotional and sensitive areas in our work. Once more I want to assure you of our total commitment to a comprehensive rational response to the HIV/AIDS epidemic. In this context we will spare no effort in strengthening partnerships against HIV/AIDS. I am therefore happy that we could identify areas of cooperation and I hope we can develop a concrete plan in enhancing this working partnership and relationship. Once more, thank you very much for a constructive meeting. We will indeed follow up the recommendations that emanated from the meeting.

Within a couple of weeks, however, after reading Debating AZT, Mbeki and Tshabalala-Msimang would unequivocally reject the drug, and from then on it would be open hostilities and permanent war, with the TAC’s unending attacks on the government’s policy positions, and on the President and the Health Minister personally, unbroken by any Christmas armistices.

Mbeki spent November and December 1999 reading. And reading. Joel Netshitenzhe, director of government communications, confirmed that he had ‘read much literature on the issue of AIDS, including the literature of those who might not hold the conventional view. And the question he has posed from time to time is whether there has been sufficient interrogation of the issue. He merely says, “Instead of believing, be sure you have established the facts.” And I thought that would be a measure of a good President.’

He wasn’t the only one doing a big rethink about received wisdom on AIDS, and the articles of belief founding it – that Africa’s health problems originated from a virus (emerged from African jungles) to which Africans were especially susceptible, due to their exceptional fecundity; that the unseen infection could be determined with Western blood tests; and that only Western drugs could treat it. On 2 December Tshabalala-Msimang had a ninety-minute meeting with Geshekter, who convinced her that the new story of a sexually transmitted virus being to blame for the broken health of the poor in Africa wasn’t kosher, and that in reality there was nothing new happening: ‘a variety of old sicknesses have been reclassified’ as AIDS, and not only were the drugs very bad, the tests were useless too. Geshekter later described her as

thoroughly professional, calm, knowledgeable [and] well informed … She asked me basic questions. I tried to give basic answers. Anything I said I tried to back up with references or documentation. I wasn’t able on such short notice to bring a library full of material but I did my best. … We talked about the pharmaceutical issue about AZT and Glaxo-Wellcome. We talked about this ‘African sexual culture’ business, the definition of an AIDS case, difficulties with the ELISA test, the way the Western Blot gets read differently depending on which lab, on which continent and which technician is doing the reading. I was impressed by her. She was a model of professionalism, care, scrutiny and calm in the face of this gathering storm.

As the candle in Mbeki’s study burned low, the shimmering AIDS bubble – until then the very public object of his particular fascination – burst in front of him. He told his HIV/AIDS sceptic friend Sam Mhlongo, Head of Department and Professor of Primary Health Care and Family Medicine at Medical University of Southern Africa in Pretoria, who had also spent many years in English exile, that he rued having been so gullible in having uncritically believed all that the ‘AIDS experts’ had told him. Half a year earlier, at his inauguration as President on 16 June 1999, he’d been firm in the faith, piously sporting an AIDS ribbon for all the world to see and warning in his speech: ‘There can be no moment of relaxation while the number of those affected by HIV/AIDS continue to expand at an alarming pace.’ (Mandela, in contrast, wore no ribbon at the ceremony, and had nothing to say about AIDS.) In his address at the opening of Parliament nine days later Mbeki continued:

The government will also review all the work done so far to confront the scourge of HIV/AIDS with a view to the intensification of all efforts relating to this epidemic. Of critical importance will be that we take all necessary steps to ensure that the partnerships against HIV/AIDS that have been formed and the public educations we have been conducting do actually result in changing behaviour patterns, improve support to AIDS victims and orphans and speed up steps towards the development of a vaccine.

And four months later when he’d raised the toxicity of AZT in Parliament at the end of October, Mbeki was still talking the believer’s talk, was still full of holy fire, warning again that ‘we are confronted with the scourge of HIV/AIDS against which we must leave no stone unturned to save ourselves from the catastrophe which this disease poses’. Mbeki’s boilerplate statement on World AIDS Day, 1 December, evidently written well in advance, was a classic recitation of every cliché, every Western meme collectively making up the fearsome mythology of AIDS in Africa. It was a speech of which Achmat, Cameron and the whole gang of AIDS camp followers would have been proud:

People of South Africa, today we mark World AIDS Day. As South Africans, we participate in the World AIDS Day events as part of our ongoing support for the Partnership Against AIDS campaign. On this day, we must all join hands as people of South Africa and of the world against a silent killer that threatens our lives and the very fabric of our existence. On this day, we must use this opportunity to make our family, our friends, our neighbours and our fellow South Africans conscious of the dangers that HIV/AIDS poses to every single person in our country and to the health and future of our entire nation. We must urge all our youth to protect themselves at an early age and their loved ones against this disease by abstaining from sexual activity as much as possible by being faithful to their partners or by always using a condom if they are sexually active. To the youth of our country, we ask you, who are most vulnerable to this disease, to think about your future and the future of our children, before you become involved in a sexual relationship. To the men of our country, we ask you to use a condom if you engage in a sexual relationship which has the potential of exposing you, your partner or your wife to the danger of HIV/AIDS, for using a condom is a sign of respect to your partner, not a sign of mistrust. Together let us urge everyone in our nation to take responsibility for their own lives into their own hands in order to ensure that this killer disease is eradicated from our society. Every day we are burying more young people than ever before who have died because of AIDS. Every day a child suffers and has to learn to fend for him or herself when a parent dies as a result of this disease. Every day, when someone, who is infected, dies, we lose a lifetime of skills and experiences; we suffer a blow to our economy that we have only just begun to rebuild. I believe, therefore, that it is important for all of us to educate each other about the danger that HIV/AIDS poses to the socio-economic situation in our country. HIV/AIDS threatens to undermine our efforts to grow our economy and build a better life for all our people. It kills those on whom our society relies to provide income through agriculture, through mining, in the factories, those who run our schools and our hospitals, those who govern our towns and provinces. It worsens the poverty pervasive in our society when parents who are breadwinners die. People of our country, Every day, more people die as a result of AIDS in sub-Saharan Africa than anywhere else in the world. Thus, as we enter the next century, the challenge of HIV/AIDS is still with us and it is the task of our present generation of Africans to meet this challenge, by focusing on ways of preventing the spread of this disease and by providing care to those who are infected. There can be no talk of an African renaissance, if AIDS is at the door of our continent. We must recognise that the scourge of HIV/AIDS cannot be dealt with by one country alone. It requires a collective global effort. The challenge is to seek ways to minimise its effects, to prepare for its impact and to co-operate in the finding of long-term solutions. When the history of our time is written, let it record the collective efforts of our societies responding to a threat that put the future of entire nations in the balance. Let future generations judge us on the adequacy of our response. To overcome the challenge that this disease poses, every one of us must play an active part. If you are a member of a church or non-governmental organisation or a school that does not as yet have an HIV/AIDS programme, see to it that you come together to draw up such a programme. We must continue to break the silence and talk about this disease with openness. Those among us, who are infected, must be encouraged to tell others about their experiences. This will help to discourage the discrimination which they have at institutions and places of work. Rejection of those who are suffering is not acceptable; and we as a nation must offer all the support we can to people living with HIV/AIDS. People of South Africa, as we join hands in a Partnership Against AIDS, we must believe in our capacity to succeed in our struggle to stop the spread of this disease. We must build the Partnership Against AIDS so that it unites every community in our country into a dynamic force for changing people’s mindsets and behaviours. Government welcomes the initiatives that are being taken by the business community and the entire private sector, women’s groups, youth and student groups, the religious community, sporting organisations and the many non-governmental organisations to strengthen this partnership. As we join hands today, let us create a truly caring and humane partnership for health and prosperity for this will strengthen our efforts in shaping the next century as our African century. I thank you.

The first inkling of a shift in Mbeki’s perspective – from too much sex as the cause of AIDS, to too little good food – was apparent from a comment made during an interview by CNN a month later, on 3 January 2000. Addressing Africa’s crippling debt burden – repayment of which was consuming a quarter of its exports – he pressed: ‘Ways and means must be found to wipe out this debt as quickly as possible.’ The debt issue was closely linked to the AIDS pandemic, he said, and any programme to deal with it ‘has to be part of this integrated response to the challenge of poverty on the African continent’.

But as Mbeki’s faith was lapsing, the US was dangerously escalating the holy war: using his rotation as president of the UN Security Council in January, US ambassador Richard Holbrooke first declared ‘a month on Africa’, and then made AIDS the subject of the first Security Council meeting of the year, inviting US Vice President Al Gore to address it: ‘I came up with the idea that we should hold a special session of the Security Council on HIV/AIDS. I was told by everyone, including my own staff, “You can’t do this. It’s not done. It’s not in the U.N. charter.” And I said, “But AIDS is a security issue because it’s destroying the security, the stability of countries.”

Gore’s opening statement on 10 January went:

I call to order this first meeting of the United Nations Security Council in the 21st Century. … Today marks the first time, after more than 4,000 meetings stretching back more than half a century, that the Security Council will discuss a health issue as a security threat. We tend to think of a threat to security in terms of war and peace. Yet no one can doubt that the havoc wreaked and the toll exacted by HIV/AIDS do threaten our security. The heart of the security agenda is protecting lives – and we now know that the number of people who will die of AIDS in the first decade of the 21st Century will rival the number that died in all the wars in all the decades of the 20th Century. When 10 people in sub-Saharan Africa are infected every minute; when 11 million children have already become orphans, and many must be raised by other children; when a single disease threatens everything from economic strength to peacekeeping – we clearly face a security threat of the greatest magnitude. This historic session not only recognizes the real and present danger to world security posed by the AIDS pandemic – which I will discuss in further detail during my remarks as head of the US delegation – this meeting also begins a month-long focus by this Council on the special challenges confronting the continent of Africa.

And so on. Kofi Annan agreed: because AIDS was wiping out Africa’s civil servants, police and soldiers,

In already unstable societies, this cocktail of disasters is a sure recipe for more conflict. And conflict in turn provides fertile ground for further infections. The breakdown of health and education services, the obstruction of humanitarian assistance, the displacement of whole populations and a high infection rate among soldiers – as in other groups which move back and forth across the continent: all these ensure that the epidemic spreads ever further and faster.

When it was his turn to talk again, delivering ‘his remarks as head of the US delegation’, Gore contrived to whip the nigger back into line by commencing to quote Mbeki from back in the days when he was still a believer:

Mr Secretary General, Members of the Security Council, Distinguished Guests, and, in particular, Honored Delegates from the Nations of Africa: “HIV/AIDS is not someone else’s problem. It is my problem. It is your problem. By allowing it to spread, we face the danger that our youth will not reach adulthood. Their education will be wasted. The economy will shrink. There will be a large number of sick people whom the health will not be able to maintain.” Mr Secretary and Members of the Council: These are not my words. They were not uttered in the United States or the United Nations. They were spoken by my friend, President Thabo Mbeki of South Africa, as he declared South Africa’s Partnership Against AIDS more than a year ago. The same words should be spoken out not only in South Africa, not only in Africa, but all across the earth. In Africa, the scale of the crisis may be greater, the infrastructure weaker, and the people poorer, but the threat is real for every people and every nation, everywhere on earth. No border can keep AIDS out; it cuts across all the lines that divide us. We owe ourselves and each other the utmost commitment to act against AIDS on a global scale – and especially where the scourge is greatest.

AIDS is a global aggressor that must be defeated. As we enter the new millennium, Africa has crossed the first frontiers of momentous progress. Over the past decade, a rising wave of African nations has moved from dictatorship to democracy, embraced economic reform, opened markets, privatized enterprises, and stabilized currencies. More than half the nations of Africa now elect their own leaders – nearly four times the number ten years ago – and economic growth in sub-Saharan Africa has tripled, creating prospects for a higher quality of life across the continent. Tragically, this progress is imperiled, just as it is taking hold, by the spread of AIDS which now grips 20 million Africans. Fourteen million have already died – one quarter of them children. Each day in Africa, 11 000 more men, women, and children become HIV positive – more than half of them under the age of 25. For the nations of sub-Saharan Africa, AIDS is not just a humanitarian crisis. It is a security crisis – because it threatens not just individual citizens, but the very institutions that define and defend the character of a society.

This disease weakens workforces and saps economic strength. AIDS strikes at teachers, and denies education to their students. It strikes at the military, and subverts the forces of order and peacekeeping. The United States is profoundly moved by the toll AIDS takes in Africa. At the same time, we know that our own country has not achieved as much as we should or must in our own battle against AIDS. I am pleased that our Surgeon General is here today; his recent report tells us that we have not overcome the ignorance and indifference that lead to infection. We must continue to study the success of others, while we seek to share our progress with them. …Until we end the stigma of AIDS, we will never end the disease of AIDS. We also must do much more to provide basic care and treatment to the growing number of people who, thank God, are living, instead of dying, with HIV and AIDS. This requires affordable medicine, but also more than medicine; it requires that we train doctors, nurses, and home-care workers, that we develop clinics and community-based organizations to deliver care to those who need it. Today, fewer than 5 percent of those living with AIDS in Africa have access to even basic care. We know we can prolong life, reduce suffering, and allow mothers with AIDS to live longer with their children, if we offer treatment for opportunistic infections like tuberculosis and malaria. … Last year, I announced the largest-ever increase in the US commitment to international AIDS programs – $100 million to fight AIDS in Africa, India, and other areas. Today, I announce America’s decision to step up the battle. The budget the Clinton-Gore Administration will send to our Congress next month will include an additional increase of $100 million for a total of $325 million to fund our worldwide fight against AIDS. … Next July, the global community will gather in Durban, South Africa, for the 13th International AIDS Conference. … We will work with the organizers of the Durban Conference to advance this essential objective. It is essential, because how we speed the money, and how effectively we target it, not just how much we spend, will determine how many lives we save. AIDS is one of the most devastating threats ever to confront the world community. Many have called the battle against it a sacred crusade. The United Nations was created to stop wars. Now, we must wage an win a great and peaceful war of our time – the war against AIDS.

And on he spoke. Holbrooke explained after the meeting that what the US had in mind was that countries should ‘begin to redefine security as broader in the post-Cold War era than it used to be’. Which is exactly what happened three months later when Mbeki provoked a concrete response along these lines, by sending Clinton a threatening dissident manifesto in a diplomatic pouch – but we’re still coming to that.

UNAIDS executive director Peter Piot subsequently sized up international political reaction: ‘It was the first time that the Security Council debated on something that was not, let’s say, war and peace. … That was a breakthrough because it opened so many doors, and presidents, prime ministers say, “Oh, it was debated in the Security Council, this must be a serious problem,” which was ridiculous, but I literally got that kind of reaction.’

Mbeki’s next move was to prepare dossiers containing the leading scientific critiques of the HIV theory of AIDS, and the use of AZT to treat it, and to forward them in early January to four prominent South African scientists for comment. None, however, demonstrated the brains or the integrity to make a public break with their church and support him. What the storm over AZT had illuminated for Mbeki, and the stupid responses of the scientists that he’d approached, was how ignorant and lazy the featherbedded South African AIDS establishment was, and how incapable it had proved itself to be of thinking critically. Mbeki’s new disdain for it was made unmistakeably plain by his appointment, in December, of the South African National AIDS Council, comprising thirty-one members, including twelve Ministers, with the rest made up of private sector representatives involved in some way or another in AIDS. At its launch in mid-January 2000 SANAC’s chairperson Deputy President Jacob Zuma explained its composition: ‘Individuals, communities, national government and international organisations each have a key role to play.’ But not one of South Africa’s established ‘AIDS experts’ and activists was invited aboard to play it. Laurice Taitz complained in the Sunday Times on 23 January that

the AIDS Consortium – a network of 220 NGOs – was not invited to the launch, nor was it made aware of the appointed members. Not only is there a glaring absence of scientific and academic knowledge on the panel, but there are also no AIDS activists who have ever challenged the government on its AIDS policies. The Medical Research Council, the Medicines Control Council, pharmaceutical companies, doctors and specialists working with HIV/AIDS and leaders of community projects are also nowhere to be seen.

The Mail &Guardian reported an Uproar over Aids Council on the 28th, ‘the backdrop’ to which was the

long-running conflict between Aids experts and the government, fuelled recently by the government’s controversial rejection of the anti-retroviral drug AZT despite significant evidence that it is effective in preventing the transmission of the HIV virus in pregnant women to their unborn fetuses. The rubbishing of AZT has been spearheaded by President Thabo Mbeki on the basis of subsequently questioned research discrediting the drug and highlighting its toxicity.

Unlike the Partnership Against AIDS, SANAC was launched unceremoniously – in a small basement room below the Union Buildings, attended by only a few of the appointees, a handful of government officials and some journalists. Significantly, none of the five technical task teams appointed to assist SANAC in the formulation of policy recommendations were briefed to advise it concerning the use of antiretroviral drugs. The modest launch was in keeping with the perfunctory do held to mark the first anniversary of the Partnership Against AIDS on 9 October 1999, with the birthday bash taking the meagre form of a press conference in altogether less salubrious surroundings than the one in which Mbeki had launched it – a cramped studio in the South African Broadcasting Corporation’s Johannesburg HQ. With better things to do, and real national challenges to address, Mbeki appears to have grown tired of listening to his partners’ yakking and turned the show over to his deputy Zuma.

As the scientific foundations of the HIV/AIDS model crumbled the closer he examined them, Mbeki saw the African AIDS paradigm for what it was: a business with a scarcely believable gaping hole in its middle, driven ideologically by a reclothed body of very ugly and very ancient white assumptions and beliefs about Africans. This appreciation aroused an imperative that he’d articulated with remarkable prescience in his African Renaissance Statement made at Gallagher Estate in Midrand on 13 August 1998 and broadcast in part on national television: Africa ‘can and must be its own liberator from the condition which seeks to describe our continent and our people as the poverty-stricken and disease-ridden primitives in a world riding the crest of a wave of progress and human upliftment’.

The apocalyptic vision of Africa presented by the AIDS construct, which was being pressed with a disconcertingly familiar missionary vim, was fundamentally antithetical to Mbeki’s own vision for social and ideological transformation in the country. And if fellowship was Africa’s paramount value, here was a new imported system of beliefs to putrefy it – isolating, terrifying, alienating, mortifying. Who better then to share his ideological and scientific insights with than William Makgoba, then president of the Medical Research Council? A regular guest at Mbeki’s home, Makgoba was the editor of African Renaissance (Mafube, 1999), a compendium of optimistic essays for which he, Mbeki, had just written the foreword. Here, Mbeki assumed, was an African scientist with the same vision for Africans who’d finally recovered command of their own destiny after centuries of Western colonial servitude and political and psychological oppression.

Poring over his scientific papers in the small hours one morning in early January 2000, and staggered by the enormity of what he was on to, Mbeki gave Makgoba a ring. It was to be a most disappointing conversation. An article in New York Times on 8 July, Dissent on Aids by South Africa’s President: Thoughtfulness or Folly, in which Mbeki’s midnight call to Makgoba was reported, provides an idea of the lines along which their midnight exchange went: ‘Prominent doctors accused Mr. Mbeki of dabbling in pseudo-science while people were dying.’ This was Makgoba’s standard label for any criticism of AIDS orthodoxy, which, he told Mbeki, was ‘not worth exploring’. As it quickly became apparent to Mbeki that he was talking to a scientific moron, he said cheerio, and let Makgoba return to his dreams. But from then on, it was bitter mutual contempt across an unbridgeable rift. Mbeki kept his new opinion of Makgoba to himself, but Makgoba was less circumspect, telling Science reporter Jon Cohen in June: ‘When politicians want to really interrupt science in a manner that distorts it, I can only think of the history of Nazism. Every time this has happened, it’s preluded disaster, regimes have collapsed, and people have died.’ Makgoba confirmed to Cohen in April that Mbeki had sent him about fifteen hundred pages of scientific papers critiquing the HIV-CD4 cell-AIDS model. ‘It’s pure rubbish,’ he said. ‘They never provided any data and, at the same time, they are taking things out of context.’ He said he’d told Mbeki this in a letter offering counter-arguments in favour of the orthodox viral model of AIDS. He should stop this nonsense, he’d advised: ‘His credibility as an African leader may suffer from this.’

On emerging from a meeting in the second week of January, Californian pharmaceutical biochemist David Rasnick received an astonishing message: someone from the office of the South African President had just phoned to say that Mbeki wanted to speak to him. ‘I didn’t believe it at first,’ he told the Chicago Tribune. ‘I didn’t know Presidents just called out of the blue like that.’ Rasnick was president at the time of an international association of scientists, clinicians and other concerned people, whose object was told in their name: the Group for the Reappraisal of HIV/AIDS Hypothesis. Following a second missed call, Mbeki’s office sent Rasnick a telefax on the 19th, posing some basic questions about the HIV/AIDS model in South Africa:

What means and methods are used in the Public Health system to test the ‘HIV status’ of individuals? What definition is used, again in the Public Health system, to classify a person as being afflicted with AIDS? Of the people determined to have died of AIDS, what ‘opportunistic disease’ was identified as having been the immediate cause of death? Has any research been done on the health profiles on the population where allegedly it has been found that there are large numbers of ‘HIV positive people’ (e.g. in KZN)? Has any research been done on ‘HIV positive’ infants, children and orphans with regard to their health profiles, and those of their mothers’ families? On what do we base statistics we publish occasionally on the incidence of HIV and AIDS, and how do we arrive at the projection?

It was apparent from the way the questions were framed was that Mbeki knew the answers already: HIV antibody tests were completely useless; AIDS as a medical diagnostic construct was all but meaningless; AIDS was just a range of ancient diseases renamed; in Africa AIDS was the lot of the poor; and the statistics were junk. And, of course, the broken health of Africans had nothing to do with loving too much.

Two days later, at a time pre-arranged with one of Mbeki’s aides, Rasnick’s cell-phone rang. ‘A voice came on the line and said it was Thabo Mbeki,’ Rasnick told the Tribune. Mbeki quizzed him for about fifteen minutes concerning his collaboration with Duesberg in his biology laboratory at UC Berkeley. ‘He was checking me out, seeing if I was legitimate. I suppose I passed his test, because he asked me for my personal support for his anti-AIDS efforts and I gave it to him.’ Rasnick related further to the New York Times:

He wanted our views, and we gave them to him. He had read everything we had written, everything that was available on the Internet. He knows there are some serious questions out there. I think he’s courageous. You start looking like a lunatic if you question the AIDS axioms. Knowing this in advance, he put his neck out there anyway. He wants to have a free and public hearing about all things related to AIDS.

He wanted US President Bill Clinton, UK Prime Minister Tony Blair and German Chancellor Gerhard Schroeder joining in too, he told Rasnick, who told Now magazine in Toronto in turn on 9 March, adding: ‘Mbeki has a good sense of humour and a quick laugh. He’s read extensively. He asked me if I would personally support his efforts in all this stuff that has to do with AZT and AIDS. … South Africa may be the place where this whole craziness comes to an end. It’s no messier than bringing down apartheid peacefully. I can’t think of a better-positioned person, as a head of state, in the entire world.’

Rasnick’s reply to Mbeki’s questionnaire, drawn in collaboration with Geshekter, summarised some problems with the HIV/AIDS hypothesis, but was rather hammed – wrong in parts and missing the big issues. All pointed out thereafter in a clarifying memorandum sent to Mbeki in mid-March, drawn by an obscure bio-physicist, of whom hardly anyone had ever heard, other than readers of rarified, specialist scientific and medical journals: Eleni Papadopulos-Eleopulos.

Along with a group of collaborating scientists – chiefly consultant emergency physician Valendar Turner, her fellow senior medical physicists Barry Page and David Causer, pathology professor John Papadimitriou and visiting Colombian research biologist Helman Alfonso – her Perth Group (since expanded, with the writer sometimes aboard) had been posing radical challenges to Robert Gallo’s retroviral theory of AIDS in various specialist journals from the beginning – frequently after a summary bouncing first by the scientific oafs at the door of Nature. Because please. You can’t talk this way. You’d make us look ridiculous. We’d have to eat humble pie. Be reasonable. You’re asking too much. As you chip away, speaking politely always, keeping your voice down, with none of the temper of the orthodoxy’s defenders. We can’t fault a cool word of what you write, but you’re just much too hot for us.

Strikingly diminutive in shoes, but mammoth in print, Papadopulos-Eleopulos had jumped ship from nuclear physics to biology after being hired in the seventies by the Department of Medical Physics at the Royal Perth Hospital in Australia to calibrate its radiotherapy gear. She proceeded to teach herself molecular biology from scratch, not from the textbooks but from original papers – her vast collection of which dates back to the beginning of the 20th century. (We speak of mountainous stack after stack; I have a snapshot.) By the end of the decade the autodidact in biophysics had conceived and experimentally demonstrated an epochal new model of cellular functioning: her theory that cells are primarily driven by cyclical oscillations of oxidation and reduction, governing cell processes as varied as the uptake of nutrients to locomotion and cellular division. Published in the Journal of Theoretical Biology in 1982 under the modest title, A Mitotic Theory, Papadopulos-Eleopulos’s redox model has since been adopted and propounded by none other than Luc Montagnier of the Pasteur Institute in Paris, supposedly the discoverer of HIV. This was way beyond the stuff of any PhD, but in any event Papadopulos-Eleopulos wasn’t bothered with claiming such conventional honours. In fact, in common with AIDS dissident Walter Gilbert, also a nuclear physicist, with a chair in molecular biology at Harvard and winner of the Nobel Prize for chemistry in 1980 for his invention of DNA sequencing technology, she holds no degree in biology at all. A point taken against her in her absence by Duesberg at a three-day dissident medical conference in Naples in early July 2003. To which Mhlongo retorted in her defence: ‘Be careful. Next they’ll be saying you’re not a doctor.’

The Perth Group’s missive straightening out Rasnick and Geshekter’s reply to Mbeki’s questions was sent to him privately, and was copied on to a select few AIDS dissident scientists and activists, so it didn’t reach the newspapers, but it highlighted a tension, right from the start of the South African AIDS controversy, as uneasy as the division between the Charterists and the Africanists in the ANC during the struggle, and it would surface again at the second meeting of Mbeki’s International AIDS Advisory Panel in July 2000. It has to do with the question: What do we actually mean by ‘HIV’ and ‘HIV-positive’? Infected by a virus as the ‘AIDS experts’ claim – but a harmless passenger as the American dissidents argue? Or something quite different, as the Australians contend? Rasnick was understandably put out by the Perth Group’s theft of his thunder. But from that point on, Mbeki only had eyes for Eleni. Courted in secret. Not even the other dissident scientists in the know. Right under their noses.

Mbeki liked Turner’s suggestion of a face-off between orthodox and dissident scientists, and in February he asked Tshabalala-Msimang to convene a bipartisan panel to look into ‘everything about AIDS’, from the drugs to ‘whether there’s this thing called AIDS, what it is, whether HIV leads to AIDS, whether there is something called HIV, for example. All these questions.’ It was evident from this that he was already onto the HIV isolation problem, the little-known black hole in the middle of the HIV theory of AIDS. On 28 February 2000 Tshabalala-Msimang’s special advisor Roberts formally announced on her behalf: ‘We are looking into the feasibility of getting an international expert panel to look into AIDS in Africa and the way forward. It will be internationally representative and made up of experts from the US, Europe and Africa.’ Deputy President Zuma explained on national radio that the panel would ‘look at these issues to get rid of misinterpretations and misrepresentations or differing opinions. If there are differing opinions they must be scientifically investigated so we can get at the truth.’ As Newsday reported it in the US on the 29th, under the title Added Foe in Aids War: Skeptics, its brief would be ‘to review evidence that HIV causes AIDS and allegations that the AIDS drug AZT is poisonous’ – given that ‘Dr. Peter Duesberg, a professor in the molecular biology department of the University of California at Berkeley, and his followers ... insist that HIV is a harmless virus and AIDS a nonexistent disease’ and ‘skeptics argue that AZT is a poison; AIDS, they insist, is actually caused by the drug used in its treatment. South African skeptic Anthony Brink of Pietermaritzburg, an attorney, insisted that “no one has ever been cured by AZT, but it sells like hotcakes all the same ... and it reaps profits counted in billions.”’

The Church of AIDS filled the newspapers with cries of protest and derision. The convention of the expert panel was ‘a justification for the immoral, unscientific and unlawful decision to withhold AZT or nevirapine from pregnant women’, accused the TAC. Nonsense, responded Tshabalala-Msimang on 2 March: ‘I hope that the work of the panel will demonstrate that we have no hidden agendas.’ The purpose of convening the panel was ‘to explore all aspects of the challenge of developing prevention and treatment strategies [for AIDS] that are appropriate to the African reality’. Who would be on the panel, she didn’t say: ‘My department is talking to a wide range of specialists to see who is willing and available to participate.’ She ducked answering whether Duesberg would be part of it: ‘My personal view is that those with more extreme views are unlikely to participate because we are looking for a consensus view.’ But she was open to suggestions as to who should be invited, she said. After debating their views at their meeting and thereafter on the Internet for a couple of months, the government wanted the panellists to ‘thrash out a consensus recommendation to the department’, she said. Challenged on the government’s decision not to supply antiretroviral drugs to pregnant women, she defended it saying it was taken ‘in the light of the best available evidence and the special social and economic circumstances in our country. I still think it’s the right decision.’

In a letter dated 2 March, addressed to fellow dissident scientists but which fell into the media’s hands, Rasnick revealed Mbeki’s call to him and what had been discussed between them:

Dear everyone, I am now free to divulge this information. Wednesday, January 19, 2000, Jacques Human in South African President Thabo Mbeki’s office faxed me 8 questions that the President sent to Health Minister Manto Tshabalala-Msimang. Mbeki wanted me to respond to the questions and answers. I asked Professor Charles Geshekter, PhD, to join me in responding to those questions. We sent our response to Mbeki’s office Thursday, January 20. Friday, January 21, I talked with President Mbeki for perhaps 10 min on the phone. The President and I had a very nice conversation. He asked me if I would support his efforts regarding AZT and AIDS. I made a personal commitment to support Mbeki and I also committed Rethinking AIDS: the Group for the Scientific Reappraisal, and I committed the International Coalition for Medical Justice (ICMJ) to support his efforts. Mbeki is good friends with Clinton, the Prime Minister of England, and the German Chancellor. He told me that he is going to write these heads of state and ask them to join his efforts to bring about an international discussion on AIDS and the anti-HIV therapies sometime in the spring, well before the International AIDS Conference in July. Mbeki wants to provide a public forum where the leading proponents of the HIV hypothesis and its leading critics can present the evidence for and against the following popular beliefs: 1. AIDS is contagious. 2. AIDS is sexually transmitted. 3. HIV causes AIDS. 4. The anti-HIV drugs promote life and health. (Below is what Charlie Geshekter and I sent to President Mbeki’s office.) [etc.]

Roberts’s announcement of Mbeki’s AIDS Panel plans and Rasnick’s disclosure about Mbeki’s communication with him whipped up a conflagration hotter than Hades. Tshabalala-Msimang attended and spoke at a gala dinner convened by NAPWA on 9 March, in the middle of a three-day ‘Break the Silence!’ conference ‘organised under the auspices of the Durban 2000 Conference’, which is to say paid for the pharmaceutical industry. The TAC and other groups attended too. Throughout the event Tshabalala-Msimang was harassed by about thirty demonstrators waving placards demanding ‘AZT/Nevirapine’ for pregnant mothers, and during her speech was constantly booed from the floor. Reporting the event afterwards, Achmat complained: ‘She angered almost every person by refusing to take questions and to stay for dinner.’ Was anyone really surprised? When it was his turn to speak Cameron pontificated: ‘It simply does not seem that the government can get it right on AIDS. … There are too many lives, too much happiness, too much human prosperity at stake for flirtation with dangerous and wayward theories.’ Too much happiness? Human prosperity? His? Being on to a good thing. As an AIDS superstar – pocketing $10 000 in December that year on receiving the Kaiser Family Foundation-sponsored Nelson Mandela Award for Health and Human Rights. And a ticket to a seat on the Supreme Court of Appeal.

The day after Rasnick’s disclosure of Mbeki’s contact with him, spokesman Parks Mankahlana declined to confirm it: ‘The President would be disappointed if people he has spoken to would want to use the contact with him to justify whatever view they may hold.’ Rasnick explained later, just as the first line of his letter indicated, that he’d understood there to be no objection to his mentioning that Mbeki had conferred with him; but a statement by KwaZulu-Natal Health MEC and ANC NEC member Zweli Mhkize, formally released by the Government Communication and Information Service on 13 April, appeared to convey Mbeki’s distinct displeasure: ‘It was indeed a privilege for Mr David Rasnick to discuss with the President of South Africa. But for him to publicise such a private discussion is the most discourteous abuse of a rare privilege, it is most distasteful and unacceptable.’ Whether Mbeki actually saw Mkhize’s statement, and gave it the nod before it was issued, is doubtful from Mkhize’s ignorant assertion, typical of uncritical medical thinking and out of line with Mbeki’s own view, that the toxicity of AZT ‘was another matter that has been misinterpreted’, since ‘few drugs have no side effects’. Cost, he said, not toxicity, was the issue. His maybe, but certainly not Mbeki’s.

Roberts remarked on the furious reaction to the announcement of the AIDS Panel in a post on the internet forum AF-AIDS a month later:

If the panel had met and reached preposterous conclusions then I would understand a negative reaction. But why now? Why is it considered impossible that the panel may come up with suggestions that will be helpful in the battle against AIDS in Africa? Rather than rejection and speculation would it not be better to work to get a useful result from this panel? I say this as I believe that I too would have concerns if I believed all the speculation that I have read in the South African press. … Responding from my personal perspective, the press in South Africa has, in the main, inaccurately represented my views on the question of AIDS in Africa and attributed to me some absurd positions. So it is possible that equally ludicrous positions may also have been attributed unfairly to others. Some of these ridiculous reports in the press have been used critically against me, for example, by Judge Cameron and others without validating the truth of any of these statements with me. I know that it is always easier to speculate and attribute a position and then attack it, but how this benefits the battle against AIDS eludes me.

You misunderstand, Ian. If you got into this thinking it was about science. Least of all in the florid imaginings of Edwin Cameron. Who gets so angry when you hint, as Mbeki does, that the miniature demons possessing him are all in his head. And then scowling like hanging Judge Danforth in Arthur Miller’s dramatization of the Salem witchcraft delusion, The Crucible: ‘You must understand, sir, a person is either with this court or he must be counted against it, there be no road between.’

Cameron responded to the announcements with a direct approach to Mbeki: he wrote him a letter asking him in letter not to flirt with ‘dangerous and wayward theories’ anymore (he likes that phrase) and begging him to please provide AZT to HIV-positive pregnant women; it’s the right thing to do. He packed his epistle with a moral and medical punch from the heavyweight division, with cosignatories Anglican Archbishop Njongonkulu Ndungane and Methodist Church primate Bishop Mvume Dandala speaking for God, and University of Natal Professor of HIV/AIDS Research Hoosen Jerry Coovadia for the AIDS doctors. A phalanx of eminences from both the ecclesiastical and temporal worlds. But Mbeki was unmoved. On 15 March Cameron was sitting in his chambers tinkling on his next coruscant oration when his fax machine buzzed out a sixteen-page reply. Citing a slew of studies on AZT’s foetal toxicity that I’d collated in Debating AZT, Mbeki declined Cameron’s entreaty with a pointed rebuff, reciting his dull buzzwords repeatedly in volley of delicious sarcasms:

I am taken aback by the determination of many people in our country to sacrifice all intellectual integrity to act as salespersons of the product of one pharmaceutical company [AZT manufacturer GlaxoSmithKline.] … I am also amazed at how many people, who claim to be scientists, are determined that scientific discourse and inquiry should cease, because ‘most of the world’ is of one mind … The debate we need is not with me, who is not a scientist, or my office, but the scientists who present ‘scientific’ arguments contrary to the ‘scientific’ view expressed by ‘most of the world’ … By resort to the use of the modern magic wand at the disposal of modern propaganda machines, an entire regiment of eminent ‘dissident’ scientists is wiped out from the public view, leaving a solitary Peter Duesberg alone on the battlefield, insanely tilting at the windmills. … It is clear from your letter that you believe that we should ignore or merely note these findings [the recent AZT foetal toxicity reports] because of the current ‘consensus amongst responsible and authoritative scientific leaders’ as well as ‘the available evidence’. Undoubtedly, such ‘consensus’ and ‘available evidence’ also existed on the use of thalidomide … Faced with the findings indicated in this letter, I am afraid that my own conscience would not allow that I respond only to the ‘consensus’ with which you are in agreement.’ Mbeki concluded with a reference to his decision to form an international expert panel ‘to discuss all HIV/AIDS matters that are in dispute’, and expressed the hope that ‘you will agree with me that such a meeting should be inclusive of all scientific views and not only those representative of the ‘consensus’ to which you refer. I fully recognise that I have much to learn and must be ready to admit and correct whatever mistakes I might make as a result of not heeding the advice that ‘a little learning is a dangerous thing’.

Cameron received Mbeki’s answer as a slap in the face. His ‘heart sank’, he said. The lapsed disciple forsaking the prophet. Peter denying Jesus. (The allusion is not extravagant; the judge, we’re still to read in wonder, suffers under the delusion that his true métier is to be a seer in all this.) Whereas he’d captured Mbeki’s imagination with his sex plague fantasy at their meeting in February 1996, and had him spell-bound for the next four years, it was clear from the letter that Mbeki now scorned him for his missionary sermons to the natives, expounding their imminent doom if they didn’t quit screwing around so much, as was their special wont. What gave Mbeki’s reply its special sting was the fact that not only did it show up Cameron’s Holy Eucharist as cheap rotgut, it was outing Cameron as an ignorant dupe, in line after referenced line – chapter and verse, page after page. The shoe was now on the other foot. Mbeki was tutoring the naïf, not in pipedreams, not in anodyne human rights waffle like Cameron’s National Charter for People living with HIV and AIDS, but in the brutal and most unpleasant facts. About the horrendously noxious chemical. For Cameron it was all too much. Having to think deeply. Revisit his certainties. Make a public U-turn. He read the letter trembling ‘with a sense of fear and dismay’. With the shame and humiliation. Of the outing. His burning faith oppugned. With fact and reason. He resolved to take his revenge, and he would do so over the years to come at every opportunity with the kind of cold, unflinching resolution for which offended women are classically famous – in gales of obloquy, badmouthing Mbeki in the foulest imaginable way to anyone who’d listen.

Coovadia (Cameron’s joint prize-winner of the Nelson Mandela Award for Health and Human Rights) publicly reacted to the AIDS Panel announcement by stating that it was time for scientists to take off their thinking caps and put on their helmets instead; there was a war to be fought: ‘There are 1 700 new infections every day in South Africa, 60 000 children die every year and 4,2 million South Africans are currently infected with HIV. We can’t have an academic debate while people are dying.’ We can’t afford shiny white Mercedes Benz motorcars without the help of such prize money either. Or twelve room mansions overlooking the sea. On our puny academic salaries. Handsomely supplemented by our executive vice-presidency fees of international AIDS project management companies such as Axios. Mary Crewe, director of the Centre for the Study of AIDS at Pretoria University, agreed with him: ‘We don’t have the luxury of this debate.’ In fact there wasn’t one, said Lynn Morris, a vaccine researcher at South Africa’s National Institute of Virology: ‘There is no debate among scientists. HIV causes AIDS. The evidence is overwhelming and conclusive.’ Clive Evian, a professional consultant ‘AIDS expert’, said angrily: ‘I think it’s about arrogance, it’s about baggage with the pharmaceutical industry and, most of all, it’s about delaying dealing with the issue.’ The envisaged panel was a ‘waste of money. … We need the President and Health Minister to kick out the pseudo-scientific dissidents who talk nonsense.’ Pseudo-scientific nonsense-talking dissidents like Nobel laureates Walter Gilbert and Kary Mullis – among the most distinguished and accomplished biologists of our time. Scientific democrat Glenda Gray’s opinion was that ‘If we are still querying in the 20th century whether HIV causes AIDS, then this means the country is in serious denial about the HIV/Aids epidemic. … Although it’s very important to determine innovative strategies for combating AIDS, engaging with fringe groups is not the way forward. These people should never have been given a platform. … [Questioning AIDS orthodoxy] is exactly what I would have expected from the apartheid government, not [Mbeki]. You just don’t expect someone with Mbeki’s credentials to do something that is so confounding.’ Ashraf Grimwood, chairman of the National AIDS Convention of South Africa shuddered: ‘I started feeling a very strange plot was afoot.’ The MRC’s Salim Karim was perplexed: ‘The President’s talk on World AIDS Day was excellent – and he writes his own speeches. He clearly understands this epidemic. So I don’t know. It’s not denial; it’s more complicated than that.’ As for him: ‘I have no doubt that HIV causes AIDS.’ At first AIDS acitivist and AZT promoter Charlene Smith feigned indifference: ‘Mbeki’s panel? Who the hell cares? Then she got characteristically hot and bothered: ‘We’re dying down here. Play all the intellectual games you want on the Internet, but we’re dying down here.’ And I don’t mean whites like me. Who know better than Mbeki does.

Makgoba felt

truly embarrassed for my government. I don’t think anyone knows where this thinking is coming from. It makes us look absolutely lost. … The scientists of South Africa have been providing this information [on antiretroviral drugs] for years. The longer we delay, the worse the situation becomes. The irony of this is: How can you replace the orthodoxy of the West with the unorthodoxy of the West and think that you are making progress?

Mbeki’s contacts with the AIDS dissidents were a ‘national scandal’, he said. ‘AIDS dissidents were failures in their own countries’ and South Africa was becoming ‘a fertile ground for the types of pseudo-science often embraced by politicians’. Worthless was Mbeki’s ‘politically motivated suggestion, in the absence of scientific evidence, that malnutrition and poverty cause AIDS in Africa’. The dissidents were ‘a small group of people who spend an enormous amount of time making sure their message will have an impact. When you see it for the first time, and if you are not experienced, you are likely to be seduced by it.’ The questions Mbeki was raising were ‘trivial’ and ‘mind-boggling’, he said; they turned the issue of whether HIV causes AIDS into a ‘political rather than scientific’ issue. And ‘if politicians are seeking consensus among scientists, that’s the wrong approach. One of the things that distinguishes politics from science is that in science we never seek consensus ... in science you are either right or wrong.’ And, as he thought he’d emphasize at the end of the Panel’s first day, ‘science is closed on these questions’. Mbeki’s intervention was dangerous, he warned: ‘Whenever politics takes centre stage, manipulates science for its ends, opts for the wrong scientific advice, or erodes the independence and rigour of the scientific methods in any country, the consequences have been dire.’ But imagine the trouble we’d be in had Mbeki contented himself with being advised by slobs like him, having regard to the former’s complaint in the Sunday Times two months earlier on 6 February that Makgoba and his fellow ‘AIDS experts’, such as Coovadia and Karim, are too lazy to read their medical journals – hence their foolish public statements that there was nothing to worry about; there were no recent research reports in the medical press about AZT’s extreme toxicity. Right after a whole flood of them. Really grim ones. Makgoba went on:

The current political and scientific furore in South Africa, fuelled largely by the dissident’s theories on HIV/AIDS and the seeming support of Mr Mbeki … is undermining the constructive public health messages this government has put in place. It is sending mixed messages to all those who have dedicated themselves to the alleviation and eradcation of this epidemic and is having a negative impact on the morale of affected patients and families. The undermining of scientists and the scientific method is especially dangerous in a developing country still in the process of establishing a strong scientific research base. Furthermore, it amy erode investor confidence, with dire economic consequences. We present South Africans cannot afford to make any more mistakes lest history judge us to have collaborated in one of the greatest crimes of our time.

Mamphela Ramphele supported Makgoba’s denunciation of Mbeki – more or less quoting him at a meeting in Johannesburg shortly afterwards: If the government entertained any of ‘this voodoo science, there’s a real danger people might say, “I don’t have to worry about condoms.” The disregard for the value of science is a worrying phenomenon that has crept into our new democracy.’ Mbeki’s position on AZT and soliciting of minority expert opinion on AIDS was ‘irresponsibility bordering on criminality’, she screeched. When Mbeki paid no attention to her ticking off for approaching AIDS with an open mind, and her insistence that we guys do it in a bag, she repeated her criminal charge in the first week of July in the US during an interview on the top-rated television news programme 60 Minutes.

It was difficult to imagine more vitriolic condemnation, but as Mhlongo pointed out to journalist Celia Farber:

There is no way this President will give in to attacks on him, because he is convinced, like he was in the struggle against apartheid, that there needs to be a debate. This is all related to apartheid, because the theories and practices of apartheid were not to be questioned. It was taken for granted. I grew up under apartheid. There were funerals every week because of the violence and the poverty of apartheid. There are many funerals still today, and I say that there is no evidence whatsoever that these people have died of AIDS. If you didn’t see poverty and malnutrition as the number-one cause of death in South Africa, I am prepared to close my bank account and give you all my money.

She asked him tongue in cheek: ‘How could there be all these media reports about the millions dying of AIDS in Africa? It can’t be a wholesale fabrication, can it? Don’t they say that AIDS affects the middle and upper classes, not just the poor?’ Mhlongo responded:

Look, there are no death certificates whatsoever. We have no references for anything. All you have is the media – television, radio and newspapers – agreeing on this. That stuff about the upper classes is really rubbish. I am so-called bourgeois, and I don’t see any of this among the middle class. It’s the poverty-stricken, unemployed, black South Africans who are dying, because of diseases related to poverty.

Once the AIDS Panel was set up, Makgoba, for his part, took a softer line than he had before – for a while anyway. Mbeki, he granted, is

a continuous learner. He wants to understand things. He’s basically a man who wants to exercise his power with knowledge derived from his own understanding of things. That sets him apart from Presidents in the Western world, where most people rely on being fed information from advisers. It means he doesn’t take accepted views easily. [Nonetheless,] my own view is that this process should never have been public. I am a scientist. I have been convinced by the evidence. There are politicians who are facing major policy changes and want to explore all possibilities. Indeed, I have to confess the President did consult me early in this matter. I told him what I’ve always told him. But the President felt it was necessary to consult these other people to see whether together we could resolve these differences. And I agreed to participate.

Minister in the Office of the Presidency, and personal confidant, Essop Pahad confirmed that Mbeki was the kind of guy who made up his own mind about stuff: ‘Fundamentally, he’s raising these issues because in South Africa, in our region, we have to find the necessary solutions to enable us to deal with this pandemic. And if he wants to understand something, he will not rely only on other people’s views. He wants to understand it for himself.’ Even if he came to unpopular conclusions; government spokesman Joel Netshitenzhe quoted Mbeki responding: ‘I didn’t go into this work, into this office, in search of popularity. If there are issues to be dealt with, they need to be pursued.’ Mbeki’s spokesman Parks Mankahlana explained:

The President speaks to all scientists and to everyone who believes he’s got something to contribute. Until all the questions that keep cropping up are answered, we are not going to be able to say to a person who disagrees with the conventional thinking, ‘You are wrong or right.’ [The President] has never said HIV doesn’t lead to AIDS. The fact of the matter is there is so much that is still unknown about HIV and AIDS. … All President Mbeki is saying is, ‘Let’s listen to everybody. Let’s not silence one group or another with hysterical declarations. To find a solution to this thing we have to look at all angles.’

The ANC’s Head of Presidency and Communications, Smuts Ngonyama, asked: ‘How can you have a situation where you must ban ideas? We are coming from a situation in this country where organizations were banned, newspapers were banned, people were banned. Are we returning to that stage now?’ Department of Health Director General Ayanda Ntsaluba correctly pointed out that in ‘a practical way, the debate within the ANC really does not affect what we are doing. I would have been more concerned if I got the impression that we were being diverted from the current program at government.’ ANC Secretary-General Kgalema Motlanthe later wondered: ‘If the debate over the cause of AIDS had been sorted out, why then did the dissidents and [orthodox] scientists in the newly constituted AIDS panel admit that they have come together to debate the issue for the very first time?’ Struggle activist and former political exile attorney Christine Qunta wrote supportively in Business Day on 19 May: ‘To shut out the views of scientists who do not agree with the majority, but whose theories can enhance opportunities for finding solutions to the Aids epidemic is surely out of place in the modern scientific community. Their views must be aired. … It was absolutely correct and essential for the President to seek out the views of all scientists who may help government to find answers to deal with the epidemic.’

On the other hand Saadiq Kariem, chairman of the ANC national health committee, was furious: ‘There’s a small minority of very senior people in the party who support the dissident view. … [They were] irresponsible … The implications of this are enormous and disastrous. People have already come to me and said, “If HIV doesn’t cause AIDS and AIDS isn’t sexually transmitted, why am I wearing a condom?”’ Sandy Kalyan, Democratic Alliance deputy spokesperson on AIDS, sang from the same hymn-book: Mbeki was ‘blatantly causing South Africa irrefutable [sic] harm in the eyes of the international scientific community by rehashing an old debate on the cause of AIDS’. The WHO should pay Mbeki a visit and put right ‘his strange approach to the South African AIDS crisis’. After which he should apologise to the local scientists he’d embarrassed, she said, ‘and especially to the 20 per cent of the South African population which is living with the HIV/AIDS virus’. Her boss, Tony Leon, judged the proposed International AIDS Advisory Panel ‘a waste of money, a waste of paper and a waste of words’. Treatment Action Campaign chief Zackie Achmat agreed: ‘The debates around the causality of AIDS and the toxicity of antiretrovirals are obscuring the real issue: drug-pricing policies that have left many essential meds unaffordable for the vast majority of South Africans with HIV. Rather than waste precious time reopening dead debates, the government should commit sufficient resources to addressing this crisis.’ Helen Schneider, director of the Centre for Health Policy at the University of the Witwatersrand, took a sympathetic view of Mbeki’s musing: ‘I think it’s completely explainable. There’s a very recent history of direct conspiracy against black people in this country.’ Besides which, ‘People can’t cope. What you’re seeing is this enormous struggle to come to terms with this problem.’ Unsuccessfully, in Mbeki’s case, hence his denialism. But it was kind of Helen to be so understanding. Of the traumatised natives. Having trouble thinking straight.

None too happy about the proposed AIDS Advisory Panel were the Holy Order’s foreign eminences either: ‘At first, we were thinking we would just ignore it, but now we think this confusion can really undermine all the efforts people have made to prevent this disease,’ said Awa Coll-Seck, director of the UN Department of AIDS Policy in Geneva. ‘People will reassure themselves, perhaps, that they can continue risky behaviour because HIV is not the real cause of AIDS. It’s becoming a real issue.’ Helene Gayle of the US Centers for Disease Control and Prevention denounced the sceptics, saying ‘there is no merit in questioning conventional wisdom’ about HIV. Mathilda Krim, founder of the immensely wealthy and hugely influential AIDS organization, the American Foundation for AIDS Research (amfAR), even asked Mbeki if she could fly over and talk some sense into him, but he declined to see her. Top ‘AIDS expert’ Mark Wainberg, president of the International AIDS Society, smouldered over Mbeki’s plans: ‘We often find that the ground is cut out from under our feet by people who should know better.’ And then he turned on Duesberg, the Great Satan, who was ‘contributing to the spread of HIV’ by claiming it to be a harmless passenger virus – for which guys like him should be criminally prosecuted, he said. Wainberg amplified this later in the year at the 13th International AIDS Conference in Durban in an interview for the film, AIDS in Africa, by Robin Scovill. His mouth turned down as if he’d been sucking on a lime, his eyes burning with intense anger, he charged: ‘Those who attempt to dispel the notion that HIV is the cause of AIDS are perpetrators of death. I would very much, for one, like to see the constitutions of the US and similar countries have some means in place that we can charge people who are responsible for endangering public health with endangerment, and bring them up on trial.’ And concerning Duesberg:

I think people like Peter Duesberg belong in jail. … It strikes me that someone who would perpetuate the notion that HIV is not the cause of AIDS is motivated by sentiments of pure evil, that such a person may perhaps really want millions of people in Africa and elsewhere in the world to become infected by this virus and go on to die of it, and who knows, maybe there’s a hidden agenda behind the thoughts of a madman. Maybe all psychopaths everywhere have ways of getting their views across; they are sometimes camouflaged in subterfuge. But I suggest to you that Peter Duesberg is probably currently the closest thing we have in this world to a scientific psychopath. And now this interview is finished, thanks.

Well howdy-doody. Or perhaps mazel tov. Hey, settle down, big macha, it isn’t Peter’s fault he’s a German. At a lunch table at the conference, a couple of paces from where I sat, I saw Wainberg flashing a Colgate smile as he glad-handed several dazzled women. The international AIDS hero. Who’d proposed four months earlier, to Mbeki’s astonishment, that troublemakers like me be arrested and imprisoned. As I watched him, chilled, that same favourite word of his came to mind in Hannah Arendt’s timeless summation of Adolf Eichman, huddled in his Jerusalem criminal court dock: ‘the banality of evil’.

The Aaron Diamond AIDS Research Center’s John Moore said he was ‘flabbergasted’ by the AIDS Panel announcement: ‘Mbeki has given lifeblood to a dead cause.’ But he wasn’t going to take it lying down; he’d be approaching ‘very serious levels in the US government ... because [Mbeki] needs to get proper advice, from his peers. To see these questions resurging in a country where the AIDS problem is so much more serious [than in the US] is shocking and frightening; and to see the president of a nation taking this seriously is a very shocking thing.’ Mbeki’s call for a ‘re-examination’ of the infectious AIDS model was ‘tantamount to Holocaust denial because the implications are so serious’. Seth Berkley, head of the New York-based International AIDS Vaccine Initiative agreed: people entertaining doubts about HIV as the cause of AIDS were like ‘those that believe that the Holocaust did not occur’. Moore continued: ‘You should not try to steer government policy on a path that could lead to the genocide of a nation.’ As for Mbeki and Tshabalala-Msimang, ‘a charge of genocide would not be inappropriate ... Their efforts are already having a devastating negative effect on public health in South Africa [quite how he didn’t say], and the problems could well spread further if other nations are foolish enough to take a lead from the South African government.’ The journalist interviewing Moore was startled by the vehemence of his dogmatism. Didn’t Mbeki have the ‘democratic right’ to make an independent inquiry? Moore answered with more of the same: ‘It’s the South African government’s right to reinvent the wheel if they want, but these debates have been held and settled in America and Europe 10 years ago.’ Now if there’s one thing that ‘AIDS experts’ have in common with faithless lovers, it’s how readily lies spring to their lips. Because until something of a debate began in 2003 on the online letters page of the British Medical Journal there’d never been one worthy of the name. None of the published critiques have ever been answered.

‘AIDS experts’ charging doubters with Holocaust denial was a regular tactic to quash dissent from their doctrines. For instance, challenged by the Perth group in early 1999 in regard to his claims about the alleged isolation of HIV, Britain’s leading ‘AIDS expert’, Professor Robin Weiss of the Department of Immunology and Molecular Biology, Windeyer Institute, University College, London, evaded serious engagement on the issue, concluding: ‘There will always be a few people who cannot be convinced by the data before our eyes – or who emotionally wish to deny what the rest of us regard as facts. … In my view, to deny the existence of HIV is a bit like denying the Nazi holocaust. … This terminates our debate.’ The Perth Group shared this grossly unscientific talk with Rex Ranieri, a documentary filmmaker for TV Channel Nine in Australia. Ranieri urged Weiss to respond properly, but he carried on the same way as before:

If I were a radio or television producer, I think I might seek to explore a programme on latter day flat-earthers as a sociological phenomenon. What lies behind HIV and AIDS denial? Why do such people feel persecuted by scientific orthodoxy when in reality they are simply ignored? Why do quasi-fascist concepts keep slipping in, like the holy grail of [viral] ‘purification’? Doesn’t HIV denial resemble holocaust denial? First, I would take a vacation on the beach with the writings of two Italian Nobel Laureates who had suffered under fascism: Enrico Fermi the physicist who discovered nuclear fusion, and Primo Levi, the chemist who won the Nobel Prize for Literature, but later took his own life. These two thinkers would help me to place the issues of scientific controversy and society in proportion.

And that’s where Weiss ended, forgetting to append the second bit of personal counsel he had in mind for Ranieri when writing, ‘First’, before collapsing into incoherence and irrelevance.

Chekov recognised the style of the ‘AIDS experts’ a century earlier among medical professionals in Tsarist Russia, likening their ‘dullwittedness and tyranny’ to that of the secret police. But their ‘dullwittedness and tyranny’ had a natural appeal for Cameron: raised tentatively by him at the Durban AIDS Conference, genocide and Holocaust denial would develop into staple motifs in his attacks on Mbeki year after year. The Mail&Guardian’s too.

Rasnick wondered, ‘What’s behind all these shrill attacks on Mbeki?’, before solving his riddle himself: ‘It’s thousands of activists and scientists who fear they’re going to be out of a billion-dollar business.’ Duesberg seconded that: ‘I assume that the many beneficiaries of [the HIV/AIDS] hypothesis are now concerned that, for the first time, a head of state who is independent of the US government has called this unproductive and ... very detrimental hypothesis into question.’

In his fine analysis a year later of local media inventions of the Mbeki mystique, Bound by tradition: The world of Thabo Mbeki (UNISA, 2001), Lucky Mathebe defended Mbeki’s ‘unprecedented step ... of reopening the HIV/Aids debate’ in terms of his percipient central thesis that Mbeki ‘embodies pragmatism’. Having noted that he ‘shows an aversion to pure reason or ideology’ – of the Western ilk – Mathebe wrote:

In keeping with the traditional patterns of pragmatism, Mbeki needed all views, dominant or dissenting, to be subject to a careful and ongoing process of close scrutiny or examination. Like all pragmatists he does not believe in ‘dominant’ views and he maintains a stance against a priori or ideological positions. His pragmatism has motivated him to seek new insights on the epidemic. Because he is given to the view that the universe is not closed or complete, he felt it necessary to grant the dissidents or heretics a platform to play a meaningful role in the shaping of human affairs.

Just that point was made in a public statement in mid-March 2000 by Presidential spokesman Mankahlana, in defence of Mbeki’s decision to ‘reinvigorate the debate’, as Mbeki put it, by convening his multilateral advisory panel on AIDS:

Let’s not obsess with this petty foolishness. AZT is not a cure for AIDS, and besides, it’s unaffordable. … Why are the critics of Mbeki creating the impression that [AZT is an effective treatment for AIDS] when they know it isn’t? In fact it is Mbeki’s critics who are in denial about HIV/AIDS because they create a false sense of hope that a certain drug will intervene in the problem. This is not the case. … What is important is that here we have a disease that there is no cure for. … That is why we are putting an international panel together to re-evaluate what we know, and which is clearly not complete, and therefore not the answer. … The President is saying let us all work together on this. And yes, there is going to continue to be confusion, but the person who’s going to shut us up is the person who finds a cure. The President doesn’t belong to any faction. … This panel must strive to give answers to all the unknowns. It must attempt to unravel all the ‘mysteries’, including what the profit-takers cannot tell us.

On the way, Mankahlana hit out at ‘the machinations of the profiteering pharmaceutical companies’, evidently citing from Mbeki’s table-talk:

Sure, the shareholders of GlaxoWellcome will rejoice to hear that the South African government has decided to supply AZT to pregnant women who are HIV-positive. The source of their joy will not be concern for those people’s health, but about profits and shareholder value. … Like the marauders of the military-industrial complex who propagate fear to increase their profits, the profit-takers who are benefiting from the scourge of HIV/AIDS will disappear to the affluent beaches of the world to enjoy wealth accumulated from a humankind ravaged by a dreaded disease. And we will continue to die from AIDS.

Back in the UK, the company’s executive director for Africa, James Cochran, naturally didn’t see it this way. In his view, ‘blaming the pharmaceutical industry for failure to arrest the current AIDS epidemic in Africa is convenient but simplistic. … The real barriers to access to treatment are lack of education, medical infrastructure and political will.’ Especially political will – as was evident from the government’s failure to take up its offer of AZT at a a quarter of its usual cost, an offer the government had spurned, he said.

As we read Mankahlana nailing the drug company, we were, for the most part, listening to his master’s voice: acid comments uttered privately without diplomatic sweetening. About an industry Mbeki had long-appreciated has immense clout: When during a visit to Vice President Al Gore on 5 August 1997 the latter pointed out, ‘You know Thabo, the American pharmaceutical industry exerts an influential voice in political circles’, Mbeki retorted: ‘Yes, all over the world.’ But evident from Mankahlana’s language was that he was personally still in thrall of the newspaper story that AIDS was a new dread disease ‘ravaging’ the country, and that he hadn’t himself arrived at the radical insights of his principal. And as it turned out, Mankahlana, unlike Mbeki, wasn’t personally on top of the AZT toxicity literature either. His misapprehensions about HIV and AIDS, and his ignorance concerning the toxicity of AZT, would cost him his own life seven months later – taken by the very drug he was deprecating as ineffective.

Mankahlana responded further to all the outrage in a statement Building a Monument to Intolerance, published in abdridged form by the Mail&Guardian on the 31st, under the title What the president said:

The Presidency spent considerable time the past week searching frantically for a passage in the President’s speeches which said an HIV-positive condition does not lead to Aids. Neither his private correspondence nor a reconstruction of all the discussions with either his ministers or any other authority on the question of HIV and Aids could produce any evidence of this. So the President has never said that HIV does not cause Aids. … It turns out the President’s cardinal sin was making contact with someone by the name of David Rasnick who does not share the commonly held view that HIV leads to Aids. It is said that it is wrong for him to talk to such people. They are even called dissidents. If he spoke to these people he would undermine the work done over the many years and he would cause South Africans and other people who live with HIV and Aids to lower their guard. … Assailants of the President therefore argue that the President must not question the accepted hypothesis on HIV/AIDS. He must then give AZT to HIV-positive pregnant women and those who have been victims of rape. He must tell his people to use condoms and practice safe sex. He must not listen to anyone who disagrees with the accepted line of thinking and the problem of HIV and Aids will come to an end. … Mbeki’s dilemma is compounded by the fact that he does not have the option to dispense AZT to people because it is simply unaffordable. Not only is AZT not a cure for HIV/AIDS, but also it has been proven to be ineffective unless it is used together with other drugs. This regime costs at least R4 000,00 a month. Given that the government will not afford the cocktails that are prescribed for the treatment of HIV/AIDS, our response to the pandemic must be the distribution of condoms and an unwavering belief that HIV is the sole cause of AIDS. This approach says we must sit back and do nothing about HIV and AIDS. It says that the problem is beyond our comprehension and therefore impossible to resolve. We definitely cannot accept this approach. Mbeki says this approach is inadequate. We cannot be content with knowing what the cause of the illness is. We must eradicate the sickness from the face of the earth. Because there is no cure for HIV/ AIDS and because people continue to die from AIDS the search for a solution must continue. This is all President Thabo Mbeki is advocating. Humanity is faced with a difficult problem that in the remarkable advances that have been made in science and technology notwithstanding, we are faced with a complex disease that is threatening to destroy the whole of humanity. The propensity to self-destruct and search for non-existent adversaries is common when people find themselves under siege. In any case why are we told a lie that AZT is a panacea to the problem of AIDS. It simply is not. And why are critics of Mbeki creating the impression that it is when they know it isn’t? In fact it is Mbeki’s critics that are in denial about HIV/AIDS because they advocate a false sense of hope that a certain drug will intervene in the problem. This is not the case. There is a raging debate in scientific circles that antibiotics are harmful to health. We have been using these wonder drugs for decades. Many can rightfully claim their livelihood to these drugs. And yet no one is accusing those who initiated these questions about antibiotics of being ‘scientifically naive and foolish’ … But then why is it that what we know about HIV and AIDS should not be questioned, the glaring inadequacies in humanity’s response to the problem notwithstanding? … The search for an answer to the problem of HIV/AIDS must be re-invigorated. That is why we are putting an international panel together to re-evaluate what we know and which is clearly not complete and therefore not the answer. … Frankly we cannot satisfy ourselves with the definition that the foreskins of the Zulu are the explanation for the rapid spread of the disease in one section of the country. … Government is strong in its resolve that we cannot confine our response to the problem of HIV/AIDS to an injunction not to speak to David Rasnick or telling people how to think. Whether we speak to Rasnick or not, whether there are thought police to monitor what others think, human beings will continue to die from AIDS. A disturbing trend in the response to the current debate has been the rabid intolerance to different viewpoints that has been displayed in the South African media. One prominent commentator even brandished the President a criminal because he spoke to Rasnick and also because he dared think beyond what is accepted wisdom. Surely we do not want to return to the days of Stoffel Botha and the total onslaught. As far as we know all efforts to prescribe how other people should think have failed all over the world, both under capitalism and erstwhile socialism. Even dictatorships and fascism failed to suppress the freedom of the human mind to wonder in search of solutions to the intractable problems that face us. Government advocates safe sex and the use of condoms as one of the elementary responses to the problem of HIV / AIDS. The President is going to continue to mobilise public awareness about the dreadful nature of the disease. Furthermore President Mbeki is going to intensify the fight for the end of discrimination against and exploitation of people who live with HIV/AIDS, both by insurance and medical schemes and the pharmaceutical giants who are the sole beneficiaries in the dogged defence of AZT by large sections of the media. Yes they buy a lot of advertising space and are therefore a strong ally of publishing and broadcasting houses, to the detriment of the millions that live with HIV and AIDS.

All of which sounded perfectly reasonable, who’d disagree? But disagree the drug fans did. The Mail&Guardian’s mystified editorial, What’s behind Mbeki’s crusade?, in the same issue, portrayed perfectly the general attitude in the suburbs to Mbeki’s initiatives. Its tone was classic white South African liberal (‘You can have the afternoon off, Gertie’) – moralistic and condescending:

There is nothing inherently wrong in trying to keep open the debate about HIV/Aids … But engaging in this kind of investigation can be highly problematic if you are Thabo Mbeki, president of South Africa. … he has at times behaved like someone trying to be the Boy’s Own basement lab hero of Aids science. He has allowed his attention to be diverted into abstruse debates on immunology and related science. He seems to have become the international political patron of views on HIV/Aids which seriously undermine the deployment in this country of best available methods based on the best available science for treating HIV/Aids and related conditions. In the process, the nation’s attempts to deal with this national health crisis have been plunged into confusion. … It is small wonder that scientists, diplomats and politicians, even in Mbeki’s own party, are asking whether Mbeki’s usually astute judgment has completely deserted him. His behaviour has also led to unhelpful speculation about why he is so strangely exercised by the issue. Even if the largely discredited dissident views to which he wishes to give so much air are eventually proved to have been right, this will not compensate for the ground that is being lost right now in our fight against what best science sees fit to call HIV/Aids. … We and other critics of the president’s approach to HIV/Aids would deny no one – not even crackpots [this writer, see below] – the right to challenge conventional wisdom. The issue for us is that Mbeki is missing his vocation completely if he seeks to revise scientific knowledge instead of expediting policy in the way he was elected to do. … Why has Mbeki embarked on this stubborn, silent crusade? There are no obvious reasons, no reports of African National Congress branches rising up and demanding that the president personally push the case for the earth being flat in the world of Aids science. … The dismay over Mbeki’s actions crosses the nation’s traditional fracture lines, with Mamphela Ramphele and Malegapuru Makgoba, among the most prominent of the black scientists and doctors, as desperate for a government turnaround as any white health worker. … No one disputes Mbeki’s good intentions. He clearly understands the extent of the Aids epidemic, and the social and political problems it poses. If he were not deeply concerned by the Aids problem, it is highly unlikely he would have become so deeply embroiled in it. What is unclear is his judgment on this matter – and his unwillingness to confine himself to the job he was elected to do and to restrict his forays into the intricacies of specialised subjects to the taking of best available advice.

Unable to shut down Mbeki’s plans for his proposed International AIDS Panel by shouting, the ‘AIDS experts’ now took to sulking. On 4 April the Independent Online reported that ‘furious’ about Mbeki’s contact with the ‘renegade’ experts – ‘dissident David Rasnick, in particular’ – as well as ‘the government’s refusal to provide pregnant women with the anti-Aids drug AZT’, a number of English ‘AIDS experts’ as well as ‘several US organisations and companies’ – were threatening to boycott the 13th International AIDS Conference in Durban in July. But Tshabalala-Msimang dismissed their moans: ‘We’re known for talking to everybody. It will be strange to exclude certain people because their views do not agree with the established views.’

Amazed by the virulence of the personalised criticism he was drawing, Mbeki wrote confidential letters to Bill Clinton, Tony Blair, Gerard Schroeder, Kofi Annan and other world leaders on 3 April, dispatched in secure diplomatic bags, conveying his scepticism of the First World AIDS model and approach, and deploring his critics’ ‘orchestrated campaign of condemnation’. But having posed the first political challenge to the sanctity of HIV/AIDS science – breaching its moat and battering its gate – it really ought not to have surprised him when its guardians responded from the parapets with an unrelenting torrent of burning oil, slingshots and poisoned arrows.

I am honoured to convey to you the compliments of our government as well as my own, and to inform you about some work we are doing to respond to the HIV/AIDS epidemic. As you are aware, international organizations such as UNAIDS have been reporting that Sub-Saharan Africa accounts for two-thirds of the world incidence of HIV/AIDS. These reports indicate that our own country is among the worst affected. Responding to these reports, in 1998, our government decided radically to step up its own efforts to combat AIDS, this fight having, up to this point, been left largely to our Ministry and Department of Health. Among other things, we set up a Ministerial Task Force against HIV/AIDS chaired by the Deputy President of the Republic, which position I was privileged to occupy at the time. Our current Deputy President, the Hon. Jacob Zuma, now leads this Task Force. We also established Partnerships against AIDS, with many major sectors of our society including the youth, women, business, labour unions and the religious communities. We have now also established a National AIDS Council, again chaired by the Deputy President and bringing together the government and civil society. An important part of the campaign that we are conducting seeks to encourage safe sex and the use of condoms. At the same time, as an essential part of our campaign against HIV and AIDS, we are working to ensure that we focus properly and urgently on the elimination of poverty among the millions of our people. Similarly, we are doing everything we can, within our very limited possibilities, to provide the necessary medicaments and care to deal with what are described as ‘opportunistic diseases’ that attach to acquired immune deficiency. As a government and a people, we are trying to organize ourselves to ensure that we take care of the children affected and orphaned to AIDS. We work also to ensure that no section of our society, whether public or private discriminates against people suffering from HIV/AIDS. In our current budget, we have included a dedicated fund to finance our activities against HIV/AIDS. This is in addition to funds that the central government departments as well as the provincial and local administrations will spend on this campaign. We have also contributed to our Medical Research Council such funds as we can, for the development of an AIDS vaccine. Demands are being made within the country for the public health system to provide anti-retroviral drugs for various indications, including mother-to-child transmission. We are discussing this matter, among others with our statutory licensing authority for medicines and drugs, the Medicines Control Council (MCC). Toward the end of last year, speaking in our national parliament, I said that I had asked our Minister of Health to look into various controversies taking place among scientists on HIV and AIDS and the toxicity of a particular anti-retroviral drug. In response to this, among other things, the Minister is working to put together an international panel of scientists to discuss all these issues in as transparent a setting as possible. As you know, AIDS in the United States and other developed Western countries has remained largely confined to a section of the male homosexual population. For example, the cumulative heterosexual contact, US percentage for AIDS cases among adults/adolescents, through June 1999 is given as 10 percent. (HIV/AIDS Surveillance Report: Midyear edition. Vol 11, No 1, 1999. US Department of Health and Human Services). The cumulative absolute total for this age group is reported as being 702,748. US AIDS deaths for the period January 1996 to June 1997 were stated by the US CDC as amounting to 32,750. (Trends in the HIV and AIDS Epidemic: 1998. CDC). On May 13, 1999, a SAFA-AFP report datelined Paris stated that 1998 UNAIDS and WHO reports had said that AIDS was responsible for one death in five in Africa, or about two million people. It quoted a Dr. Awa Coll Seck of UNAIDS as saying that there are 23 million carriers in Africa of HIV. This SAFA-AFP report quotes Dr. Coll Seck as saying: ‘In Southern Africa, the prevalence of the (HIV) infection has increased so much in five years that this region could, if the epidemic continues to spread at this rate, see its life expectancy decline to 47 by 2005.’ (Interestingly, the five years to which Dr. Coll Seck refers coincide closely with the period since our liberation from apartheid, white minority rule in 1994). The report went on to say that almost 1,500 people are infected in South Africa every day and that, at that point, the equivalent of 3.8 million people in our country carried the virus. Again as you are aware, whereas in the West HIV/AIDS is said to be largely homosexually transmitted, it is reported that in Africa, including our country, it is transmitted heterosexually. Accordingly, as Africans, we have to deal with this uniquely African catastrophe that: * contrary to the West, HIV and AIDS in Africa is heterosexually transmitted; * contrary to the West, where relatively few people have died from AIDS, itself a matter of serious concern, millions are said to have died in Africa; and, * contrary to the West, where AIDS deaths are declining, even greater numbers of Africans are destined to die. It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV/AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical. Such proceeding would constitute a criminal betrayal of our responsibility to our own people. It was for this reason that I spoke as I did in our parliament, in the manner in which I have indicated. I am convinced that our urgent task is to respond to the specific threat that faces us as Africans. We will not eschew this obligation in favour of the comfort of the recitation of a catechism that may very well be a correct response to the specific manifestation of AIDS in the West. We will not, ourselves, condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV/AIDS. I make these comments because our search for these specific and targeted responses is being stridently condemned by some in our country and the rest of the world as constituting a criminal abandonment of the fight against HIV/AIDS. Some elements of this orchestrated campaign of condemnation worry me very deeply. It is suggested, for instance, that there are some scientists who are ‘dangerous and discredited’ with whom nobody, including ourselves, should communicate or interact. In an earlier period in human history, these would be heretics that would be burnt at the stake! Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and in public because the established authority believed that their views were dangerous and discredited. We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited. The scientists we are supposed to put into scientific quarantine include Nobel Prize Winners, Members of Academies of Science and Emeritus Professors of various disciplines of medicine! Scientists, in the name of science, are demanding that we should cooperate with them to freeze scientific discourse on HIV/AIDS at the specific point this discourse had reached in the West in 1984. People who otherwise would fight very hard to defend the critically important rights of freedom of thought and speech occupy, with regard to the HIV/AIDS issue, the frontline in the campaign of intellectual intimidation and terrorism which argues that the only freedom we have is to agree with what they decree to be established scientific truths. Some agitate for these extraordinary propositions with a religious fervour born by a degree of fanaticism, which is truly frightening. The day may not be far off when we will, once again, see books burnt and their authors immolated by fire by those who believe that they have a duty to conduct a holy crusade against the infidels. It is most strange that all of us seem ready to serve the cause of the fanatics by deciding to stand and wait. It may be that these comments are extravagant. If they are, it is because in the very recent past, we had to fix our own eyes on the very face of tyranny. I am greatly encouraged that all of us, as Africans, can count on your unwavering support in the common fight to save our continent and its peoples from death from AIDS. Please accept, Your Excellency, the assurance of my response.

THABO MBEKI

Mbeki disclosed the purpose of his letter during a television interview by Joan Shenton, slotted into the MNet television programme Carte Blanche on 16 April, in the course of which he justified his order that the safety of AZT be investigated – for pregnant women especially:

J S: Last year you were reported in Parliament as being concerned about giving AZT to pregnant mothers. Why were you concerned?

MBEKI: Well, because lots of questions had been raised about the toxicity of the drug, which is very serious. We as the government have the responsibility to determine matters of public health, and therefore we can take decisions that impact directly on human beings, and it seemed to me that doubts had been raised about the toxicity and the efficacy of AZT and other drugs, so it was necessary to go into these matters. It wouldn’t sit easily on one’s conscience that you had been warned and there could be danger, but nevertheless you went ahead and said let’s dispense these drugs.

J S: Some AIDS doctors say the evidence is overwhelming that AIDS exists and AZT is of benefit. What is your comment on that?

MBEKI: I say why don’t we bring all points of view. Sit around a table and discuss this evidence, and produce evidence as it may be, and let’s see what the outcome is, which is why we are having this international panel which we are all talking about. They may very well be correct, but I think if they are correct and they are convinced they are correct, it would be a good thing to demonstrate to those who are wrong, that they are wrong.

J S: People say you are not keen on giving AZT to pregnant women because it is too expensive and in some ways you are seen as penny-pinching. What do you reply to that?

MBEKI: That surely must be a concern to anyone who decides this drug must be given to stop transmissions, again from mother to child, which is extremely costly and must be taken into account. But we also need in that context to answer the particular questions of toxic effect of this drug. If you sit in a position where decisions that you take would have a serious effect on people, you can’t ignore a lot of experience around the world which says this drug has these negative effects.

J S: Why have you been so outspoken recently about greed and the pharmaceutical companies?

MBEKI: I think a lot of the discussion that needs to take place about the health and treatment of people does seem to be driven by profit. We’ve had a long wrangle with the pharmaceutical industry about parallel imports, and what we were saying is we want to make medicines and drugs as affordable as a possible to what is largely a poor population. We need to find these medicines that are properly controlled, properly tested, the genuine product and no counterfeits.

J S: In the press you are exhorted to confine yourself to the job to which you were elected, and leave specific subjects to the taking of best available advice.

MBEKI: I don’t imagine Heads of Government would ever be able to say I’m not an economist therefore I can’t take decisions on matters of the economy; I’m not a soldier I can’t take decisions on matters of defence; I’m not an educationist so I can’t take decisions about education. I don’t particularly see why health should be treated as a specialist thing and the President of a country can’t take Health decision. I think it would be a dereliction of duty if we were to say as far as health issues are concerned we will leave it to doctors and scientists, or as far as education is concerned we will leave it to educationists and pedagogues. I think the argument is absurd actually.

J S: How do you feel about the reaction of your country’s leading virologists and intellectuals to your position?

MBEKI: I get a sense that we’ve all been educated into one school of thought. I’m not surprised at all to find among the overwhelming majority of scientists, are people who would hold one particular view because that’s all they’re exposed to. This other point of view, which is quite frightening, this alternative view in a sense has been blacked out. It must not be heard, it must not be seen, that’s the demand now. Why is Thabo Mbeki talking to discredited scientists, giving them legitimacy. It’s very worrying at this time in the world that any point of view should be prohibited, that’s banned, there are heretics that should be burned at the stake. And it’s all said in the name of science and health. It can’t be right.

J S: Now it has been said that the pharmaceutical industry is more powerful than government. Are you going to take this debate to other world leaders like President Clinton, Prime Minister Blair or the Prime Minister of India, who has expressed support for an investigation into these issues, as you are?

MBEKI: Certainly I want to raise the matter with politicians around the world, at least get them to understand the truth about this issue, not what they might see on television or read in newspapers. And we were very glad to see India get themselves involved in this issue. The concern around probable questions, which in a sense have been hidden, will grow around the world and the matter is critical, the reason we are doing all this is so we can respond correctly to what is reported to be a major catastrophe on the African continent. We have to respond correctly and urgently. And you can’t respond correctly by closing your eyes and ears to any scientific view that is produced. A matter that seems to be very clear in terms of the alternative view, is what do you expect to happen in Africa with regard to immune systems, where people are poor, subject to repeat infections and all of that. Surely you would expect their immune systems to collapse. I have no doubt that is happening. But then to attach such important defence to a virus produces restrictions and what we are disappointed about as an Africa government is that it seems incorrect to respond to this AIDS challenge within a narrow band. If we only said safe sex, use a condom, we won’t stop the spread of AIDS in this country.

But in hoping to enlighten ‘politicians around the world’, assist them ‘to understand the truth about this issue’, and alert them to the fact that serious questions about AIDS orthodoxy were being neglected or suppressed by the media, and that the orthodoxy was itself a product of media fanfare around AIDS, Mbeki had miscalculated. From a mistaken premise. That the most powerful politician in the world, Bill Clinton, was a decent sort. Clinton was taken aback. The Third World rebel wasn’t playing ball. Disregarding the fact that Mbeki’s letter to him was a private communication, Clinton contrived – in an outrageous breach of basic personal etiquette – to neutralise the threat it posed to his country’s AIDS project by dint of a tactical leak to the Washington Post. The Post published it on 18 April, covered by a blistering editorial, accusing Mbeki of having taken a ‘further step down a path that will make the scourge of AIDS worse’, that he ‘unaccountably continues to embrace and legitimize absolute misinformation about the causes and treatment of AIDS’, and that he ‘continues to evade the reality’ of it. Worst of all he had convened an international panel of experts including ‘dissidents’ who claim AIDS ‘is a result of malnutrition rather than infection by HIV’. The panel was ‘ludicrous waste of precious time, and a cruel hoax on his suffering people’. With one in ten of his country infected, South Africa is ‘in the midst of a medical holocaust. … No serious medical scientist doubts the causal link between HIV and AIDS. And no serious political leader should either.’

Clinton’s aides burnished the innuendo that Mbeki was nuts by feeding the Post the transparently false claim that the administration had initially endeavoured to keep the discreditable letter quiet. The Henry J Kaiser Foundation faithfully repeated this in its Daily HIV/AIDS Report the next day: ‘After receiving the letter, the Clinton administration tried to limit its distribution.’ Thinking we were stupid. And as gullible as the Washington Post’s former local correspondent Allister Sparks. Who gobbled it down without stopping to chew. In his book Beyond the miracle he parrots:

The White House was so astonished at this equating of criticism of the dissidents with apartheid tyranny [in fact Mbeki’s complaint concerned censorship not criticism] that it ran a check to see whether the letter was a hoax. It then tried to keep the letter under wraps to avoid embarrassing Mbeki, but the letter was leaked and there was an avalanche of adverse publicity in the US and elsewhere. I happened to be in Washington at the time ... and everywhere I went people would question me about Mbeki. ‘What gives with your new President?’ they would ask. ‘Is he crazy?’

They might have asked Sparks instead: Are you as big a sucker for planted misinformation as the rest of us? Because it should have been perfectly obvious that the letter, personally addressed and securely couriered, could never have been leaked to the press without Clinton’s express assent. And that the private communication would have remained ‘under wraps’ in perpetuity without it.

A negative front-page report in the Washington Post duly followed on the 19th, S. African President Escalates AIDS Feud:

At loggerheads for months with his own medical establishment over the pandemic that is killing millions of South Africans, Mbeki has now raised the dispute to the international arena with a passionate defense of his approach to the crisis in a letter dispatched this month by diplomatic pouch to President Clinton and other heads of state. … Several Clinton administration officials and foreign diplomats expressed dismay at Mbeki’s decision to intensify what they see as a diversionary dispute and to bring it to a potentially volatile international forum.

The report explained the reason for the worry:

Mbeki’s words resonate widely because his nation’s new democracy and advanced industry make it a natural leader on the continent, a status acknowledged in its selection as host of this year’s international conference on AIDS. So stunned were some officials by the letter’s tone and timing – during final preparations for July’s conference in Durban – that at least two of them, according to diplomatic sources, felt obliged to check whether it was genuine.

Most troubling to the Americans was Mbeki’s impregnable logic; the Post quoted Assistant Secretary of State Susan Rice: ‘It was clearly impassioned in parts, but I thought much of its substance was quite logical and quite compelling.’

But Makgoba disagreed: ‘I think the letter was emotional and irrational. This man will regret this in his later years. He displays things he doesn’t understand. … I think we are just creating [an image of] ourselves as an embarrassment to the world. The scientific evidence about these issues is so clear that one is really surprised that we spend so much time and energy having a heated argument about something that is very straightforward.’ The effect, he said, was that Mbeki and his government were undermining South Africa’s efforts to fight the epidemic. But Mankahlana countered that Mbeki was simply looking at all views: ‘The problem that the scientific world has is this: It has to do with human arrogance.’

Duesburg was pleased: ‘I think after this letter, I have to go [to the AIDS Panel meeting]. It’s getting hot again, just like in the old days, thanks to Mbeki. I’m surprised that there’s a place left on this planet where you can ask commonsensical questions.’

On the same day that the Washington Post was discrediting Mbeki at the bidding of the Clinton administration, his deputy Zuma spoke in his defence during a parliamentary debate, emphasizing that ‘At no point has the President said that he challenges the view that HIV causes AIDS, or the contrary. All we are saying is that the issues must be debated and all views are considered. We should not, and we will not leave any stone unturned, even if this means including the view of the so-called dissidents. … No scientists had a monopoly on all knowledge about AIDS.’ In a positive reference to the breakaway dissident chapter of the AIDS activist organisation ACT UP in San Francisco, Zuma compared the group’s contention that HIV is harmless with Galileo’s critique of the geocentric theory of planetary motion. So more was the pity that Coovadia had cancelled ACT UP SF’s booth at the AIDS Conference in July; Zuma read from their letter of complaint to Mbeki about this: ‘For the past decade in San Francisco we have witnessed the destruction of human life caused by AIDS drugs. We hoped that by exhibiting at the conference, we could warn participants to prevent a similar catastrophe occurring in their countries.’

Coovadia had put his foot down: their ‘attendance will detract from the ethos and principles of the conference,’ he said. Their ‘support for the “Duesberg theory”, which is inaccurate and harmful and has constantly been discredited in the scientific community … can only harm efforts at HIV openness, cause tremendous confusion among people at risk and undermine much needed prevention efforts’. The South African Medical Association spoke the same way in its journal the SAMJ in May: ‘Whilst SAMA welcomes any debate on health it is obliged to point out that the view HIV may not cause AIDS has been thoroughly discredited by several recent scientific studies. [An entirely false statement.] This view is dangerous and its propagation may lead to cases of AIDS that may have otherwise been prevented.’

On the 20th, a day after the Washington Post’s attack on him, the South African Press Association wired Mbeki’s response, conveyed by his spokesman Mankahlana, to calls that he go for an HIV test: ‘The President is not prepared to engage in trivia; he has got more important things to worry about than testing for HIV/AIDS. Those who want to go and test for HIV/AIDS must do so.’

After contemptuously leaking Mbeki’s private letter to him to the press, Clinton promptly made plain his low opinion of it by announcing a ‘Marshall Plan for AIDS’. A bill went through the House on 15 April directing the Treasury to see to the establishment of a trust fund to be administered by the World Bank to collect public and private funds to combat AIDS in Africa. The bill authorized an annual US contribution of $100 for five years. ‘The survival of the continent is at stake,’ said Democratic Party Representative Barbara Lee for California. ‘AIDS is decimating the continent and leaving behind millions of orphans in its wake.’ ‘… no issue in the world is more consequential,’ said Jim Leach, Democratic Representative for Iowa.

Things took a serious turn two weeks later when on 29 April Clinton formally declared AIDS abroad – in Southern Africa particularly – a threat to US national security. A National Intelligence Estimate prepared in January, on which the White House claimed to have relied – strategically declassified and posted on the CIA’s website – claimed that it was the consensus of government analysts that a quarter of Southern Africa’s population would die of AIDS and that the numbers would rise for a decade, causing ‘a demographic catastrophe’, and creating an ‘orphan cohort unable to cope and vulnerable to exploitation and radicalization’. The Estimate warned that ‘state failure in partial democracies’ would be the result. Since there aren’t any true democracies in Africa. As AIDS killed off Africa’s people ‘revolutionary wars, ethnic wars, genocides and disruptive regime transitions’ would follow. ABC’s World News quoted administration officials the following day. The ‘global death rate from HIV/AIDS is so overwhelming, the spread of infection so rapid and the consequences to national security so dire ... that the United States must in effect declare war on the disease’.

And it was more than big talk: Clinton established an ‘interagency working group to develop a series of expanded initiatives to drive the international efforts’ to fight it. By making this declaration, Clinton was bringing the National Security Council into the game. Which is no joke. Mhlongo told me how he later got a visit at his MEDUNSA office by a pair of CIA spooks (in transparent poses), questioning him inter alia about what they suggested were Mbeki’s mental problems.

Sandra Thurman, director for the White House Office of National AIDS Policy, told Associated Press: ‘We have to respond to this because we’ve never seen a crisis like HIV and AIDS globally. We’re beginning to understand that this epidemic not only has health implications, but has implications as a fundamental development issue, an economic issue and a stability and security issue. With the logistical expertise that the national security community brings, with the diplomatic expertise that is necessary to sort of pave the road for leaders around the world to respond to this epidemic, this gives us a whole new ability to respond to AIDS like we would respond to any other international threat.’

As it made AIDS in Africa the new threat to American security for its spooks to deal with, the White House announced that it would seek $254 million from Congress to fight AIDS in Africa, double the steady $120 million annual allocation that had been spent over the preceding seven years.

Taking Clinton’s lead, the World Bank declared AIDS in Africa its ‘No. 1 priority’ in the same month, a move predicted by its president James Wolfensohn’s speech before the UN Security Council on 10 January, in which he announced that AIDS had become its ‘central development issue. … Many of us used to think of AIDS as a health issue. We were wrong. AIDS can no longer be confined to the health or social sector portfolios. AIDS is turning back the clock on development.’ Swayed by his pitch, the UN Security Council followed suit in May by declaring AIDS a ‘global security issue’.

The political implications of Mbeki’s appeal for a panopoly of views about AIDS to be heard and considered had become enormous. South Africa’s freedom to make its own policy was being cramped by decrees passed overseas, whose writ extended into our country, with millions of dollars allocated to carrying them out. The pressure on Mbeki to conform to the party line and to desist from subverting the orthodox virus/chemotherapy consensus was intense. He was becoming a threat to the safety of the world. And who needs reminding what happened to Patrice Lumumba in newly independent Congo shortly after Eisenhower passed that very judgement upon him? After which, it emerged during the Church hearings in the Senate in 1975, the CIA was only too quick to oblige.

The American administration’s beliefs that South Africa was the rotting pit of venereal disease among blacks that the ‘AIDS experts’ were claiming it was, and that Mbeki’s scepticism presented a serious stumbling block to American plans to cure the epidemic, was demonstrated by the first order of business of US Secretary of State Colin Powell on a state visit to South Africa a year later, in the third week of May 2001. Within hours of his arrival he paid a visit to an AIDS clinic for a photo-shoot. Asked by a journalist whether he’d talked to Mbeki, he clenched his jaw and answered only that he was ‘doing everything possible’ to combat AIDS. Two years later he’d be declaring AIDS the world’s worst crisis, a ‘weapon of mass destruction’.

The Mail&Guardian published an opinion piece on 1 May 2000, Mbeki’s Aids letter defies belief, by some tired former pathology professor, one Michael Berger. Trading on his fading papers to sound authoritative, because it was quite evident that he hadn’t actually taken the trouble, as Mbeki had, to read into the matters about which he spoke, his article celebrated that characteristic old South African English attitude, with a veneer of reason covering snarling chauvinistic disdain. Compensating for his astigmatic inability to see what troubled Mbeki about AIDS ideologically, over and above the fact that the science was bad, Berger resorted to a series of banal, unexamined ex cathedra assertions, before sticking the knife in about his unhealthy ‘cast of mind’. He opened by asking,

what does one make of Mbeki’s implicit denial of the relevance of Western science and Western solutions? Does it imply a belief that the West’s view of Aids in Africa represents a racist attempt to “smear” African morals and culture? There is, indeed, a body of opinion, small and fringe though it may be, which claims that the current scientific view on the origin and spread of Aids in Africa is an attempt to portray Africans as immoral and addicted to sexual excess. By calling into doubt the central tenet of the current belief on the origins of Aids, namely, that it is a viral infection spread mainly by sexual contact, Mbeki is tacitly denying what he may see as a Western conspiracy against his continent. It seems to me impossible to reach a single conclusion; the letter admits of so many interpretations. Possibly, it doesn’t matter and the president’s motivations and reasons for writing in this vein were mixed. Whatever the full answer, the letter is deeply disturbing. It demonstrates a capacity for justifying the most unreasonable of positions by a brew of implausible appeals to populist sentiments and prejudices. It suggests a racial-based perspective, not uncoloured by paranoia. It is quite possible that overseas investors will see a link between Robert Mugabe’s cynical pre-election end-game to the north of us and the kind of imagery employed by Mbeki in his letter. But, more importantly, the mode of discourse reflected in Mbeki’s letter is no stranger to South Africa. Sober, reality-based assessment is cast aside in favour of ideologically driven rhetoric – as if the intensity of verbalised belief can supersede objective fact and rational argument and displace any unwelcome, internal doubts. And so it can in a limited sense, but at a great price to a vulnerable society which harbours such modes of thinking. It is not a great step from the limited issue of Aids to the wider political playing field. Surely the stakes are too high, for our country and Africa as a whole, for us to afford such propensities in ourselves or in our political leaders?

Princeton University demographer Robert Shell, then at Rhodes, picked up Berger’s basic implication and put it expressly later in the year, on 4 October: ‘The ANC must find a way to get Mbeki to resign. As far as HIV researchers are concerned, we would like him to go.’ Stefan Vella, Wainberg’s successor as president of the International AIDS Society, was reported on the radio asserting at the opening of the 14th International AIDS Conference in Barcelona on 8 July 2002 that recalcitrant political leaders not cooperating in implementing AIDS treatment programmes – he meant Mbeki – should be sacked. It was amazing. Like the Vatican in the old days vetting the appointment of kings and queens, the AIDS theocracy today decides who’s fit to govern. Depending on their beliefs.

On 7 May 2000 the Sunday Independent climbed into Mbeki about his letter too. On the basis of a series of false historical assertions (commonly called lies), liberal journalists Jeremy Gordin and Adele Sulcas rejected his appeal to his fellow heads of state for an open intellectual and scientific environment in which to address AIDS:

HIV/AIDS is not a freedom of speech issue. It is about scientifically verifiable facts. … What’s more, the various controversies taking place among scientists on HIV/AIDS ... took place six and ten years ago. The dissident scientists were not ... burnt at the stake or even silenced. In fact, they were initially paid a great deal of attention. But then they were proved to be unsound by contrary evidence and have remained silent ever since, until you [Mbeki], among others, recently provided them with a new forum.

Contrasting with all the incensed ‘AIDS experts’, GlaxoSmithKline, with the most on the line, preferred, for the public record, to keep things sweet. After meeting Mbeki in the UK in early May in the company of about fifty other business executives, its English chairman Sir Richard Sykes expressed his company’s sympathy for the laggard slow to get the hang of the game, and hoped that once he’d recovered from his perplexity, he might rejoin the team:

One could say most of the world recognises that HIV causes AIDS, and that treating people with drugs which are trying to keep it under control is a way forward. The President is trying to understand that, and we in the pharmaceutical industry hope he will come to that conclusion as he has these discussions, and hopefully we could move forward to deal with the situation. We believe that what he is trying to do is to get a clear understanding himself, so that when he gets that understanding, he will then say: ‘Okay, this is the problem, this is the cause and this is the way forward, and we are going to work in collaboration with others to try to deal with this important issue for South Africa.

By buying our drugs. Billions worth. Finally understanding. Moving forward.

The wonder of it was why there was so little Western interest in the content of the African politician’s dare concerning the safety and use of AZT, having regard to the published literature in the scientific and medical press to which he had called attention, and the obvious trouble with the HIV theory of AIDS model in the face of the glaring epidemiological discrepancies that he’d traced with some sarcasm in his confidential letter. There was lots of flash and noise in the responses, but nobody actually addressed the awkward points he was raising. Because he’s African? In a private note, a correspondent of mine in the US, Aiden Gregg, highlighted a revealing fact trite among social science researchers:

I agree with your description of the motives that impel orthodox AIDS scientists not to subject their research assumptions to rigorous standards of scrutiny. But what is interesting is that these motives do not seem to be operating at a wholly conscious level. It’s not often the case, I suggest, that mainstreamers plan their evasiveness in advance; rather it spontaneously emerges in the absence of any principled commitment to investigating the basis of HIV-skeptical position with thoroughness and even-handedness. Regrettably, people in a position of privilege and prestige don’t see the need even to ‘entertain’ radical proposals. One interesting parallel here is the social psychological research that shows that high-status individuals rely more on stereotypes in understanding the behavior of low-status people, whereas low-status individuals are more likely to use individuating information to understand the behavior of high-status people. Higher status means lower accountability, and lower accountability means there is less need to think deeply about an issue. It’s all about increasing accountability to compel intellectual engagement.

Engagement for starters perhaps with Brewer, Gisselquist and others – all basically AIDS orthodox – who, in the March 2003 issue of the International Journal of STD and AIDS, comprehensively reviewed and analysed the literature cited in support of the almost universally accepted theory that sex is the vector of HIV transmission in Africa, and found Mounting anomalies in the epidemiology of AIDS in Africa: Cry the beloved paradigm:

There is substantial dissonance between much of the epidemiologic evidence and the current orthodoxy that nearly all of the HIV burden in sub-Saharan Africa can be accounted for by heterosexual transmission and the sexual behaviour of Africans. … We propose that the existing data can no longer be reconciled with the received wisdom about the exceptional role of sex in the African AIDS epidemic. … Dispassionate assessment of our conclusions admittedly depends on a willing suspension of disbelief, since the current paradigm is deeply embedded.

Time and the BBC picked up the piece, and the Canadian Mail and Globe editorialised it, but between the ‘AIDS experts’ and journalists in South Africa, with everything to lose, it passed without a mention.

An article by Jon Cohen in Science at the end of April 2000, South Africa’s New Enemy criticised Mbeki for ‘publicly questioning whether HIV is the cause of the AIDS epidemic that is ravaging his nation’. It quoted his spokesman making an unfortunate statement – quite at odds with Mbeki’s own grip of the science and the fallacies of AIDS orthodoxy – that was seized upon and widely condemned by Mbeki’s detractors:

Parks Mankahlana, Mbeki’s spokesperson, confirms a widespread rumor that providing treatment to infected pregnant women worries the government because of the number of surviving orphans this policy would create. ‘A country like ours has to deal with that,’ insists Mankahlana. ‘That mother is going to die, and that HIV-negative child will be an orphan. That child must be brought up. Who’s going to bring the child up? It’s the state, the state. That’s resources, you see?’

But of course this was not how Mbeki saw it at all. He’d seen right through the ‘HIV-positive means you’re going to get AIDS and die’ myth, this business model of the pharmaceutical industry running the medical industrial complex.

Unable to stop the enquiry into their dark arts – whether in truth they were a deadly scam – South Africa’s AIDS mandarins snarled in the run-up to the first AIDS Panel meeting. ‘AIDS is ravaging this country, not only by consuming those who are in their most productive years, but ravaging it because of the drain it’s going to place on our economy.’ Mbeki’s open-ended approach to AIDS was ‘going to damn the next generation. …I think the President and this country will be judged by history for this folly,’ said Slim Karim. But he’d take part in the AIDS Panel meetings ‘to assist South Africa in coming out of this mess’. The one Mbeki had led the country into. Coovadia shook his head; Mbeki’s convention of his AIDS Panel ‘shows that politicians have a fundamental lack of understanding how science works’. University of the Witwatersrand Medical School Bioethics Professor Udo Schuklenk dismissed the dissidents as ‘a remote minority, a small sect’. Couldn’t these unbelievers see that HIV-fighting ‘drugs have been developed that keep people with AIDS alive, that give them a perfectly good quality of life, that bring them back to productive working lives’?

CHAPTER

Following Tshabalala-Msimang’s introductory address, Mbeki’s opening speech at the first meeting of his Presidential Advisory Panel on AIDS at the Sheraton Hotel in Pretoria on 6 May 2000 was extraordinary for its penetrating clarity, his common-sense bucking against AIDS orthodoxy where it so obviously took off from the facts, and his self-effacing ironic humour in typecasting himself as a fool for questioning it. I’ll admit that as I listened to him speak a few metres away, I lost control of my sluices:

I am indeed, very, very pleased that we have arrived at this moment and would like to welcome Stephen Owen [the moderator] and other distinguished people from outside our country, as well as the scientists from within our own country who are here. Welcome to what for us is a very important initiative. I am going to read a few lines from a poem by an Irish poet [and rebel], Patrick Pearce [just before the English shot him]. It will indicate some of what has been going through my mind over the last few months. The poem is entitled, ‘The Fool’ and it says: ‘Since the wise men have not spoken, I speak but I’m only a fool; A fool that hath loved his folly, Yea, more than the wise men their books or their counting houses or their quiet homes, Or their fame in men’s mouths; A fool that in all his days hath never done a prudent thing, ... I have squandered the splendid years that the Lord God gave to my youth in attempting impossible things, deeming them alone worth the toil. Was it folly or grace?’ I have asked myself that question many times over the last few months: whether the matters that were raised were as a result of folly or grace. You will remember the letter we sent inviting you to this meeting. It included a quotation from a report by the WHO on the global situation of the HIV/AIDS pandemic. It said that of the 5.6 million people infected with HIV in 1999, 3.8 million lived in Sub-Saharan Africa, the hardest hit region. There were an estimated 2.2 million HIV/AIDS deaths in the region during 1999, being 85% of the global total, even though only one-tenth of the world population lives in Sub-Saharan Africa. In addition, the report said there are now more women than men among the 22.3 million adults and one million children estimated to be living with HIV/AIDS in Sub-Saharan Africa. It was this situation, communicated to us by organisations such as the WHO and UN AIDS, which clearly said that here we have a problem to which we have to respond with the greatest seriousness. And, of course, among the Sub-Saharan Africans are the South African Africans, with millions of people said also to be HIV positive and also many people dying from AIDS. The Minister has indicated our response to this, so I won’t go over that ground. But it is important, I think, to bear it in mind because some have put out the notion that our asking certain questions in order to understand better and therefore be able to respond better, constituted an abandonment of the fight against AIDS. What the Minister has said indicates what we have indeed done. There are other things she didn’t mention including the allocation of dedicated funds in our annual budget specifically to address this issue. That is from the point of view of the national government, in addition to what other layers of government are doing. We believe that that response is important, and it is being carried out in an aggressive way, in a sustained way, and in a comprehensive way so that we do indeed respond to the picture that is painted by these figures. It was because it seemed that the problem was so big, if these reports were correct, that I personally wanted to understand this matter better. Now as I’ve said, I’m only a fool and I faced this difficult problem of reading all these complicated things that you scientists write about, in this language I don’t understand. So I ploughed through lots and lots of documentation, with dictionaries all around me in case there were words that seemed difficult to understand. I would phone the Minister of Health and say, ‘Minister, what does this word mean?’ And she would explain. I am somewhat embarrassed to say that I discovered that there had been a controversy around these matters for quite some time. I honestly didn’t know. I was a bit comforted later when I checked with a number of our Ministers and found that they were as ignorant as I, so I wasn’t quite alone. What we knew was that there is a virus, HIV. The virus causes AIDS. AIDS causes death and there’s no vaccine against AIDS. So once you are HIV positive, you are going to develop AIDS, and you are bound to die. We responded with that part of the response the Minister was talking about – public awareness campaigns, encouraging safe sex, use of condoms, all of those things. But as one read on, one noted that we had never said anything in all of this public awareness campaign, that people need to practice safe sex and use condoms in order to stop the other sexually transmitted diseases – syphilis, gonorrhoea and so on – as though these did not really matter. What mattered was this virus. As one read all of these things, one discovered what, as far as I know, was the first report published in our medical journals in this country about the incidence of HIV among our people in this part of the world. It was published in the South African Medical Journal in 1985. Among other things, that article said that groups at high risk of developing the acquired immune deficiency syndrome – AIDS – in the United States and Europe include homosexual and bi-sexual males; those who abuse intravenous drugs and haemophiliacs. The article further says that AIDS has been reported in Central Africa. However, homosexuality, drug addiction or blood transfusion have not been reported as risk factors in these patients. It has therefore been suggested that the agent causing AIDS is endemic in Central Africa. However, our preliminary data show that although individuals with antibodies directed against HIV are to be found in South Africa, these positive individuals only come from a high-risk group comprising male homosexuals. Individuals who did not belong to any of the known high risks groups did not have HIV antibodies. Our data, says the article, therefore suggests that the agent implicated in the causation is not endemic in Southern Africa. That was in 1985. And of course all of the other documentation that I’ve seen suggests that what was reported here in 1985 to be the risk group in this part of the world, remained the risk group in the United States and Western Europe with a preponderance of these infections being among homosexuals and therefore by homosexual transmission, as it is said, of the virus. But according to these reports, clearly something changed here. In a period of maybe five, six, seven years after 1985, when it was said that such transmission in this region was not endemic in Southern Africa, there were high rates of heterosexual transmission. Now as I was saying, being a fool I couldn’t answer this question about what happened between 1985 and the early 1990s. The situation has not changed in the United States up to today, nor in Western Europe with regard to homosexual transmission. But here it changed very radically in a short period of time and increased very radically in a short period of time. Why? This is obviously not an idle question for us because it bears very directly on this question: How should we respond? There has been this change, for reasons I can’t explain but you, as scientists, surely would be able to explain. Why this change? What therefore is our most appropriate response? And so we started communicating with some of the people in this room, to ask what is the cause? There is a whole variety of issues that the Minister of Health has just said she will not comment upon, which also I will not comment upon because they are very much part of the subject of your discussions. We were looking for answers because all of the information that has been communicated points to the reality that we are faced with a catastrophe, and you can’t respond to a catastrophe merely by saying I will do what is routine. You have to respond to a catastrophe in a way that recognises that you are facing a catastrophe. And here we are talking about people – it is not death of animal stock or something like that, but people. Millions and millions of people. Somewhat of a storm broke out around this question, which in truth took me by surprise. There is an approach which asks why is this President of South Africa trying to give legitimacy to discredited scientists, because after all, all the questions of science concerning this matter had been resolved by the year 1984. I don’t know of any science that gets resolved in that manner with a cut-off year beyond which science does not develop any further. It sounds like a biblical absolute truth and I do not imagine that science consists of biblical absolute truths. There was this very strong response saying: don’t do this. I have seen even in the last few days, a scientist who I’m quite certain is eminent [Mark Wainberg, president of the International AIDS Society] who said that perhaps the best thing to do is that we should lock up some of these dissidents in jail and that would shut them up. It is a very peculiar response but it seemed to me to suggest that it must surely be because people are exceedingly worried by the fact that large numbers of people are dying. In that context any suggestion whatsoever that dealing with this is being postponed because somebody is busy looking at some obscure scientific theory, is seen as a betrayal of people. Perhaps that is why you had that kind of response which sought to say: let us freeze scientific discourse at a particular point; and let those who do not agree with the mainstream be isolated and not spoken to. Indeed it seems to be implied that one of the important measures to judge whether a scientific view is correct is to count numbers: how many scientists are on this side of the issue and how many are on the other – if the majority are on this side, then this must be correct. In the end, what I’m saying is that as Africans we want to respond to HIV/AIDS in a manner that is effective, a manner that does indeed address the fact of these millions of lives that are threatened. As I noted, the WHO says that in Sub-Saharan Africa, 2 million people died in 1999 alone. It is truly our hope that this process will help us to get to some of the answers, so that as public representatives we are able to elaborate and help implement policies that are properly focused, and that actually have an effect. I’m quite certain that given the people who are participating in this panel, we will get to these answers. And so you see why I’ve been thinking over this matter over the last few months that perhaps I should have allowed the wise men to speak. Indeed when eminent scientists said: ‘You have spoken out of turn,’ it was difficult not to think that one was indeed a fool. But I am no longer so sure about that, given that so many eminent people responded to the invitation of a fool to come to this important meeting. Welcome and best wishes. Thank you very much.

Who dropped the ball I don’t know, but vital to the plan for the conference of orthodox and dissident scientists that Turner had proposed was the adjudication of the issues being raised by the dissidents – as essential as baking powder in the birthday cake. But there was none. In Turner’s correspondence with Allen, he’d emphasized the need for an adjudicator to try the rival cases, and proposed ten scientists from each camp, including Nobel laureates, to present them. A clue to the reason why no such adjudicating board was appointed lies in the fact that, as Tshabalala-Msimang pointed out when the decision to convene the panel was announced, she expected the ‘top scientists’ on the panel to arrive at a consensus. But it was entirely unrealistic, as events were to show, to expect that professionally and financially invested ‘AIDS experts’ could be persuaded to surrender their dogmas by way of reasoned debate. Presiding at the AIDS Panel meetings instead, we got an ever-smiling law professor from Canada, Stephen Owen of the Institute for Dispute Resolution at the University of Victoria, British Columbia, keeping things polite and Canadian. That was it. The result was that the controversy was left in the air. Entirely defeating the purpose. Turner described the lost opportunity as ‘a great pity’. Putting it mildly. On a personal note, I was so dismayed by this basic blunder that I decided against attending. An invitation to dinner with the dissidents changed my mind. I drove up on Friday 5 May 2000, and was glad I did. The reception I got all round gave me an instant recharge. As did the camaraderie and opportunities to strategise and philosophize day and night over the rest of the weekend. And likewise at the second meeting in July, which I attended as an accredited observer.

It was fortunate that Owen wasn’t asked to decide anything. Because it was quickly obvious that he didn’t know what was going on, that he’d arrived with a complete misconception of the colloquium’s purpose, that he lacked any appreciation of the basic scientific issues being raised, and that his head was filled with the drama painted in the newspapers, which he’d never paused to question. As revealed by his statements to the press after the first day: ‘So far there has been abundant evidence of a connection between HIV and AIDS but how direct the connection is, is not known. [Despite the disagreements between the orthodoxy and the dissidents] there is an awareness of the critical need for action. We cannot simply wait. There is a recognition among both sides that they have to act on the best evidence.’ The kind of mindless talk lawyers get paid for. Smiling. Sitting with Mbeki after the second meeting, he advised him (to quote an orthodox panellist in the Mail&Guardian on 8 September) ‘to push forward with the five-year plan, to say he had now heard all sides, that the government would be doing everything including the use of ARVs, and that he would advise Mbeki to look into parallel importation and compulsory licensing’. Never mind that the fundamental causation dispute remained unresolved.

Mbeki’s convention of orthodox and heterodox medical and scientific experts to debate their disagreements about the cause and treatment of AIDS was spurned by the former. With the notable exception of Robert Gallo, who stayed away to evade Duesberg’s embarrassing questions, they came, but they wouldn’t answer the dissidents’ challenges. So as the debating chamber it was intended to be, the exercise was largely a flop, an unrequited offer to engage, a one-way flow of ideas. Coovadia commented spot-on: ‘I knew we would learn nothing from them. We were talking past each other. It was as absurd as talking between people who believe in God and those who don’t.’ Yes it was. The orthodoxy would not or could not talk to the problems raised by the dissidents, both at the meetings and in a closed Internet forum. It was all soapbox grandstanding. For instance, in his response to Duesberg’s point that nothing happens in cell cultures purportedly inoculated with HIV, I watched Clifford Lane, deputy director of the US National Institute for Allergy and Infectious Diseases (NIAID), and co-author, with director Anthony Fauci, of the AIDS chapter in Harrison’s Internal Medicine, swaggering like John Wayne, although himself built like a mosquito: ‘Come over to my lab and I’ll show you HIV burning its way through CD4 cells.’ Overlooking that HIV expert Simon Wain-Hobson of the Pasteur Institute in Paris had already conceded years earlier in Nature in January 1995: ‘An intrinsic cytopathic effect of the virus is no longer credible’; that Luc Montagnier of the same place, now generally credited with having first ‘discovered HIV’, has long asserted that HIV needs ‘co-factors’ to do its harm; and that HIV is supposed to be a lentivirus, dormant for years. (A new model proposing HIV to be hyperactive from the onset of infection quickly collapsed under orthodox criticism.)

A year and a half after Lane’s macho talk in Johannesburg, Gallo was in India attending an AIDS conference. Interviewed by the Indian Express on 19 December 2001, he was asked first off: ‘What’s your current research about?’ He admitted in roundabout style that two decades after alleging that he’d discovered the cause of AIDS, he still lacked a basic model of pathogenesis: ‘I and my team of scientists are trying to find out how HIV causes AIDS and devise better ways to treat it’ – signalling his own appreciation that this idea of his that HIV kills CD4 cells and then leads to the onset of any one of about thirty opportunistic illnesses, is insupportable. And that the drugs have way outlived their shelf-life. An article in Nature Medicine in July 2003, HIV-1 pathogenesis, by Mario Stevenson, confirmed that nobody really knows how or why HIV causes illness: ‘Despite considerable advances in HIV science in the past 20 years, the reason why HIV-1 infection is pathogenic is still debated and the goal of eradicating HIV-1 infection remains elusive.’

A surprise last-minute arrival at the first panel meeting raised a few eyebrows: four American ‘AIDS experts’ pitched up unannounced to listen in quietly on the last day of the meeting – all suitably dark-faced to kind of blend in with the locals. Word was that Clinton had asked Mbeki if he might send some of his people over. ‘That’s the United States AIDS forces coming in,’ remarked Duesberg laconically. ‘It seemed like they were there to observe,’ said Rasnick. Evidently Clinton was rattled by what Mbeki was doing, the threat he was posing, the trouble he was causing.

Mandela, for one, initially stood apart from the general condemnation of his successor. During a trip to the US in mid-May, a group of university students in New York asked his opinion of Mbeki’s conduct in enquiring about the safety of AZT and in convening his AIDS Panel. He answered that Mbeki had ‘done his homework before going public’. Such kind words would soon dry up.

On the 21st Clinton formally received Mbeki at the White House on his first official visit to the US. Mbeki asked Clinton for US support, ‘whatever our differences’ concerning his government’s approach to AIDS in South Africa – whatever Clinton’s appalling recent discourtesy to him. But the Americans had only one thing on their minds: unblocking the drug pipe, as their Surgeon General David Satcher announced in a press statement a couple of days later. US officials had questioned Mbeki about his position on AIDS, he said, and had ‘talked to’ him about his decision to deny AZT to pregnant women on the grounds of cost and toxicity. ‘We expressed concern about that. We’ve expressed our concern about babies born that could be saved.’ Zuma noticed: ‘All that people care about is this AZT – nobody asks me what we are doing to make sure the babies survive [thereafter]. It is fuelled by the argument that we need more to buy more drugs, rather than saving children’s lives.’ Challenged regarding his position on AZT, Mbeki disputed that he’d ever made the categorical statement that it was ineffective: ‘I never said that. Pure invention. Pure invention.’ Indeed he hadn’t, his style in the controversy being to raise questions rather than assert positions.

Among those who’d taxed Mbeki on his fresh approach to AIDS while he was over in the US were Vice President Al Gore and Secretary of Health and Human Services Donna Shalala. The latter later recalled: ‘Thabo Mbeki – I do not believe he was in denial as much as he saw it as a conspiracy, a much more traditional African response. Both Vice President Gore and I argued with passion with him to move on this issue. And you know, we had polite responses. … He simply listened politely and basically said to us, “We understand what we need to do in our country,” and, “Thank you very much.”’ To Mbeki’s ‘more traditional African’ mind, AIDS was all a conspiracy, she thought.

The centrality in the AIDS controversy of the tussle over providing AZT to pregnant women was summed up in the title to Carol Paton’s report of the trip in the Sunday Times on 4 June: Glaring omission mars Mbeki’s defence to the Americans of his stance on AIDS. Mbeki gave a good account of his reservations about the conventional HIV/AIDS model and the drug approach to it, she wrote, and notwithstanding them, the government was running a large-scale awareness campaign in collaboration with ‘civil society’. She reported him explaining that the provision of AIDS drugs to all those infected, even were their cost to be cut by up to eighty-five per cent, would consume the entire health budget. And as the drug manufacturers themselves admitted, patients on such drugs needed constant monitoring, something for which the country lacked the infrastructure. Mbeki then raised again the unexplained paradox that, whereas in the West, AIDS was largely confined to gay men, in Africa it was a heterosexual affair. He said he was also puzzled why in 1985 South African ‘AIDS experts’ had claimed that there was no AIDS epidemic here, but that just five years later they were saying that the disease was completely out of control.

South Africa’s most eminent liberal journalist and former newspaper editor, Allister Sparks, happened to be in Washington when Mbeki flew in, all wound up by the story that his colleagues had turned out concerning the home ‘country riven by ... the terrible unmanageable HIV/AIDS pandemic’, as he described it in Beyond the Miracle, ‘which had swelled into a massive epidemic in South Africa on a scale that threatened the whole future of the country’. His knickers in an awful knot over Mbeki’s AIDS doubts, especially his recent letter conveying them, Sparks considered that Mbeki had foolishly created ‘a situation that cried out for damage control’, and that he, Sparks, was just the man to fix it. So the bull-frog of South African journalism hopped over to see South African ambassador Sheila Sisulu, to burp out his proposal that Mbeki come over to the National Press Club’s Washington auditorium to ‘clarify his position. … He would be able to reach the whole world at once and put the issue to rest with a simple statement that could go something like: “Of course I believe HIV causes AIDS, but in South Africa we have some special circumstances which I will now tell you about…”’ But Sparks’s hopeful mission was answered with no more than a biscuit and a cup of tea and an explanation of Mbeki’s position on AIDS that confused him even further.

As it turned out, Mbeki had his own plans to clear the air. Since the Washington Post had given him a pounding after Clinton leaked his letter, he agreed to an interview by its correspondents in South Africa two weeks before his trip. ‘It seems to me that everybody in government should try to understand this thing as thoroughly as possible so that we can respond to this issue. There are real, genuine scientific questions recognized by scientists that need to be resolved,’ he told them. But Mbeki’s careful elucidation of the reasons for his questioning stance in relation to AIDS orthodoxy fell on deaf ears. Asked whether the country could afford his cautious, questioning approach when activists were claiming that about one-and-a-half thousand South Africans were being infected daily, he retorted impatiently: ‘How is that figure derived? Do you know? I don’t know.’ The Washington Post certainly wasn’t interested in ‘understanding this thing as thoroughly as possible’ – even less Mbeki’s assertion that there were unresolved ‘scientific questions’, with its implication that American scientists had it all fucked up. On 16 May, about a week ahead of his visit, the newspaper criticized him again in Mbeki vs. AIDS Experts: S. African’s Radical Views on Epidemic Baffle Allies:

In a country with one of the world’s fastest-spreading AIDS epidemics, the restlessly curious Mbeki has repeatedly ignored medical consensus and shrugged off price discounts offered by pharmaceutical companies, steadfastly refusing to distribute antiretroviral medicines, such as AZT, to South Africans infected with the AIDS virus, HIV. … [Mbeki] is revisiting a question that most medical experts had considered long closed: Does HIV cause AIDS? In doing so, he has alienated and mystified a broad range of political allies, advisers and even friends who held him in high regard.

The piece closed with an effulgent offering from the director of the Paediatric AIDS Unit at Johannesburg’s Chris Hani-Baragwanath Hospital, Glenda Gray: ‘“We have 600,000 children admissions each year. … Forty percent of those children are HIV positive. We’re spending a lot of time and resources every day dealing with something that is almost preventable.” She paused. “If they’re not going to provide us with AZT,” she said, “then the best thing that the government can do is to ask us to strangle them all at birth.” Yes dear.

After seeing the Washington Post hash it, Mbeki tried explaining his case to the newspaper again, this time briefing its editors at a meeting over lunch. But, as they told Sparks, they were left as ‘baffled and critical’ as before by his ‘convoluted and obscure’ explanation of his approach. Mbeki had yet another go at explaining his position on the television programme NewsHour with Jim Lehrer. Asked, ‘You have said you were mischaracterized in some of the comments you said about the relationship between HIV and AIDS … Exactly where do you stand?’, Mbeki replied:

Well, yes. I don’t know where these reports came from that we are taking a position saying there is no connection between HIV and AIDS. I never said it. At the beginning of this month, the month of May ... a group of scientists came to South Africa representing the different points of view with regard to these matters. One of the results of which was that the Centers for Disease Control would host a process ... so that they can work out these matters that are outstanding with regard to HIV/AIDS, because we need more information so that we can act more vigorously and more effectively.

Without quoting him to enable readers to decide for themselves, Sparks condemned Mbeki’s direct answer in his book as ‘evasive’, even as he conceded elsewhere: ‘A close scrutiny of all Mbeki’s speeches on the subject shows that he has never denied that HIV causes AIDS.’

Although Paton reported that ‘By the middle of his US tour, sentiment in the media showed signs of becoming more even’, the Mail&Guardian played up the negative press that Mbeki drew in an article the week after the Washington Post piece, quoting a particularly insulting charge, and falsely claiming it was typical: ‘A week ago New York Newsday spoke for much of American opinion when it said: “A certain open-mindedness is fine. But a person can be so open-minded that his brains fall out. At worst Mbeki is a callous demagogue – skilfully diverting attention from a public health crisis he can’t control. Or maybe he’s a misguided fool. In any case he’s in deep trouble.”’ To which, editor Barrell added the thoughtful counsel: ‘Mbeki should step back, leave science to the scientists and – for God’s sake, Mr President – look after the politics.’

On the 25th, before leaving the US, Mbeki popped in to see Presidential candidate George Bush, then Governor of Texas, who received him at the Governor’s Mansion. They seemed to have hit it off on a personal level. Certainly Bush appears to have been mighty taken by Mbeki. When they met again at the White House a year and a month later, Bush, now in office, positively glowed with personal warmth at their press conference: ‘It is my honour to welcome President Mbeki to the Oval Office. It’s good to see you again, Sir. The last time we visited was in the Governor’s Mansion in Texas. … I’m so glad you’re here.’ It was the same press conference vibe again when Bush visited Mbeki on 9 July 2003:

Mr President, thanks. Gosh, we’re honoured to be here. Thank you for your wonderful hospitality. … I appreciate our strong relationship – and it is a vital relationship. Mr President, I want to thank you very much for working hard to make it a vital and strong relationship. We’ve met quite a few times in the recent past, and every time we’ve met I’ve – I feel refreshed and appreciate very much your advice and counsel and your leadership. … I want to thank you for your friendship, appreciate the hospitality. It’s been a great honour to be in your country.

It was enough to put a tear in the eye. Then again, more seriously, Mbeki’s successful early courtship of Bush in anticipation of the latter’s presidency revealed his genius for long-term strategic scheming, because by concertedly establishing and nurturing a tight personal rapport with Bush, he pre-emptively neutralised the likelihood that, in asserting the interests of the Developing World against the First’s, he’d spark a full-bore US intelligence-orchestrated campaign to discredit him and bring him down. Hence his confidence in later openly deploring the imminent invasion of Iraq, and then after it, obliquely but unambiguously and sharply knocking the US in a plea for reform of the UN made in a speech to the General Assembly on 23 September 2003: for the UN to meet its challenges, all countries, both rich and poor, both the powerful and the disempowered, should commit themselves to act in a manner that recognised

none of us is an island, sufficient unto themselves. … What we have said today may not be heard because we do not have the strength to have our voice heard. Tomorrow we may be obliged to say – no more water, the fire next time. As the fires burn, the UN will die, consumed by the flames. … We must act together to say in our words and our actions, as countries and as the UN, there will be water next time not fire.

Tshabalala-Msimang delivered her Health Department’s Budget Speech for 2000/2001 on 6 June, and in it she raised her big concern:

As you will recall that in October last year whilst addressing the NCOP, the President raised some concerns about reported toxicity of the antiretrovirals. He then tasked me to investigate this matter. Flowing from that call, I requested the Medicines Control Council to do a risk benefit analysis particularly on AZT with priority given to its use in MTCT [during pregnancy]. A similar request was sent to the Cochrane collaboration centre located at the MRC. I have previously mentioned that the first reports of the MCC were unsatisfactory in that they did not address the fundamental questions I raised. In its final report the MCC concluded that it is of the view that the benefits of AZT use outweigh its risks in the case of MTCT. However the MCC also did point to the fact that the long term effects of AZT on the children exposed have not been established. Incidentally, a similar observation is made by the manufacturers of this product in the package insert. I believe we should reflect on the totality of this information as we grapple with the difficult decision on the options available to us on the pressing challenge of reducing MTCT. This is particularly so when some of the babies to be exposed (70 to 75%) would be uninfected without our intervention with these drugs. As previously indicated, we shall again consider all these factors together with the cost implications when we receive the report on the SAINT studies from our researchers in our next MINMEC [meeting with her provincial health ministers].

As the 13th International AIDS Conference in Durban in July 2000 approached, the Mail&Guardian berated Mbeki further. Two days before Mbeki opened the conference on the 9th, editor Barrell wrote a hoity-toity editorial entitled The death sentence has been brought back. As a vignette encompassing the ignorance, the mythmaking and the sentiment of the white liberal press around AIDS it was a beaut. It also bore out that old adage about failed and frustrated writers becoming journalists:

There is really no time left in which to dodge around the truth. South Africa has reimposed the death sentence. Once a world leader in judicial executions – until the moratorium of 1989 put a stop to hangings – the new South African government has brought back executive killing with a harsh vengeance. But this is not the execution of criminals, no mercifully ruptured neck. Those now condemned to die are the innocent: newborn babies who, by anti-retroviral drug intervention, could be saved from contracting the HIV from their infected mothers. The total number of babies consigned to this grotesque new ‘death row’ now exceeds 100 000; a figure which increases by about 2 500 a month. The lucky babies are already dead. Those who remain look forward to brief and wretched lives, to miserable and pitiful deaths. The life expectancy of a baby infected with the HIV can be as much as eight years. Some succumb much sooner, a quarter of their number die within 18 months. But they all eventually will die and their deaths are protracted and miserable. The emotional devastation to their parents and families can have no measure. Many babies will simply be abandoned. In the words of a paediatrician, working in a public hospital in Johannesburg: ‘A far more humane option would be to put these HIV-infected babies to a painless death as soon they were proved to be carrying the virus. To subject them to inevitable and such terrible suffering is beyond human belief.’ For the past four years the South African government health service has been steadfast in its refusal to sanction the use of appropriate drugs in these cases. It continues to do so in the face of overwhelming medical testimony. It dilly-dallies and it procrastinates, it obfuscates and it blatantly lies. This ‘policy’ is not only approved by the South African president, it is encouraged and amplified by him. It is pointless yet again to canvass the consummate futility of the South African government in its handling of the HIV pandemic. The invidious mismanagement is of record. Although the Deputy President, Jacob Zuma, recently claimed a 90% success in the ‘awareness campaign’, there are 1 700 new HIV infections a day – 200 higher than last year, and rising. South Africa has by far the worst record in Africa – if not the world. To call the government’s handling of the HIV/Aids crisis a disaster would be to praise it. The South African public health service caters to the poorest. Hence, the estimated 100 000 South African babies who have either already died or are in the awful process of doing so, are African. Any medical management which might reduce this inhuman statistic has been put on hold until such time as the health authorities yet again have patiently reassessed their policies, indulged in the luxuries of further debate, installed what new committees they deem, have sat around and worked out what new alibis they might propose for their almost utter lack of practical action. The high cost of anti-retroviral drug treatment is the excuse most usually flown in defence of the government’s refusal to save the lives of these babies. What brand of obscene bureaucratic diffidence states a ticket price for a life? ‘We’re sorry about your baby having to die. The cost of his life was just outside this year’s budget.’ Such cold indifference to human response is called the Nuremberg option. What is extraordinary is why the whole disgrace has yet to be brought before the South African Constitutional Court. The relevant clause in the Constitution includes the guarantees: Everyone has the right to have access to Health Care Services, including reproductive health care and no one may be refused emergency medical treatment. It can be argued that an unborn baby at risk of contracting the HIV is a medical emergency. As is now plain for all to see, President Mbeki and his advisers have painted themselves into a corner. There is no way out which will not result in major retractions by the president and his minions. What Mr Mbeki might try to remember, as he vacillates and coddles Irish martyr poetry, is that for each hour that he does nothing, another four black children struggle to draw breath, puke and ache, their skins festered, their mouths filled with ulcers, their bodies racked with disease – living skeletons as they approach a suffocating death. These are the children condemned who, by drug intervention, could have been saved from contracting the HIV. These are also the apparently acceptable price for the president’s face.

These are also the sapient insights of Mail&Guardian editor Howard Barrell, shared with the nation for Mbeki’s notice – all flowing from the universal supposition, preached by ‘AIDS experts’, that giving pregnant black women AZT saves their babies’ lives. Without which they soon leave for the next world in a spectacular show that the plague is upon them.This was the journalism of the liberal press at it moral zenith. In the purple style of Edgar Allen Poe, writing in The Masque of the Red Death in Tales of Mystery and Imagination:

The ‘Red Death’ had long devastated the country. No pestilence had ever been so fatal, or so hideous. Blood was its Avatar and its seal – the redness and the horror of blood. There were sharp pains, and sudden dizziness, and then profuse bleeding at the pores, with dissolution. The scarlet stains upon the body and especially on the face of the victim were the pest ban which shut him out from the aid and sympathy of his fellow-men. And the whole seizure, progress, and termination of the disease, were the incidents of half an hour.

Like The death sentence has been brought back, a thrilling read.

Rather than answering the challenges to their doctrines posed by the dissidents given a forum by Mbeki, and exposing themselves to the risk of ridicule and redundancy in their jobs, with the loss of power and privileges that would entail, activist medical clerics took to politics, by way of secret plotting in medieval style. They decided to publish a joint confession of faith by as many of the clergy as possible, and grandly too, in Nature, the world’s most haughty scientific journal, giving their ‘Durban Declaration’ the pomp of an encyclical, even though its plebeian expression and coarse conceptual shape created the impression that it was a first draft turned out in a hurry by someone other than a scientist. The idea was that by sheer weight of their numbers, the roar of their clamour would drown out the heretic voices. The Pasteur Institute’s Wain-Hobson in Paris recruited some cardinals and big orders to lend their names to the committee’s masthead to thunder nicely, and then circulated an email chain letter that read like this: ‘

The object is to get as many names of scientists and doctors to sign on. Names of signatories will appear on the Nature website. If you would like to sign on, we would be delighted. Send me an e-mail confirming this. To economize space on the website, we have to name people in a single line. Many of you will say that HIV/AIDS is not your area. However, over the years you have heard enough of the arguments to understand the association. Furthermore, many of you know well infectious diseases and understand Koch’s postulates. If you have colleagues in the laboratory or in the clinic who you feel would like to sign, please ask them. The more the better. However, please note that in order to be authoritative we feel it necessary to restrict the list to those with major University qualifications. Please do not ask students. Apologies for this. We would need email replies as soon as possible and before June 27. Finally please do not talk to reporters about the Durban Declaration until Nature publishes it. If you are asked by a member of the press, just say “I’d be pleased to talk to you about this, but I’m afraid I am not at liberty to do so at the moment”. Please could you point this out to others who wish to sign on. Many thanks, Simon Wain-Hobson on behalf of the organizing committee – The Durban Declaration.

The preamble to the Durban Declaration, published on 6 July, read:

The declaration ... was stimulated by the current controversy in South Africa about whether HIV is the cause of AIDS. This has caused massive consternation among all scientists, doctors and many others in the international community who treat AIDS patients or who work on AIDS in other ways. There is widespread anxiety that denying or doubting the cause of AIDS will cost countless lives if blood screening, use of condoms, and methods to prevent mother-to-child transmission of the virus are not implemented or, worse, even abandoned. The declaration has been signed by over 5,000 people, including Nobel prizewinners, directors of leading research institutions, scientific academies and medical societies, notably the US National Academy of Sciences, the US Institute of Medicine, Max Planck institutes, the European Molecular Biology Organization, the Pasteur Institute in Paris, the Royal Society of London, the AIDS Society of India and the National Institute of Virology in South Africa. In addition, thousands of individual scientists and doctors have signed, including many from the countries bearing the greatest burden of the epidemic. Signatories are of MD, PhD level or equivalent, although scientists working for commercial companies were asked not to sign. The Durban Declaration has an organizing committee of over 250 members from over 50 countries.

The Durban Declaration comprised seven articles of belief – basically that HIV causes AIDS, the tests are good, you’ll die without the drugs, and so on, ludicrously inadequately referenced, and warning again, ‘It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives.’ (‘The New York Times Declaration’, published on 9 July by the same crowd, made the same claim in its subtitle: HIV causes AIDS. To argue otherwise costs lives.) But the conclusion of the Durban Declaration conceded, in effect, that to date the joint endeavours of the ‘AIDS experts’ all over the world had been perfectly futile. Their medicine hadn’t turned out any good, so the only thing for it was to stop the disease by non-medical interventions. By public health propaganda exhorting us all not to do it. But wear condoms, if we absolutely can’t help ourselves.

The inherently political rather than scientific character of the whole affair was given up by its propagandic language, along with a big, bright colour portrait of five happy black children, captioned: ‘Future orphans? The death toll from AIDS in Africa will be enormous unless action is taken now.’ But the point of the exercise was to swamp the dissidents by calling out a mob swelled by folk invited to sign up with no knowledge of the topic, all pointing to the authority of their eminences atop the list, and not wheedle for yet more government money. Responding to rumours about the document, Coovadia claimed confidentiality: ‘All I can say is that it … will be released at a time when it will get maximum publicity.’

Seeing it for the foolish, unscientific stunt it was, Mbeki let it be known through his spokesman: ‘If the drafters of the declaration expect to give it to the President, or the government, it will find its comfortable place among the dustbins of the office.’ Mbeki had only to say boo, and it crumpled up and died. (In fact there was a bit more to the statement than the bit quoted in the media, which left out that if the signatories thought they could bypass the AIDS Advisory Panel in this way, the declaration would be thrown out.) A press conference at the Durban AIDS Conference, at which the petition was to be formally presented, was cancelled. Mbeki had called it ridiculous, and that was the end of it. Because it was. Not only ridiculous, personally contemptuous: among the signatories were both local and foreign members of his AIDS Advisory Panel – announcing that it was a dangerous waste of time (‘a few vocal people continue to deny the evidence. This position will cost countless lives.’).

The Perth Group’s detailed rebuttal of the claims made in the Durban Declaration was rejected as usual by Nature – no room it said, but it subsequently published a brief letter. In a private note, Turner commented on the mark:

In many ways the Durban Declaration is reminiscent of the ‘Bishop’s licence’, the practice adopted by Pope Innocent VIII in the fifteenth century of declaring which authors may be read and which may not. The Bishop’s licence was the immediate forerunner of the Index Librorum Prohibitorum or ‘Guide to Prohibited Books’ drawn up by Pope Paul VI in 1557. Of course such attempts at censorship proved ineffective and if anything turned banned authors into ‘forbidden fruit’. But at least the Vatican had the decency to publish the names of the books along with their authors. The Durban Declaration made no such concession. Anyone seeking education or enlightenment could not claim any bounty from Nature. The shutters were down, the doors were bolted and no one was talking back.

It was a disgraceful episode but an instructive one. The rough weave of the language in which the declaration was set closely matched that of Wain-Hobson’s chain-letter, supporting my surmise that he’d knocked out the declaration too. Despite its striking crudity and its fundamentally unscientific character, the professional ‘AIDS expert’ had no difficulty garnering many thousands of open votes, and then publishing his dismal manifesto as a scientific statement in Nature. In sum, the Durban Declaration was another notable illustration of how mediocrity thrives in the AIDS era, and how AIDS has corrupted modern science. The pattern seems to be that dim men with bad ideas sold with lots of flash make the big deals.

CHAPTER

The 13th International AIDS Conference opened in Durban on Sunday evening, 9 July 2000. I was there. It was unbelievable. Even credulous AIDS-buff Robert Kirby was revolted, and said so in his TV column Channelvision in the Mail&Guardian the following week:

You would hope that after all the controversy, after all the monstrous, grotesque mismanagement by the South African government of the HIV/Aids scourge, after all the lies and the misdirection, the whole cruel disaster, someone with a little discretion, a soupçon of good taste and reserve, would have decided that enough was enough: that a serious international conference about one of mankind’s worst plagues should be afforded an equally serious opening formality.

But uh-uh:

It was about as inapposite and tasteless a display of garish effects as you could imagine. … [a] mega-kitsch display of Las Vegas bojo effects and gymnast-and-veil routines. This was the opening to an international science conference, not a soccer tournament. All it lacked was a fireworks display and some parachutists. Maudlin lyrics, no matter how dressed up and bellowed out they are, remain maudlin lyrics. Stunningly sentimental “poetry” mouthed in a trembling voice to subtle touch-screen graphics does not alter the flabby banality of its content. Whoever said that the disciplines of fascist display-art died with the führer was very wrong.

In a comment on its website, pro-AIDS drug activists in ACT UP New York concurred in Kirby’s pan of the show as

literally a made-for-television ‘Wonderful World of Color does AIDS’ telecast. The audience was ‘warmed-up’ by a television producer asking people to raise signs reading ACT UP (distributed as they entered the stadium) and pleading to everyone to shout out ‘ACT UP’ followed by a minute of silence. Then the telecast extravaganza began ‘live’ with music, dancing and drummers in traditional costumes on stage and suspended in the air in front of a huge chorus with a backdrop of projected images of children with AIDS. There were fireworks and fog machines and the opening address by the President of South Africa.

Followed by enormous red balloons released to bounce over the heads of the crowd. We all had such fun bumping them on. The only dampener on things was Mbeki’s opening address:

On behalf of our government and the people of South Africa, I am happy to welcome you to Durban and to our country. You are in Africa for the first time in the history of the International AIDS Conferences. We are pleased that you are here because we count you as a critical component part of the global forces mobilised to engage in the struggle against the AIDS epidemic confronting our Continent. The peoples of our Continent will therefore be closely interested in your work. They expect that out of this extraordinary gathering will come a message and a programme of action that will assist them to disperse the menacing and frightening clouds that hang over all of us as a result of the AIDS epidemic. You meet in a country to whose citizens freedom and democracy are but very new gifts. For us, freedom and democracy are only six years old. The certainty that we will achieve a better life for all our people, whatever the difficulties, is only half-a-dozen years old. Because the possibility to determine our own future together, both black and white, is such a fresh and vibrant reality, perhaps we often overestimate what can be achieved within each passing day. Perhaps, in thinking that your Conference will help us to overcome our problems as Africans, we overestimate what the 13th International AIDS Conference can do. Nevertheless, that over-estimation must also convey a message to you. That message is that we are a country and a Continent driven by hope, and not despair and resignation to a cruel fate. Those who have nothing would perish if the forces that govern our universe deprived them of the capacity to hope for a better tomorrow. Once more I welcome you all, delegates at the 13th International AIDS Conference, to Durban, to South Africa and to Africa, convinced that you would not have come here, unless you were to us, messengers of hope, deployed against the spectre of the death of millions from disease. You will spend a few days among a people that has a deep understanding of human and international solidarity. I am certain that there are many among you who joined in the international struggle for the destruction of the anti-human apartheid system. You are therefore as much midwives of the new, democratic, non-racial and non-sexist South Africa as are the millions of our people who fought for the emancipation of all humanity from the racist yoke of the apartheid crime against humanity. We welcome you warmly to South Africa also for this reason. Let me tell you a story that the World Health Organisation told the world in 1995. I will tell this story in the words used by the World Health Organisation. This is the story: ‘The world’s biggest killer and the greatest cause of ill-health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given the code Z59.5: extreme poverty. Poverty is the main reason why babies are not vaccinated, why clean water and sanitation are not provided, why curative drugs and other treatments are unavailable and why mothers die in childbirth. It is the underlying cause of reduced life expectancy, handicap, disability and starvation. Poverty is a major contributor to mental illness, stress, suicide, family disintegration and substance abuse. Every year in the developing world 12,2 million children under 5 years die, most of them from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they are poor. Beneath the heartening facts about decreased mortality and increasing life expectancy, and many other undoubted health advances, lie unacceptable disparities in wealth. The gaps between rich and poor, between one population group and another, between ages and between sexes, are widening. For most people in the world today every step of life, from infancy to old age, is taken under the twin shadows of poverty and inequity, and under the double burden of suffering and disease. For many, the prospect of longer life may seem more like a punishment than a gift. Yet by the end the century we could be living in a world without poliomyelitis, a world without new cases of leprosy, a world without deaths from neonatal tetanus and measles. But today the money that some developing countries have to spend per person on health care over an entire year is just US $4 – less than the amount of small change carried in the pockets and purses of many people in the developed countries. A person in one of the least developed countries in the world has a life expectancy of 43 years according to 1993 calculations. A person in one of the most developed countries has a life expectancy of 78, a difference of more than a third of a century. This means a rich, healthy man can live twice as long as a poor, sick man. That inequity alone should stir the conscience of the world but in some of the poorest countries the life expectancy picture is getting worse. In five countries life expectancy at birth is expected to decrease by the year 2000, whereas everywhere else it is increasing. In the richest countries life expectancy in the year 2000 will reach 79 years. In some of the poorest it will go backwards to 42 years. Thus the gap continues to widen between rich and poor, and by the year 2000 at least 45 countries are expected to have a life expectancy at birth of under 60 years. In the space of a day passengers flying from Japan to Uganda leave the country with the world’s highest life expectancy – almost 79 years – and land in one with the world’s lowest – barely 42 years. A day away by plane, but half a lifetime’s difference on the ground. A flight between France and Cote d’lvoire takes only a few hours, but it spans almost 26 years of life expectancy. A short air trip between Florida in the USA and Haiti represents a life expectancy gap of over 19 years. HIV and AIDS are having a devastating effect on young people. In many countries in the developing world, up to two-thirds of all new infections are among people aged 15-24. Overall it is estimated that half the global HIV infections have been in people under 25 years with 60% of infections of females occurring by the age of 20. Thus the hopes and lives of a generation, the breadwinners, providers and parents of the future, are in jeopardy. Many of the most talented and industrious citizen, who could build a better world and shape the destinies of the countries they live in, face tragically early death as a result of HIV infection.’ (World Health Report 1995: Executive Summary WHO.) This is part of the story that the World Health Organisation told in its World Health Report in 1995. Five years later, the essential elements of this story have not changed. In some cases, the situation will have become worse. You will have noticed that when the WHO used air travel to illustrate the import of the message of the story it told, it spoke of a journey from Japan to Uganda, another from France to the Cote d’lvoire and yet another from the United States to Haiti. From developed Asia, Europe and North America, two of these journeys were to Africa and the third to the African Diaspora. Once again, I welcome you to Africa, recognising the fact that the majority of the delegates to the 13th International AIDS Conference come from outside our Continent. Because of your heavy programme and the limited time you will spend with us, what you will see of this city, and therefore of our country, is the more developed world of which the WHO spoke when it told the story of world health in 1995. You will not see the South African and African world of poverty of which the WHO spoke, in which AIDS thrives – a partner with poverty, suffering, social disadvantage and inequity. As an African, speaking at a Conference such as this, convened to discuss a grave human problem such as the acquired immune deficiency syndrome, I believe that we should speak to one another honestly and frankly, with sufficient tolerance to respect everybody’s point of view, with sufficient tolerance to allow all voices to be heard. Had we, as a people, turned our backs on these basic civilised precepts, we would never have achieved the much-acclaimed South African miracle of which all humanity is justly proud. Some in our common world consider the questions I and the rest of our government have raised around the HIV-AIDS issues, the subject of the Conference you are attending, as akin to grave criminal and genocidal misconduct. What I hear being said repeatedly, stridently, angrily, is: do not ask any questions! The particular twists of South African history and the will of the great majority of our people, freely expressed, have placed me in the situation in which I carry the title of President of the Republic of South Africa. As I sat in this position, I listened attentively to the story that was told by the World Health Organisation. What I heard as that story was told, was that extreme poverty is the world’s biggest killer and the greatest cause of ill health and suffering across the globe. As I listened longer, I heard stories being told about malaria, tuberculosis, hepatitis B, HIV-AIDS and other diseases. I heard also about micronutrient malnutrition, iodine and vitamin A deficiency. I heard of syphilis, gonorrhoea, genital herpes and other sexually transmitted diseases as well as teenage pregnancies. I also heard of cholera, respiratory infections, anaemia, bilharzia, river blindness, guinea worms and other illnesses with complicated Latin names. As I listened even longer to this tale of human woe, I heard the name recur with frightening frequency: Africa, Africa, Africa. And so, in the end, I came to the conclusion that as Africans we are confronted by a health crisis of enormous proportions. One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defence against attack by many viruses and bacteria. Clearly, if we, African countries, had the level of development to enable us to gather accurate statistics about our own countries, our morbidity and mortality figures would tell a story that would truly be too frightening to contemplate. As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus. It seemed to me also that every living African, whether in good or ill health, is prey to many enemies of health that would interact one upon the other in many ways, within one human body. And thus I came to conclude that we have a desperate and pressing need to wage a war on all fronts to guarantee and realise the human right of all our people to good health. And so, being insufficiently educated, and therefore ill prepared to answer this question, I started to ask the question, expecting an answer from others: what is to be done, particularly about HIV-AIDS! One of the questions I have asked is: are safe sex, condoms and anti-retroviral drugs a sufficient response to the health catastrophe we face! I am pleased to inform you that some eminent scientists decided to respond to our humble request to use their expertise to provide us with answers to certain questions. Some of these have specialised on the issue of HIV-AIDS for many years and differed bitterly among themselves about various matters. Yet, they graciously agreed to join together to help us find answers to some outstanding questions. I thank them most sincerely for their positive response, inspired by a common resolve more effectively to confront the AIDS epidemic. They have agreed to report back by the end of this year having worked together, among other things, on the reliability of and the information communicated by our current HIV tests and the improvement of our disease surveillance system. We look forward to the results of this important work, which will help us to ensure that we achieve better results in terms of saving the lives of our people and improving the lives of millions. In the meantime, we will continue to intensify our own campaign against AIDS including: a sustained public awareness campaign encouraging safe sex and the use of condoms; a better focused programme targeted at the reduction and elimination of poverty and the improvement of the nutritional standards of our people; a concerted fight against the so-called opportunistic diseases, including TB and all sexually transmitted diseases; a humane response to people living with HIV and AIDS as well as the orphans in our society; contributing to the international effort to develop an AIDS vaccine, and; further research on anti-retroviral drugs. You will find all of this in our country’s AIDS action plan, which I hope has been or will be distributed among you. You will see from that plan, together with the work that has been going on, that there is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV-AIDS. However, we remain convinced of the need for us better to understand the essence of what would constitute a comprehensive response in a context such as ours which is characterised by the high levels of poverty and disease to which I have referred. As I visit the areas of this city and country that most of you will not see because of your heavy programme and your time limitations, areas that are representative of the conditions of life of the overwhelming majority of the people of our common world, the story told by the World Health Organisation always forces itself back into my consciousness. The world’s biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty. Is there not more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of human solidarity remains a valid precept governing human behaviour! On behalf of our government and people, I wish the 13th International AIDS Conference success, confident that you have come to these African shores as messengers of hope and hopeful that when you conclude your important work, we, as Africans, will be able to say that you who come to this city, which occupies a fond place in our hearts, came here because you care. Thank you for your attention.

Surprisingly, Makgoba said he liked Mbeki’s address: ‘Considering all we’ve gone through over the last few months, it’s an excellent speech. … He said all that could be said and I am quite happy with it. The President has given clear leadership.’ We were happy that you were happy, Willy; no one else was. Mbeki Makes Doctors Despair reported the London Guardian the following day, mangling what he’d said: ‘The scientific establishment was stunned yesterday by President Thabo Mbeki’s public rejection of the conventional wisdom that Aids, which is the leading cause of death in Africa, is caused by the virus HIV.’ It’s unlikely any of those stunned doctors attended the Conference on Primary Health Care, convened by the WHO at Alma-Ata in the USSR in 1978 – following which the Alma-Ata Declaration went: ‘The existing gross inequality particularly between developed and developing countries is politically, socially and economically unacceptable. … An acceptable level of health for all people of the world by the year 2000 can be attained through a fuller and better use of the world’s resources.’

After Mbeki’s address, Phil Wilson of the African-American Aids Initiative gnashed his teeth over unanswered prayers: ‘The house is on fire and Mr. Mbeki is sitting around trying to decide whether it was started by a match or a lighter. … He talks about a plan ... he doesn’t talk about action. I was hoping and praying he would find a way to gracefully back out of this madness.’ Professional Boston AIDS activist and journalist David Scondras, a member of the AIDS Panel, said Mbeki had broken his heart: ‘We all had high hopes. We gave him a beautiful opportunity to turn around and he didn’t.’ Oxford ‘AIDS expert’ Professor Roy Anderson spoke alike: ‘I was disappointed, to put it bluntly. It was an opportunity to concentrate on the main task … the main issue which in South Africa is an acute problem.’ So did conference chairman Coovadia:

What I’m sensing from people is an absolute sense of disappointment. ... Many people believed that the President would use the occasion to try to quell some of the disquiet around government’s position on HIV-AIDS. … There were great expectations that some of the disputes and the disquiet around the government’s position on HIV/AIDS and the dissidents and so on would be resolved and President Mbeki would employ the opportunity that was given to him to give a reappraisal of the position. People are now saying that they are really disappointed that it did not happen and instead we had another discussion about poverty which we already know is a fundamental problem in our society.

Kenneth Roth, executive director of Human Rights Watch, didn’t like Mbeki’s speech much either: ‘It is incumbent on him to give a clear message about the cause of AIDS. His job is not to orchestrate debate in a quiet college classroom. It is giving the best scientific information to the people in his country ... [He is] failing miserably.’ MRC AIDS research boss ‘Slim’ (obese actually) Karim was ‘disappointed that an opportunity was lost, both to set the record straight on the causation of AIDS, and to present a concrete plan to prevent mother to child transmission’. Mbeki’s agreement to speak at the opening of the conference had made him ‘very hopeful. I mean, I thought he needed 25 minutes because he needed to explain what had happened and he needed to mark out a new path. Only when he actually was 10 minutes into his speech, I realized he was not going to make any drastic new announcement.’Lynn Morris of the National Institute of Virology had the same thoughts: ‘This was a good opportunity for him to put a closure on the whole thing, and he didn’t.’ ‘Mbeki waffles on while Rome burns,’ thought Glenda Gray. Just as disappointed was Karim’s wife Quarraisha: ‘If only he said unequivocally that HIV causes AIDS and he made an announcement on reducing mother to child transmission, he would have seized the moral high ground. And he didn’t. And you look around, the strong statement that all the delegates here are making, and they continue to go against all of that!’ Professor Thomas Croates of the University of California had hard words: Mbeki’s position was ‘genocidal’, he said. In a report on 16 July, the Washington Post described how Lee Wildes, representing the American group AIDS Empowerment and Treatment International, ‘all but snarled into his microphone’. He seems to have hoped for a fix by the CIA, Lumamba-style: ‘You need to do something about Mbeki. I can’t even get a vitamin sent into this country.’

‘Comrades, today is a sad day for everyone!’ responded Achmat to Mbeki’s speech. And later: ‘There’s nothing in the world that can explain it. There is nothing in the world that can explain it. To find out that a government does not care about the lives of poor people and the lives of black people and are prepared to consign us to the graveyard was actually quite shocking.’ Top American AIDS boss Anthony Fauci of NIAID lamented: ‘He could have emerged as a spectacular leader of the whole African continent. He flubbed it.’ So the American government was going to have to take action – he made clear in an interview for the PBS Frontline television documentary The Age of AIDS, shown in the US on 30 and 31 May 2006. In view of Mbeki’s recalcitrance about towing the American line on AIDS, the Americans decided to use the TAC to carry out their foreign policy objectives, namely to get AIDS drugs flowing into South Africa and the rest of the Developing World: ‘You’re looking at it straight in the eye and you say, “What am I going to do?” And that was really crystallized by the activist movement that we saw in South Africa, and it was that impetus that led to the resolve to get treatment, care and prevention into the trenches in developing nations in whatever manner or form we can.’ Washing CIA money discretely through American corporate philanthropies to willing and cooperative dupes being the favoured way of going about such things.

At a demonstration for AIDS drugs outside the Durban City Hall, organised by the TAC for the start of the conference, the activists got Winnie Madikizela-Mandela over to say what she thought of Mbeki’s speech, and she didn’t let them down. His ANC government’s refusal to dish out the drugs was ‘a betrayal of our struggle for social justice’, she said.

AIDS exists! HIV causes AIDS! Like the spread of global parasitic imperialism, AIDS is roaming the world, attacking the poor and the marginalized. … In our beloved Africa, it has already cut a swath of destruction, swallowing up families and communities and villages. … We knew this was a plague and that it was moving south … yet we did nothing. We must take the responsibility for that failure. … Our failure to act has made us the murderers of our own people. Our government, for which so much blood was shed, has backed down and become an obedient servant of the multinational [drug companies]. … More than 1 600 people in South Africa become infected with HIV every day and

16 000 people die every year. The majority of the people dying are poor and black. This is a social holocaust.

Achmat picked up the theme: ‘AIDS is a holocaust against the poor and the responsibility lies with the drug companies who put profits before responsibilities. It’s wrong, immoral, unethical and unconstitutional not to provide those drugs.’ Newsday reported on 11 July:

After endless political nonsense from South Africans who should know better, it fell to Winnie Mandela to declare the brutal truth. … Yet South African President Thabo Mbeki not only refuses to acknowledge that HIV causes AIDS. His government is reluctant to fund programs that would offer cheap antiretroviral drugs to mothers – drugs that could sharply cut HIV transmission rates to their children.

In its report covering Mbeki’s speech the day before, Newsday noted: ‘In a long, dry speech delivered without interruption for applause or other response, Mbeki identified poverty as the culprit for his nation’s epidemic.’ Newsday’s opinion thereanent was captured in the title of the piece: Focus on Poverty, Not on HIV, AIDS: S. Africa leader’s speech frustrates delegates. No doubt it did, because unfortunately, as H L Mencken once pointed out, ‘What ails the truth is that it is mainly uncomfortable and often dull.’

The London Independent reported the City Hall demo and Mbeki’s address before it the next day, under the rousing heading, Durban Conference: Mbeki Accused Of ‘Betrayal’ Over Aids Treatment: Anti-Capitalist Rhetoric Deflects Spotlight From South African President’s ‘Mishandling’ Of Crisis In Disease-Ravaged Country – including the remarkable news that the ‘TAC has called for World Bank debt relief to be conditional on healthcare expansion in Third World countries’. Which is quite something to think about: the TAC urging the World Bank not to relax its choke-hold on any developing country reluctant to buy AIDS drugs – the only kind of ‘healthcare’ that the TAC is in business for. Suborning extortion you might call it.

But in urging this kind of blackmail of our government, Achmat and his friends in the Bush administration see eye to eye: US Treasury Secretary Paul O’ Neil came on an AIDS tour of the country with Irish singer Bono of the rock group U2 the following year. Who cried for the cameras during a visit to Glenda Gray’s Paediatric AIDS Unit at Chris Hani-Baragwanath Hospital – as the front-page headline of the Daily Dispatch reported on 25 May 2002: Emotional Bono visits Aids mothers. He was understandably upset, having been told that the bouncing babies, apparently fine, were actually infected by a terrible virus and weren’t going to live long. ‘The Secretary will be able to send one message back to the President. This is an emergency what we have seen today,’ he wept. ‘Astounded’ by the prioritisation of prevention programmes over drug purchases in the disbursement of foreign aid funds, O’ Neill responded: ‘There is something wrong when the system does not take care of the here and now. … We, the world, have got to deal with this problem. … This is do-able.’ The report concluded: ‘O’ Neil, who has long criticised the misuse of foreign aid by recipient countries, said he wanted re-evaluations of where US foreign assistance was being spent as well as an increase in that assistance.’ To control domestic health policy with his country’s money.

Following Mbeki’s Sunday night opening address, Cameron presented the first Jonathan Mann Memorial Lecture at the conference the next day. The Deafening Silence Of Aids portended the empty bombast to follow, with the claim in the noisy title quickly conceded as false by Cameron himself: ‘Nor has there been silence, as the title of my lecture suggests. Indeed, there has been a cacophony of task groups, workshops, committees, councils, policies, drafts, proposals, statements, and pledges.’ So why then claim there is one? For theatrical effect? To tally with the conference slogan, ‘Break the Silence’? To Break the Wind?

Cameron’s speech was decorated with limp rococo flourishes such as:

UNAIDS careerist, the late Jonathan Mann’s ‘statement cannot be accepted without nuance, since in Africa it is relative mobility and affluence that have placed people at risk of exposure to HIV. [Hey, that’s like a totally amazing new insight, Judge, but what are you actually trying to tell us? That blacks have all got AIDS because they’re rich? And swarm around the continent screwing everyone. Unlike American and European heterosexuals on their own turf. And suddenly in the last decade or so. If not, what?] But Mann’s analysis here had led him to a more fundamental and general insight – one that formed the focus of his future work and advocacy. This was his realisation that health and human rights are not opposing [had anyone said they were?], but are complementary approaches to what he called “the central problem of defining and advancing human well-being”. [Wow, a brilliant, deeply thought-provoking new formulation of an ancient problem of philosophy.] … But the demography of HIV has been overlain by a shift even more momentous and one that in its nature is optimistic. [Old AIDS drugs, useless alone, work near miracles combined. In their very nature.] AIDS can now be compared with other chronic conditions which on appropriate treatment, and with proper care, can in the long term be subjected to successful medical management. [As long as you don’t mind croaking first of the toxicity of your care.] Amongst the public at large, the result has been that fear, prejudice and stigma associated with AIDS have lessened. [Is there maybe a study to refer us to, bearing this out? Or are you just talking pretty?] And persons living with HIV/AIDS have suffered less within themselves [is there another way to suffer?] and in their working and social environments. In short, the new combination drug treatments are not a miracle. But in their physiological and social effects they come very close to being miraculous.

Although like a hillbilly Baptist, Cameron might feel full of holy vitality after drinking his poison (arsenic tonics were once ubiquitously prescribed and enjoyed well into the 20th century), the mounting literature on the inefficacy and deadly toxicity of AIDS drugs would lead the ‘AIDS experts’ to announce an embarrassing retreat from them just a few months later. Their physiological effects on Cameron we’ll read about later.

Amidst the poverty of Africa, I stand before you because I am able to purchase health and vigour. I am here because I can pay for life itself. To me this seems a shocking and monstrous iniquity of very considerable proportions – that, simply because of relative affluence, I should be living when others have died; that I should remain fit and healthy when illness and death beset millions of others.

That phrase again: ‘relative affluence’ – presumably different from the ‘relative ... affluence’ of Africans that puts them at risk of AIDS. But strangely enough, straight affluent whites have been virtually untouched by the scourge.

Without a scruple for the impropriety of his doing so, the appellate judge then abused the occasion as a senior member of the judiciary to criticise the executive’s AIDS policy insultingly, demean the President as a silly crank, praise the government’s opponents in the TAC and outline the shape of the policies that his brethren would later force the government to adopt:

In my own country, a government that in its commitment to human rights and democracy has been a shining example to Africa and the world has at almost every conceivable turn mismanaged the epidemic. So grievous has governmental ineptitude been that South Africa has since 1998 had the fastest-growing HIV epidemic in the world. It currently has one of the world’s highest prevalences. ... A basic and affordable humane intervention would be a national programme to limit mother-to-child transmission of HIV through administration of short courses of anti-retroviral medication. [The humane effect on babies of a short course of AZT we read in Debating AZT; the latest studies are reviewed in Poisoning our Children. The effects of nevirapine you can read in The trouble with nevirapine.] Research has shown this will be cost-effective in South Africa. Such a programme, if implemented, would have signalled our government’s appreciation of the larger problem, and its resolve to address it. To the millions of South Africans living with HIV, it would have created a ray of light. [GlaxoSmithKline also bills AZT as ‘A Ray of Hope’.] It would have promised the possibility of increasingly constructive interventions for all with HIV, including enhanced access to drug therapies. To our shame, our country has not yet come so far as even to commit itself to implementing such a programme. The result, every month, is that five thousand babies are born, unnecessarily and avoidably, with HIV. Their lives involve preventable infections, preventable suffering, and preventable death.

I just make up my numbers as I go. As a religious type I also believe, like everyone else, that HIV-positive means disease and suffering and death around the corner. Unless I purchase the indulgences sold by the pharmaceutical industry.

Cameron then attacked Mbeki as a born fool:

In our national struggle to come to grips with the epidemic, perhaps the most intractably puzzling episode has been our President’s flirtation with those who in the face of all reason and evidence have sought to dispute the aetiology of AIDS. This has shaken almost everyone responsible for engaging the epidemic. It has created an air of unbelief amongst scientists, confusion among those at risk of HIV, and consternation amongst AIDS workers.

Not just a stupid fool, a criminally negligent one:

One of the continent’s foremost intellectuals, Dr Mamphela Ramphele, has described the official sanction given to scepticism about the cause of AIDS as ‘irresponsibility that borders on criminality’. If this aberrant and distressing interlude has delayed the implementation of life-saving measures to halt the spread of HIV and to curtail its effects, then history will not judge this pronouncement too harsh. I cannot believe that our President’s address at the opening last night has done enough to alleviate the concerns.

The judge pressed for the government to take the TAC on board in formulating policy:

At the launch of the International Partnership Against AIDS in Africa in December 1999, UN Secretary General Kofi Annan made an important acknowledgement. He stated: ‘Our response so far has failed Africa.’ The scale of the crisis, he said, required ‘a comprehensive and coordinated strategy’ between governments, inter-governmental bodies, community groups, science and private corporations. … There has also been the principled trumpet of treatment activism. In America, brave activists changed the course of Presidential politics by challenging Vice-President Gore’s stand on drug pricing and trade protection. Their actions paved the way for subsequent revisions of President Clinton’s approach to the drug pricing issue. In my own country, a small and under-resourced group of activists in the Treatment Action Campaign, under the leadership of Zackie Achmat, has emerged. In the face of considerable isolation and hostility, they have succeeded in re-ordering our national debate about AIDS. And they have focussed national attention on the imperative issues of poverty, collective action and drug access. In doing so they have energised a dispirited PWA movement with the dignity of self-assertion, and renewed within it the faith that by action we can secure justice. [By scoring drugs. After coming out of the closet.] What has been a story of grievous mismanagement, we have failed to construct the sort of inclusive alliance under governmental leadership that has been indispensable to AIDS prevention programmes. We know that that should have happened and it has not happened, it should have happened under governmental leadership, including the AIDS NGOs which have done magnificent work under difficult circumstances instead of which they have felt alienated and ostracised by government.

Listening to Cameron’s wussy speech was to picture his brothers in the judiciary wincing, but apparently not; his criticism of the government’s AIDS policies, his own policy demands, his praise for the TAC and his urging that the government should collaborate with it and take its cues in formulating policy all prefigured exactly the High and Constitutional Courts’ prescriptions to the government in the subsequent nevirapine case.

Folk won to Cameron’s gloomy superstitions and as ardent with zeal for them were ‘the continent’s foremost intellectuals … principled … brave … a perceptive man of principle’. But against anyone offside, or merely unconvinced and unmoved by his ridiculous fire and brimstone sermonizing, Cameron concluded by levelling the basest and coarsest of moral accusations, charging complicity in the crimes of the century. Whipping out memories of apartheid and the Holocaust to drive his case home, the trick went down a treat:

Those of us who live affluent lives, well-attended by medical care and treatment, should not ask how Germans or white South Africans could tolerate living in proximity to moral evil. We do so ourselves today, in proximity to the impending illness and death of many millions of people with AIDS. This will happen, unless we change the present government ineptitude and corporate blocking. Available treatments are denied to those who need them for the sake of aggregating corporate wealth for shareholders who by African standards are already unimaginably affluent. That cannot be right, and it cannot be allowed to happen. No more than Germans in the Nazi era, nor more than white South Africans during apartheid, can we at this Conference say that we bear no responsibility for 30 million people in resource-poor countries who face death from AIDS unless medical care and treatment is made accessible to them. The world has become a single sphere, in which communication, finance, trade and travel occur within a single entity. How we live our lives affects how others live theirs. We cannot wall off the plight of those whose lives are proximate to our own. That is Mann’s call – the clarity of his call – his legacy to the world of AIDS policy; and it is the challenge of his memory to this Conference today.

AIDS drugs for Africa. Cameron got a rapturous ovation. They stood clapping and cheering forever, applauding what Science writer Jon Cohen called ‘one of the most remarkable acts of activism I’ve seen in twelve years of covering AIDS’.

But Tshabalala-Msimang was unimpressed by reports of his speech: ‘We reject the notion that simply defines the adequacy of national responses to the provision of antiretroviral drugs. We are unapologetic about the fact that the focus on primary prevention remains the core of our programme.’

The juxtaposition of Cameron’s address right after Mbeki’s highlighted the marked intellectual disparity between the two men, and a paradoxical one it was too. Whereas Mbeki the politician spoke in the exacting, empirical manner of a careful judge reviewing the hard facts, the judge conversely employed the language and alarmist devices of a vulgar politician, making one recklessly unsubstantiated morbid declamation after another, intended to appal and cow. It might have been trimmed in Crimplene ruffles, but it was a tip-truck load of pretentious waffle no less, spiked with the wild, hateful charges that having regard to the policy it had set on AIDS, the new ANC government was scarcely different from the criminal regimes of the apartheid and Nazi states, with the result that our country faced imminent collapse thanks to its incompetence and callous indifference. In talking this way Cameron bought straight into white stereotypical perceptions about African government identified by Mbeki on BBC television during an interview by Tim Sebastian on 6 August 2001: ‘There is a view among some people that there must be a collapse, there must be a cataclysm, it’s not quite possible that you could have a black government managing a sophisticated country and economy like this.’ Orwell nicely explained the vacuousness of Cameron’s speech by noting in his essay Politics and the English Language, written in 1946, that ‘the slovenliness of our language makes it easier for us to have foolish thoughts’. The intriguing thing about Cameron’s foolish thoughts, showcased in his talk, was that, as George W Bush’s are, they were so rousing for the mob listening, generated such éclat and were so very politically effective. Whereas, contrariwise, Mbeki’s sober calls to the facts and to reason went off like Guy Fawkes in the rain.

Another difference between the two speeches, the two minds, was that in counterpoint to that typical white liberal pessimism with which Cameron’s talk was freighted, an orgiastic celebration of doom and gloom (such as gives the Mail&Guardian its modern odour), Mbeki was at pains to emphasize characteristic African hopefulness. The gist of the passage to which I allude bears repeating:

The peoples of our Continent ... expect that out of this extraordinary gathering will come a message and a programme of action that will assist them to disperse the menacing and frightening clouds that hang over all of us as a result of the AIDS epidemic. … we are a country and a Continent driven by hope, and not despair and resignation to a cruel fate. Those who have nothing would perish if the forces that govern our universe deprived them of the capacity to hope for a better tomorrow

– the American forces that Cameron was proselytising for, dealing certain, early, painful death to millions of African poor. Without the pharmaceutical industry’s cut-price beneficence to head off the imminent African calamity. In so speaking Mbeki was repudiating those morose new conceptions being imposed from without on African people, with the help of guys like Cameron, that a brand-new virus was suddenly about, predominantly among white gay men in the US and Europe, but everywhere among black heterosexuals in Africa. A plague coming down from the dark north. Spread by loving. Most signally down here too, just in time to spoil our hopes for our revolution. Ideas comfortably at home in First World Christian cultures, especially American, but horribly alien in the optimistic, indigenous cultures of Africa. Alien to anyone, like Mbeki, who turned the TV off long enough to ponder them.

Cameron’s speech may have been all piss and wind, but it contained a twinkling clue. Speaking generally, psychologist Rollo May described his sort: ‘People who claim to be absolutely convinced that their stand is the only right one are dangerous. Such conviction is the essence not only of dogmatism, but of its more destructive cousin, fanaticism. It blocks off the user from learning new truth, and it is a dead giveaway of unconscious doubt.’ The temper of Cameron’s talk is well explicated by post-modernist philosopher Jean Francois Lyotard’s conception of ‘metanarratives’ – authoritarian grand theories, whose fired-up subscribers, be they religious or political, always lay claim to be the sole custodians of truth, and intolerantly deny all and any alternatives.

As Cameron was speaking, and the Durban AIDS Conference hummed along, Mbeki was flying to faraway Togo, on much more important business: attending the annual Organisation of African Unity summit, where he again defended his decision to open the AIDS debate to dissident contributions on the basis that it was a free speech issue, with special significance given the country’s apartheid past: ‘Exclusion of ideas, simply because they are different from mine, I don’t think is very healthy. In our own case, just in terms of the political transition in South Africa, we would not have achieved what we achieved if we had excluded certain views.’

Views like those of the country’s national Minister of Health: Incredibly, Coovadia and Karim refused Tshabalala-Msimang’s request to address the final plenary session of the conference to set straight what she felt had been the misreprentation of the government’s position. Here were the cardinals flexing their muscles, showing who were in charge. And it wasn’t the country’s elected representatives.

Not only were Mbeki’s public doubts about their doctrines ‘extremely belittling’ to him ‘as a scientist involved in AIDS research’, said Professor Greg Hussey, head of paediatric infectious diseases at UCT, later on; much more importantly than that, he was threatening their money. This was of course emotionally distressing, he said; it ‘sits at the back of your mind and it complicates the way you react with the health department. It is extremely wearying and is upsetting to have to contend with what the minister, what the department is going to say. You are wary, especially with international grants, that they [the department] are going to say no.’ Ian Sanne, head of the Infectious Diseases Unit of the University of the Witwatersrand, explained similarly:

Research is becoming less competitive for international funding because of the government’s stance. Scientists recognise that research needs to be conducted in collaboration with the Department of Health. But this needs to be a joint effort. No one in the Department of Health wants to approve a research agenda in a timeous fashion, in part because they are scared for their own careers. We are being asked to identify research questions in a resource poor setting, but then we have problems accessing international funding when our government is not going to implement the research.’ And it was important for guys like him to get that money from pharmaceutical companies to do drug experiments on Africans, he said, because without AIDS drugs ‘this disease is universally fatal. There’s no reason we should not be using everything at our disposal to fight it and give people the chance to live as full a lifetime as is possible.

Fight it with deadly poisonous drugs. Guaranteeing a short one.

When the week’s business at the conference was done, Mandela delivered the closing speech. No longer tactfully deferential to his successor as President, he immediately took to chastising Mbeki like a child for the trouble he had caused concerning ‘one of the greatest threats humankind has faced. … It is never my custom to use words lightly. If twenty-seven years in prison have done anything to us, it was to use the silence of solitude to make us understand how precious words are and how real speech is in its impact upon the way people live and die.’ It was a clever start, implying superior wisdom and moral authority. His negative insinuations he now spelt out:

If by way of introduction I stress the importance of the way we speak, it is also because so much unnecessary attention around this conference had been directed towards a dispute that is unintentionally distracting from the real life and death issues we are confronted with as a country, a region, a continent and a world. I do not know nearly enough about science and its methodologies or about the politics of science and scientific practice to even wish to start contributing to the debate that has been raging on the perimeters of this conference. I am, however, old enough and have gone through sufficient conflicts and disputes in my life-time to know that in all disputes a point is arrived at where no party, no matter how right or wrong it might have been at the start of that dispute, will any longer be totally in the right or totally in the wrong. Such a point, I believe, has been reached in this debate. The President of this country is a man of great intellect who takes scientific thinking very seriously and he leads a government that I know to be committed to those principles of science and reason. The scientific community of this country, I also know, holds dearly to the principle of freedom of scientific enquiry, unencumbered by undue political interference in and direction of science. Now, however, the ordinary people of the continent and the world – and particularly the poor who on our continent will again carry a disproportionate burden of this scourge – would, if anybody cared to ask their opinion, wish that the dispute about the primacy of politics or science be put on the backburner and that we proceed to address the needs and concerns of those suffering and dying. And this can only be done in partnership. I come from a long tradition of collective leadership, consultative decision-making and joint action towards the common good. We have to overcome much that many thought insurmountable through an adherence to those practices. In the face of the grave threat posed by HIV/AIDS, we have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so now, and right now. Let us not equivocate: a tragedy of unprecedented proportions is unfolding in Africa. AIDS today in Africa is claiming more lives than the sum total of all wars, famines and floods, and the ravages of such deadly diseases as malaria. It is devastating families and communities, overwhelming and depleting health care services; and robbing schools of both students and teachers. Business has suffered, or will suffer, losses of personnel, productivity and profits; economic growth is being undermined and scarce development resources have to be diverted to deal with the consequences of the pandemic. HIV/AIDS is having a devastating impact on families, communities, societies and economies. Decades have been chopped from life expectancy and young child mortality is expected to more than double in the most severely affected countries of Africa. AIDS is clearly a disaster, effectively wiping out the development gains of the past decades and sabotaging the future. Earlier this week we were shocked to learn that within South Africa one in two, that is half, of our young people will die of AIDS. The most frightening thing is that all of these infections, which statistics tell us about, and the attendant human suffering, could have been, can be, prevented. Something must be done as a matter of the greatest urgency. And with nearly two decades of dealing with the epidemic, we now do have some experience of what works.

Since the government already had an extensive AIDS awareness and prevention programme in operation based on the infectious AIDS model, Mandela could have been referring to only one thing – Mbeki’s reluctance to deal AIDS drugs: ‘He will, with me, be the first to concede that much more remains to be done. I do not doubt for one moment that he will proceed to tackle this task with the resolve and dedication he is known for.’ For the rest, Mandela’s speech was a predictable string of the usual exhortations: we ‘must’ this, we ‘need’ that,

to fight this war. … The challenge is to move from rhetoric to action and action at an unprecedented intensity and scale. … Promoting abstinence, safe sex and the use of condoms and ensuring the early treatment of sexually transmitted diseases are some of the steps needed and about which there can be no dispute. Ensuring that people have access to voluntary HIV counselling and testing services and introducing measures to reduce mother-to-child transmission have been proven to be essential in the fight against AIDS. … Partnership with the international community is vital. A constant theme in all our messages has been that in this globalised world, we have indeed again become the keepers of our brother and sister. That cannot be more graphically the case than in the common fight against HIV/AIDS.

Coovadia was thrilled: ‘You cannot imagine how your speech is music to our ears. It has answered so many spoken and unspoken questions.’ Even the bit about globalisation being all about looking after each other. We thought you were supposed to be the expert, Jerry. With all the answers. To Mbeki’s questions.

Mandela, it was clear, had moved from agnostic to passionate convert – ‘shocked’ by the latest report from UN-AIDS claiming that twenty per cent of (black) South Africans were infected, that half of all (black) fifteen-year-olds would eventually die of AIDS, and that ‘With a total of 4.2 million infected [black] people, South Africa has the largest number of people living with HIV-Aids in the world.’ The Mail&Guardian and the rest of the country’s newspapers published these factoids with wide eyes. Mbeki on the other hand dismissed them out of hand as ‘hysterical estimates’. Which of course is what they were. Shaking his head as he read Mandela’s speech. With pity. At his predecessor’s gullibility, for a start. His naivety. Looking past the surface gleam of Mandela’s sweetly reasoned appeal and into the game being played. The game to which the old man was perfectly oblivious. Because Mandela’s speech certainly wasn’t getting in the way of business. It’s precisely what distinguished it from the one given by Mbeki – a savvy leader of the emerging world, alive to the fact that AIDS, essentially, is a neo-colonialist project. Pusch Commey described him well in the London-published New African in September 2000 as a ‘political grandmaster who has thought 20 moves into the global chess game of richman/poorman, plunderer/victim’, of whom ‘Africa can indeed be proud’. Who’d recognised ‘African AIDS’ as the latest front for the conduct of the North’s global trade offensive against the South, and who had ‘dared to threaten the very foundation upon which is built a huge Aids edifice that feeds on the virus. Pharmaceutical companies, Aids researchers, the medical establishment, microbiologists, NGOs, entrepreneurs, you name it. And which replicates as fast as the virus itself as sufficient panic is created to force governments and institutions to fork out more and more cash.’

Borrowed cash. Vice-president of the World Bank for the African region, Callisto Madavo, announced during the Durban AIDS Conference that the bank had allocated $500 million to fund HIV-AIDS programmes in Africa. He said the money would be made available for borrowing from the International Development Association, the bank’s ‘soft-loan window’. Karen Bennett, a conference spokesperson, said she was pleased: ‘The world is finally recognising that this is where the centre of the epidemic now is.’ The First World, perhaps. But not the South African government, which said no thanks to the offered loans. The US Export-Import Bank tried its luck too, touting loans at seven per cent, the commercial interest rate, to twenty-four sub-Saharan countries for the purchase of AIDS drugs. But on 24 August, the International Herald Tribune lamented: ‘The US offer of $1 billion in annual loans to finance the purchase of anti-Aids drugs in sub-Saharan Africa has been rejected by South Africa, one of the countries most devastated by the disease, health officials said.’ Oddly enough, there were no other takers either.

In the manner of a dinner guest who’d drunk too much and spoken alike, and was phoning to propitiate the host the next day, Cameron apologised for the excesses of his remonstrances to the government a day after the conference ended, and agreed with Mbeki that poverty played a crucial role in what the ‘AIDS experts’ were calling AIDS in the country. Speaking at a forum hosted at the University of the Witwatersrand, he said, ‘Poverty is a determinant of who falls ill with AIDS, but there is also a virological component – this is what wasn’t said in [Mbeki’s] speech five days ago.’ This was a strange concession for Cameron to make if one assumes that a senior judge picks his words with care, because the ordinary dictionary meaning of a ‘determinant’ is akin to what we lawyers call a sine qua non. An absolutely necessary precursor. You have to be poor before the virus can get you, in other words. But that’s certainly not what he meant. Actually he was just blabbering. As usual. It’s what having the virus does to you. Cameron liked Mandela’s speech, though: the Independent Online reported on 15 July 2000 that he’d praised it for setting ‘the tone for action against HIV/Aids by unequivocally stating the immediate need for the use of drugs to prevent mother-to-child transmission of HIV’. Just as Cameron had already unequivocally stated it. The immediate need. For drugs.

A week later an editorial in the Mail&Guardian repeated its charge that Mbeki and his Ministers were murderers, nay, genocidal killers now, for turning their porcine noses up at the use of AZT in government hospital maternity wards, and warned that

if our government any longer hesitates and prevaricates on the issue of providing anti-retrovirals to HIV-positive pregnant women, it should not be surprised to hear charges of genocide directed at it. For to fail to act right now against the HIV/Aids pandemic on the basis of best-available science and with all the resources we can muster will have genocidal results. Whether that outcome is the result of malevolence, of incompetence, of panic-induced denial, or of pig-headed obduracy among senior members of the government will scarcely matter. For they will have been warned often enough. Yes, history will then judge them harshly, as former president Nelson Mandela said in a closing speech to the World Aids Conference in Durban last week. But, before history has its turn, the rest of us will have a go at them – and our judgment will not be generous. A failure to act now is genocide. President Thabo Mbeki and his entire government must either get their act together in combating the HIV/Aids catastrophe – now – or get out of government.

It was all getting rather ridiculous.

Of course the commentary in the liberal press was deeply insulting. But much more than personally so: Mbeki picked up the white supremacism inhering in the general cultural disdain of the English world behind it. DA leader Tony Leon’s remarks at a party meeting in Stanger, near Durban on 25 July were the last straw:

Not all news has been good news for South Africa. The president has done considerable damage to his government’s – and his own – reputation. His mishandling of the Zimbabwe crisis and HIV/AIDS policy are two cases in point. President Mbeki’s speeches convey a paradoxical suspicion of developed nations, yet a sense of entitlement – that they somehow ‘owe us’. There is also a near-obsession about finding ‘African solutions’ to every problem – even if this means flouting scientific facts about AIDS in favour of snake-oil cures and quackery.

It was low. But then so is Tony Leon. Who in the mid-70s had written for the apartheid army journal Paratus that the illegal invasion of Angola was ‘one of many splendid tasks of the army’, and who’d described the apartheid military as this ‘giant helping hand’. Brigadier-General Bosman complimented him sarcastically in the Gauteng Provincial Legislature on 9 November 1998:

Mr Speaker, I wonder if the honourable member is aware of the fact that while I was in the Defence Force, I had a very talented young man who did his national service indirectly under my command. He was very talented, sir, because he was a journalist with Paratus, one of the better journalists, and he was one of the best propaganda writers for the Defence Force at the time. As a matter of fact, Mr Speaker, he was very effective … He was very talented with his writing on the total onslaught and that man, sir, was Mr Tony Leon. Thank you, sir.

The talented apartheid propagandist’s remarks were low because the truth of it was that Mbeki had pertinently deplored entitlement attitudes on more than one occasion in his speeches – for instance, urging ‘our abandonment of the concept of the Deliverer with the corollary of the Entitled Recipient’ at a fundraising dinner for the University of Transkei held in Johannesburg on 30 April 1998, and then on 3 June calling in Parliament for an end ‘to the abuse of freedom in the name of entitlement, said to arise naturally from our having been the victims of apartheid’. And his position in relation to the West was infinitely more sophisticated than Leon’s gross caricature – racist generalising, all of it. Leon’s gloating over Mbeki’s involvement with Virodene poked at a sore, and his implication that Mbeki was ‘flouting scientific facts’ in condemning AZT and in doubting the rest of AIDS medicine rubbed salt in it. Because whatever Virodene’s merits or otherwise, AZT was certainly useless, and deadly poisonous too. Whites like Leon ignorantly backed AZT for no other reason than that it was produced and had been marketed successfully by one of the biggest and most profitable corporations on the planet. By whites. Mbeki had been universally castigated for rejecting it – his position deprecated patronisingly by Mary Crewe, head of the Centre for the Study of AIDS at the University of Pretoria: ‘I find it fascinating that Mbeki keeps talking about how the solutions have to come from the ‘African people’ and not from foreign experts, but the South African people want AZT for pregnant women. They also want rape prophylaxis and more funding for treatment of people with AIDS. At what point do you accept what the people are asking for?’ At what point do you buy what the pharmaceutical industry is selling? At what point do you wonder whether ‘the people are asking for’ drugs? Just because the TAC and the newspapers say they are.

Reading Leon’s speech, Mbeki was livid. And retaliated early the following month.

On 11 August Mbeki delivered the second Oliver Tambo Memorial Lecture in Johannesburg, entitled Where are they now? – where, after liberation, are the black intellectuals and the black bourgeoisie in the struggle for national transformation? – Mbeki reproved the country’s ‘native petite bourgeoisie, with the native intelligentsia in its midst, that, in pursuit of well-being that has no object beyond itself, commits itself to be the foot-lickers of those who will secure the personal well-being of its members’. Then he turned on Leon:

The white politician makes bold to speak openly of his disdain and contempt for African solutions to the challenges that face the peoples of our continent. According to him – who is a politician who practices his craft on the African continent – these solutions, because they are African, could not but consist of pagan, savage, superstitious and unscientific responses typical of the African people, described by the white politician as a resort ‘to snake-oil cures and quackery’.

Mbeki’s assumption that by ‘snake-oil cures’ he was referring to African traditional medicine was wrong, said Leon six days later: addressing business leaders in Johannesburg he said that in speaking about snake-oil he was alluding to Virodene, and the quackery he had in mind was Duesberg’s dissident views.) Leon was enunciating a millennium-old racism, said Mbeki: ‘This racism has defined us who are African and black as primitive, pagan, slaves to the most irrational superstitions and inherently prone to brute violence. It has left us with the legacy that compels us to fight, in a continuing and difficult struggle, for the transformation of ours into a non-racial society.’ Mbeki pointed out that the range of crimes against humanity historically perpetrated by Europeans against Africans would never have occurred unless the former knew as a ‘matter of fact’ that the latter were less human than themselves, and closed by noting: ‘Our white politician would not have made the statements he reportedly made, unless he knew it as a matter of fact that African solutions amounted to no more than snake-oil cures and quackery.’ He then moved on, but not before a final bite: he wasn’t going to devote his lecture to ‘the arrogance and racism of those who have convinced themselves they are superior’, but rather to those who have suffered under it.

And still are. Citing a stack of illustrative personal experiences reaching back to her schooldays in a mixed-race school in former Rhodesia, Thandi Chiweshe found Racism is still alive and kicking in a lengthy, articulate and painfully frank opinion piece published in the Zimbabwe Independent two days after Mbeki’s lecture:

over the last few months, living as I currently do in South Africa, I cannot help but become not just dismayed but angry. In this country you live and breathe race and racism. It is omnipresent wherever you are. … Following the events in Zimbabwe in the last few months, there has been a flurry of reports and analysis that seeks to say that racism is now a non-issue. This is the case in South Africa but also in Zimbabwe. In South Africa, this was brought on by the events in Zimbabwe and the recently held national conference on racism. Indeed nobody in their right mind would ever support Bob and his band of marauders. Yet at the same time there is a high level of dishonesty that currently pervades our public discourse on racism at a national, regional and international level. This is the dishonesty that says racism is the figment of the bad politician’s imagination. That before Bob and company resurrected it, racism was dead and buried in Zimbabwe and we were all living happily in harmony. This refrain has also been picked up in South Africa and other places and now we have a whole international choir that sings, “racism is dead”. Well, for me as a young, short, fat black woman, it is very much alive and doing quite well by all accounts. In fact, it never really died, it just mutated. … By denying that racism is real and that it is still exercised in various places we are actually making it grow bigger and much more dangerous. As black people, by buying into this denial we have become complicit in its growth and therefore in our own continued marginalisation and domination. … Our problems with HIV/Aids are now being explained in terms of our sexual depravity by some. In development circles we hear often enough about how our cultures are the key problem and that nothing can be done about those (read: strange/barbaric/weird so we can’t really be bothered to even understand those). In South Africa, when President Mbeki dares raise racism, he is told, not too kindly, that he should worry more about delivering to the people that voted him into power. There is a denial that the very same problems that he is supposed to address were a direct result of colonialism, apartheid and the current economic order. But he dare not talk about that or he will become racist himself. … Indeed, racism today is not as pedestrian and as explicit as it was in 1940 … it has a newer set of legs, and it has become more sophisticated. Yet many of us continue to experience racism in its very pedestrian forms. This is what makes us unable to give it its rightful name and consequently unable to devise strategies to deal with it.

Leon responded to Mbeki’s attack on him in the media the following day. He would take ‘great pleasure’, he announced, in submitting the text of Mbeki’s speech to the forthcoming conference on racism being convened by the Human Rights Commission. Mbeki, he said, was intolerant of political opposition: ‘His only response to opposition is an attempt to either co-opt it, silence it or demonise it.’ Lacking the heft to fell Mbeki fair and square, Leon aimed his punches on the eyebrow cut:

President Mbeki must now explain to South Africa and the world why it is that he has as recently as two years ago championed the totally disreputable and now medically, scientifically and legally discredited and now outlawed, so-called miracle Aids cure Virodene. He squandered his prestige on what might rightfully be called a form of quackery, and now takes issue with me because I dare to mention this blindingly self-evident fact. Since everyone who ever disagrees with President Mbeki and his government is a racist or an alleged self-hating black, I presume that Thabo Mbeki’s views on this matter are so discredited and frankly disreputable as to not require too much serious attention. If President Mbeki spent more time where I do – among the people in their communities – he would know that the truth of the matter is that he has wasted precious time and huge resources of state on prosecuting politically correct solutions and often eccentric viewpoints at the expense of real and sustained delivery and help to the mass of our people. President Mbeki is busy perfecting tactics which turn questions of fact into questions of motive and which malign genuine constitutional opponents of his government with the most dangerous racial stereotyping which has no place in a modern democracy in Africa, or anywhere else in the world for that matter.

But Mbeki’s charges of racism had nothing to do with racially stereotyping his opponents – since it’s racists who negatively agglomerate those whom they physically or psychologically oppress, not the other way round. Nor was it the kind of gross racism seeing a black man refused a table in a restaurant or slighted by a white clerk in a government office. The racism that Mbeki discerned in his white liberal critics’ attacks on him was much more insidious, precisely because, like a permanent smell coming up through the floorboards, it was so subtle, so ineffable. The kind that drives liberals like Tony Leon, Howard Barrell and David Beresford apoplectic if he mentions it. They grew up in the house with it so don’t notice it. When, through his spokesman, Mbeki spoke of the ‘institutional racism’ of the Mail&Guardian in that newspaper on 17 December 2000, he was referring to a mindset, founded by what one might call the West is best assumption. If the West offered AZT, it must be bloody marvellous. If Western experts said blacks were dying in heaps from a new disease they got on account of their extraordinary promiscuity, it must be true. For Mbeki, an African, to dispute this Western wisdom was not merely incomprehensibly unreceptive, it evidenced mental problems. Putting him beyond the pale. A moral, intellectual and political outlaw. With any strike to destroy him and his reputation sanctioned, however base, however extreme. There was certainly no need to seriously entertain what he was saying. Such as that there was a ‘large volume of scientific evidence alleging that, among other things, the toxicity of this drug [AZT] is such that it is in fact a danger to health’; ‘When you are dealing with a virus and you … put [AZT] into the human body, whatever antiviral agent comes into this particular cell, it has to … produce phosphorous particles [i.e. be triphosphorylated], which are the things that have an impact on the virus [but] science isn’t even agreed upon that question. Does such phosphorylation take place?’; and that ‘scientists don’t know what they are looking for when testing for HIV’. The point comes home when one ponders how completely different international reaction would have been had Tony Blair been doing the talking.

Referring to ‘the racist stereotypes that are part of our daily menu of information and perception, and the formation of popular consciousness’, Mbeki raised these themes again in his Letter from the President in ANC Today on 30 May 2003, concerning speculation and insinuations in the media about high-level corruption in the arms deal, implicitly smearing him too: ‘... the threat is made that a “shadow of allegations might engulf” these “highest reaches of government” ... which means the President.’ He began by referring to liberal media opposition to the investigation by the Human Rights Commission of a complaint by the Black Lawyers Association and Black Accountants Association in November 1998 about endemic racism in the white-controlled media:

The ANC made its own submission to the hearings. One of the critical issues it raised was the role of the intensely negative, highly offensive and deeply entrenched stereotype of Africans among some in our country, which makes it inevitable that much reporting in our country would be racist. The ANC made the point that this stereotype necessarily dictated that some in our country would proceed from the position that our government was corrupt as alleged, unless it proved itself to be innocent. Among other things, it cited the instance of an article in a weekly journal [the Mail&Guardian], in which the journalist concerned gratuitously accused the writer of this Letter of dictatorial tendencies. The ANC explained the circumstances surrounding the writing and publication of this article, which were relevant to the subject of the hearings. This matter having been contested and subsequently taken to court by the journal concerned, the judge found in favour of the ANC. Needless to say, the determination made by the courts did not get the public exposure that the resort to these courts by this journal had evoked. The false allegation of wrong doing by the ANC was what was vigorously implanted in the public mind. To the contrary, the rejection of this allegation by the courts, and therefore the independent judicial assertion of the truth about this matter, was assiduously hidden from the public. Had this truth been communicated as openly as it should have been, it would have undermined the racist stereotype of Africans, and demonstrated the correctness of the decision of the HRC to hold its hearings. It was therefore not in the interests of some in our country, who believe in the stereotype, that this truth should be widely known. The same stereotypical conviction about our government being corrupt, unless it proves itself innocent, has re-surfaced with regard to the defence procurement decided by our government in 2000.

In the opening lines of his Letter, Mbeki yet again employed that favourite phrase, ‘as a matter of fact’, always used ironically to debunk the particular ‘fact’ in question subscribed to by his ‘civilised’ white liberal opponents:

In the Biblical Gospel according to St Matthew, it is said that Jesus Christ saw Simon Peter and his brother Andrew fishing in the Sea of Galilee. And He said to them: ‘Follow Me, and I will make you fishers of men.’ Perhaps taking a cue from this, some in our country have appointed themselves as ‘fishers of corrupt men’. Our governance system is the sea in which they have chosen to exercise their craft. From everything they say, it is clear that they know it as a matter of fact that they are bound to return from their fishing expeditions with huge catches of corrupt men (and women).

Mbeki indicated later on the sort of folk who know all they know ‘as a matter of fact’:

As an important part of the struggle to realise this objective [‘of building a truly people-centred society’], we should not, and will not abandon the offensive to defeat the insulting campaigns further to entrench a stereotype that has, for centuries, sought to portray Africans as a people that is corrupt, given to telling lies, prone to theft and self-enrichment by immoral means, a people that is otherwise contemptible in the eyes of the ‘civilised’. We must expect that, as usual, our opponents will accuse us of ‘playing the race card’, to stop us confronting the challenge of racism.

An aspect of Leon’s response to Mbeki’s attack that warrants note is his accusation that Mbeki was intolerant of opposition, maligning and demonising his opponents. It really sounded rather like the bully crying, the pot calling the kettle black, considering the slanderous treatment Mbeki was receiving for his public musings about the integrity of AIDS medicine – evincing the moral: Never disagree with a liberal who concerns himself with the welfare of the natives. For the rest, Leon’s talk was cheap propaganda. From the politician with the amusing fantasy that, in contradistinction to Mbeki, he’s a man of the people, ‘the people in their communities’. Whose idea of the ‘facts’ is what GlaxoSmithKline’s directors fed him. A couple of doctors in attendance, maybe. Followed by pink salmon and the best wines ordered up and enjoyed in the boardroom afterwards. All downed with lots of clubby pinstriped bonhomie.

The London press picked up the stridency of the Mail&Guardian’s editorials, with the result that much the same vituperative tone coloured contemporaneous articles in the English papers. Writing in the Observer on 20 August, the Mail&Guardian’s David Beresford reported the TAC’s announcement that it was off to court in an article entitled Mbeki ‘lets Aids babies die in pain’: ‘Campaigners against Aids in South Africa will start legal proceedings this week to force the government to save thousands of babies from painful and lingering deaths.’ Beresford knifed Mbeki on the way:

A Sussex University economics graduate, seen during the years of struggle against apartheid as the ANC’s arch-diplomat, Mbeki was widely regarded as sophisticated and cosmopolitan. Time and experience now offer, however, another perspective – of a man whose sensitivity on race points to a previously undiscovered psychological trauma which, while deserving of sympathy, makes him among the politicians least qualified to heal past wounds.

The Times made a similar charge on the 23rd: ‘Mbeki is suffering from a gargantuan persecution complex … [he is] acting like a nutter.’ The Independent spoke the same way the next day: ‘There is also growing disquiet within the ANC over Mr Mbeki’s judgement, which, senior members say, is damaging the party.’ Helen Suzman Foundation director RW Johnson put his boot in too, slandering Mbeki in the Spectator on the 26th: ‘Crudely put, many now believe that Mbeki is no longer playing with a full pack – that he’s off his rocker. … he may really be suffering the nervous breakdown that some suspect. … A Russian friend said to me, “It’s strange about Mbeki. In Russia it generally takes about five years for our presidents to go mad. He’s done it in one.”’ (But it’s not only Mbeki that Johnson despises, it’s African leadership generally – evidenced in his preceding proposal in the Daily Telegraph on 22 May that Africa be ‘recolonised’.) In a piece entitled Mbeki ‘Enemy of the people’ on the 27th, the Times buffed its earlier smear:

Nelson Mandela was always going to be a hard act to follow ... If the man to do it was [Mbeki], it seemed just an eccentric part of the new Pretoria politics. That was before President Thabo Mbeki declared himself a medical expert who understood his country’s Aids epidemic better than the global authorities. As a result, only legal action may force his government to admit that relatively cheap drugs given to pregnant women could prevent thousands of babies being fatally infected. Mbeki’s denial of the accepted facts about Aids is combined with an arrogant belief that what Africa needs is money, not the white man’s medicine. In his inauguration speech, Mbeki claimed that his people were no longer ‘the children of the abyss’. It would be a cruel irony if he proved to be the man to lead them into it.

The conservative Daily Telegraph climbed in too, repeating the Times’s charge that Mbeki ‘eccentric’ over his approach to AIDS and ‘hypersensitive’ to criticism for smarting at the aggression of his critics.

Visiting the city in the final week of September, Mbeki’s Minister in the Office of the Presidency, Essop Pahad, deplored the London press’s ‘persistent, poisonous attacks’, and wrote a reply to Johnson’s insults in the Spectator on the 30th, in which he took him to task for his ‘arm’s-length psychoanalysis of a president whom he has never so much as met’ (in fact he he did once) and for ‘alleging that the leader of Africa’s most secure democracy’ was insane. Back home, Pahad protested further to the Sunday Independent:

The far-reaching nature of the personal attacks on the president is staggering and incredible. If similar remarks were made against a prominent British leader, under the protection of organisations bearing the name of prominent and respected persons of equivalent calibre to Helen Suzman, there would be a major uproar. In some cases these personal attacks also originate in the South African press and this is also unacceptable.

Approached for comment, Suzman, who thought Johnson’s attack on Mbeki ‘good in parts’ but ‘over the top’ in others, was not so concerned about the unapproved loan of her foundation’s name to Johnson’s article; ‘What I worry about more is a president’s office that is unable to deal with criticism.’ Jeremy Gordin, then managing editor of the Sunday Independent, couldn’t see why Pahad should have been so upset; on the same day that Pahad’s indignant objection appeared in the Spectator, he reported the hoo-ha in the Star under the heading, ‘Mad’ Mbeki reports set Pahad ranting. Gordin quoted author Ronald Suresh Roberts suggesting that for Johnson, ‘Aids is just another occasion for Africa-bashing, another platform from which to confuse South Africa’s friends and damage South Africa’s influential push for a global economic new deal.’ But indeed it was: AIDS, and the lapse in Mbeki’s ardour for the ideology he’d deconstructed, had become a club with which to beat him down, discredit him, and undermine his drive to reorder international economic relations.

The American press also proposed that Mbeki was round the bend. ‘Under pressure to spend millions to prescribe AZT, President Mbeki indulges flat-earthers’, was Time’s response in April 2000 to Mbeki’s defence of his decision to invite ‘dissidents’ aboard his AIDS Panel; his ‘misplaced trust of medical authority’ threatened countless lives; without the drugs, a quarter of South Africa’s population would be dead by 2010. In South Africa’s Leader Flunks AIDS Lesson on 11 July, Newsday asked, ‘Has Mbeki lost his mind? That sounds like a decent question to most Americans. Until Mbeki pried open all the old questions about HIV, the issue was widely viewed as the obsession of a few tireless cranks.’ At best, in the American view, on the issue of AIDS Mbeki had become separated from all judgment. On 21 January 2002 the New Republic was still asserting:

To American eyes, Thabo Mbeki is a contradiction. Throughout his political career, he’s been known as a pro-Western moderate. … And yet on AIDS, he spews Afrocentric nonsense – denying that Western science can help his people, claiming that racists are exaggerating the scope of the disease, and flirting with homegrown quack cures. A recent New York Times editorial remarked, ‘It is hard to understand how Mr. Mbeki ... can be so irresponsible about AIDS.’

The attacks on Mbeki in the US press would be revived in April, May and September 2003.

As the English and US press were going at banjaxing his reputation like buggery, Mbeki took some low kicks locally from Mondli Makhanya in an opinion piece in the Sunday Times on 24 September. It was intriguing as an instance of a tame black journalist writing to sound like a white liberal, bloated with power afforded him at last, with his piece containing the same sort of air, logical fissures and analytic superficiality. (The docile native’s toadying to the liberal press bosses by posturing against Mbeki was rewarded two years later with the editorship of the Mail&Guardian after Barrell went back to England, and thereafter the Sunday Times.) Makhanya began with an approving description of a witty address Mbeki had given as Presidential candidate in June the year before, delivered, like his others on the pre-election campaign trail, almost exclusively in the country’s vernacular languages:

By election-campaign standards, too, the metamorphosis was a masterstroke: the bookish intellectual was now connecting with the urban proletariat and being embraced by them as one of their own. Even the sceptics in the international and local media were bowled over by the new Mbeki. Reams were written about Mbeki the thinker, Mbeki the hands-on manager, Mbeki the nuts-and-bolts man and Mbeki the man of the people. The business community, jittery about the post-Nelson Mandela era, perked up and began singing his praises. … The man of the people is no more. The thinker and orator whom many were in awe of no longer exists.

And why? Why he’s no longer a man of the people, orator, thinker? Because he was doing his own investigating, thinking, and drawing his own disconcerting conclusions:

The foreign media, who had raved about the Sussex University graduate who would lead Africa out of its malaise, now deride him. His noble efforts to fight Africa’s battles on the international stage have been completely overshadowed by a ridiculous controversy over his doubt about the link between HIV and AIDS. Mbeki has become his own worst enemy. A hallmark of the Mbeki presidency has been what can only be described as an intellectual superiority complex. Behaving almost like a benevolent dictator, Mbeki has nursed the notion that he knows what is right for South Africa to such an extent that no amount of lobbying and public pressure can divert him from a chosen path. … At the moment, Mbeki finds himself caught up in an unnecessary controversy that has done his presidency and South Africa immense harm. Only a few in his trusted inner circle can honestly claim to understand why he is flying in the face of irrefutable science and reopening the debate on the link between HIV and AIDS. So dismissive of public opinion has Mbeki been that he has been unwilling to bow to pressure from churches, trade unions, the non-governmental sector and the health profession. Few democratically elected presidents would risk the unpopularity that comes with having the moral and intellectual opinion of the country turned against them. Yet Mbeki, one of the most astute modern politicians, has done exactly that. So what is it about Mbeki that compels him to behave in a way that not only undermines his presidency, but also damages South Africa’s reputation as one of the few African countries run by sane men? The answer is that Mbeki is a starkly different ANC president from those who came before him. The ANC he leads is also very different to the one led by his predecessors. His intellectual superiority complex and the consequent individualist style with which he runs the ANC sets him apart from his predecessors.

Mbeki was establishing a ‘personality cult’, Makhanya wrote:

If the ANC is to reverse this trend, it should be in the area of HIV/AIDS that it intervenes to remind Mbeki that it is sometimes possible for him to be wrong and for others to be right. … The ANC’s willingness, or its lack thereof, to break ranks with Mbeki on this question will determine just how serious it is about accountability. As for Mbeki, his response to popular opinion will reveal whether his vision of a new Africa led by people who do not see themselves as demigods is real or whether it is just a sexy catch phrase he dreamt up one boring Sunday afternoon at Sussex University. He can still rebuild the image he enjoyed in June 1999 and set himself back on track to leave the legacy he wants. All he has to do is pull out the Thabo Mbeki who inspired the thousands who gathered at FNB Stadium on May 30 last year. He needs to reconnect with the people he governs.

He needs to abandon his insights, principles and convictions, and throw his lot in with the media-formed popular consensus. Like a sheep. Like Makhanya the lickspittle. Anxious to keep on the right side of whites, first and foremost. To stay in their good books. And get their jobs.

Writing in the October issue of New African, editor Baffour Ankomah attributed the murderous intensity of the English newspapers’ character attacks on Mbeki, incited by the local Mail&Guardian, to the fact that

In 15 months as president, Mbeki has proved beyond doubt that he is nobody’s errand boy. Recently, the powers that be wanted him to deliver the head of Zimbabwe’s Robert Mugabe on a silver plate. He refused. His unusual display of African presidential confidence is causing ripples abroad, especially in Britain, where he has become the target of crude headlines in recent days. The aim is to give him a bad name so they can hang him.

Ankomah warned of what had befallen other ‘progressive leaders’ such as Lumumba and Nkrumah, ‘cut down’ for their independent vision:

Forty years ago, Nkrumah was called a ‘megalomaniac’ (mad, in short) for preaching African unity, and wanting to industrialise Ghana as a model for the new Africa of those days. His government was overthrown. His projects were called “white elephants”. Yet, today, Nkrumah’s 11-point African Union programme (published in 1963) [the subject of Mbeki’s university master’s degree thesis] has been adopted and implemented almost wholesale by the European Union. The West continues to think for Africa. An African leader with an independent opinion suggesting an African solution must be daft.

The trouble with Mbeki’s open doubts about the HIV-AIDS model went beyond irritating evidence of a non-compliant, independent African vision and will. He was implicitly calling into question the integrity of Western commercial medicine. At its best. Because if virologists were its revered and mystical Jesuits, retrovirologists claimed mastery of even darker arts. It might chop and change chaotically (we’ll see), but the HIV theory of AIDS and the aggressive chemical approach to its management was allopathic medicine at its most sophisticated, most confident. And Mbeki was implying it was all bull. (Later on in this book, we’ll be touching on how medicine has succeeded the Church as a primary source of vital beliefs in Western culture.) Mbeki was defiantly holding out against them. He wasn’t paying due obeisance to the new Baal. The fury he generated was accordingly deadly. Hence the charges of genocide – treated at Nuremburg by hanging; of lunacy – treated by psychiatrists by inflicting brain damage, by knife, chemicals or electricity; and for perceived unfitness to rule, there was the Patrice Lumumba option.

A further reason for the rancour generated by Mbeki’s impugnation of AZT in particular was that subconsciously in the collective mind of his white critics, the drug represents a concrete token of an idealised notion of progressive Western medical science – looming like a rampart against a deeply rooted perception of retrograde African ignorance, in a country where Africans have worryingly taken charge. The drug has become politically fetishized – the weapon doctors wield to fight this horrible disease that only blacks seem to get, together with a few white homosexuals. Hence the pre-eminence of the AIDS drug issue in the white-run media. South African black critics hammered Mbeki over AZT and similar drugs for a related reason; allegiance to the drug cause put them in line with modernity. It’s a psychologically comfortable place. The whole of the white world nods to denote its favour. Nobody noticed that Mbeki’s African, pragmatic, open-ended approach to AIDS medicine coincides with Western scientific philosophy at its best, articulated so well by Sir Carl Popper, for instance. And summed up in one sentence by Albert Einstein: ‘The important thing is never to stop questioning.’

Disgusted by the viciousness of the attacks on Mbeki, a dozen prominent black business people, professionals and academics led by attorney Christine Qunta placed a full-page 1000-word protest that she drafted in the Sunday Times on 6 May 2001, noting that ‘Not during the worst days of apartheid, or even when the revelations of the Truth Commission showed the full horror of the human rights abuses committed under the political leadership of a succession of apartheid rulers … have apartheid politicians been singled out for such contempt, such open hatred, such unfair reporting as has the President.’

The bitter acridity of newspaper copy about the AIDS treatment and causation controversies also flowed from journalists’ offended self-perceptions. Mathebe deftly mapped this in the final chapter of Bound by tradition: The world of Thabo Mbeki, explaining ‘Mbeki’s unpopularity by reference to the fact that he is given to intellectual deliberation, which the modern journalist sees as his or her province or exclusive domain’. But here was a man who clearly thought for himself, and worse: he thought he knew better. Than white journalists. And not only do journalists rate themselves as thinkers, they’re crusaders for truth too; Mathebe cites an observation by a French commentator, Mogin, that ‘it is media people who most often think they embody the challenge to the status quo’, and who imagine themselves to be ‘“naturally” progressive because they daily hold history at the end of their pen’. And that because they wield power, politicians are morally suspect, and their statements and actions probably dissimulation. The violence of journalists’ language in assailing Mbeki was amplified by their inflamed self-opinion as ‘the custodians of moral virtue’, as Mathebe put it. Hence the intolerant, hateful and destructive gales of cant in their judgments condemning him. Simply for pointing out the existence of an alarming corpus of literature on the extreme toxicity of AZT. And for acknowledging that a controversy existed about the cause of AIDS – started by Duesberg, no less, one of the world’s most prominent retrovirologists. It got journalists into a moral fever, unequalled in the history of their business. As they went about GlaxoSmithKline’s. Really, it was to puke over.

Another element accounting for the dull reception liberal journalists have given Mbeki’s thoughts on AIDS is that they are simply not listening to him generally; they find no sympathy with his drive to vindicate African dignity, because in their cosy conclaves what he’s saying doesn’t reach their souls. To them it’s just posturing and prattle, like any other politician’s. And not glowing with a complex set of African attitudes, values and approaches, quite distinct from European and American ones – brought into hard focus by AIDS and highlighting their profound differences. The chasm between the progressive and liberal agendas too. And where Mbeki’s statements on AIDS are pained and uncomfortable, implying the persistence of white racist thinking after the revolution, to liberal journalists they make no sense at all.

Arthur Miller explained the hot reception of Mbeki’s challenges in the introduction he wrote to his Collected Plays, written in 1957 and included in Death of a Salesman: Text and Criticism edited by Gerald Weales (Penguin Books, 1996):

At first blush a new idea appears to be very close to insanity because to be new it must reverse important basic beliefs and assumptions which, in turn, have been institutionalized and are administered by one or another kind of priesthood with a vested interest in the old idea. … The polemical method, as well as the scientific exposition, the parable, or the ethical teaching, all depend upon a process which, in effect, says, ‘What you believe is wrong for these reasons; what the truth is is as follows.’ Tremendous energy must go into destroying the validity of the ancient proposition, and destroying it from an absolutely opposite viewpoint. An idea, if it is really new, is a genuine humiliation for the majority of the people; it is an affront not only to their sensibilities but to their deepest convictions. It offends against the things they worship, whether God or science or money.

Throughout the controversy at its hottest, the Mail&Guardian reworked the lines of its editorials and articles week after week, but its song remained the same, and it provided a vivid instance of what Herbert Marcuse captured in the title of his oft-quoted essay, Repressive Tolerance – his deconstruction of the sham claim of advanced liberal societies to abide dissent. George Orwell made the same point in his intended preface to Animal Farm (only published decades later, because it was not on to talk that way), explaining how in such societies, as opposed to dictatorships,

Unpopular ideas can be silenced, and inconvenient facts kept dark, without any need for any official ban. … At any given moment there is an orthodoxy, a body of ideas of which it is assumed that all right-thinking people will accept without question. It is not exactly forbidden to say this, that or the other, but it is ‘not done’ to say it. … Anyone who challenges the prevailing orthodoxy finds himself silenced with surprising effectiveness. A genuinely unfashionable opinion is almost never given a fair hearing, either in the popular press or in the high-brow periodicals.

Nearly all other newspapers took the Mail&Guardian’s lead, both in South Africa, in England and elsewhere. This was the newspaper to heed, its credibility perfected as a brave anti-apartheid firebrand. (None other than Mbeki himself had gone out soliciting legal defence funding for it when its reporting during the late apartheid era repeatedly landed it in court.) The result was the consolidation of an almost unanimous international public consensus, particularly keen in white liberal circles, that African babies – not white, Indian, or ‘coloured’ – were being infected with a deadly virus by their mothers, and were dying in droves, suffering horrible lingering deaths. Because Mbeki’s government wouldn’t come to their rescue. With AZT. And that Mbeki himself was sad, bad and mad. The last bastion of unelected state power, the predominantly white courts, would have to save the South African black populace from the demented ogre. The heartless dictator. The useless, stupid kaffir.

CHAPTER

September 2000 was a dizzy month in the South African AIDS controversy. It began with Mbeki explaining his reservations about the monocausal viral model of acquired immune deficiency – the propensity to fall sick, in plain speech – in an interview in Time on the 4th:

Now, if you go through the literature, ordinary standard literature available in medical schools, there will be a whole variety of things that can cause the immune system to collapse. Endemic poverty, the impact of nutrition, contaminated water, all of these things, will result in immune deficiency. If you take the African continent you add to that things like repetitive infections of malaria, ordinary STDs [sexually transmitted diseases] – syphilis, gonorrhoea etc. All of these will result in immune deficiency. Now it is perfectly possible that among those things is a particular virus. But the notion that immune deficiency is only acquired from a single virus cannot be sustained. The problem is that once you say immune deficiency is acquired from that virus your response will be anti-retroviral drugs. But if you say the reason we are getting collapsed immune systems is a whole variety of reasons, including the poverty question which is very critical, then you have a more comprehensive response to the health condition of a person. … I am saying that you cannot attribute immune deficiency solely and exclusively to a virus.

Asked, ‘Would you acknowledge that HIV is a causal factor in AIDS?’ Mbeki replied:

I am saying sure, no problem at all, there may very well be a virus. But there is a lot of debate among scientists, which is why we said let all these different factions come together. Let’s all get together ourselves and sort out this question. There cannot be any dispute about all these other things which result in immune deficiency. It’s in the medical school textbooks at university. So one of the first things they are going to try to answer is, when you take a person’s blood and measure it, what are you measuring? Are you measuring a virus or what? For what has been said is that these tests are measuring HIV. But what are these tests really measuring? The scientists are not agreed among themselves that what they are measuring is a virus. They are measuring the response of the immune system to something attacking it. But TB [tuberculosis], for example, destroys the immune system and at a certain point if you have TB you will test HIV positive because the immune system is fighting the TB. Then you will go further to say TB is an opportunistic disease of AIDS whereas in fact TB is the thing that destroyed the immune system in the first place. But if you come to the conclusion that the only thing that destroys immune systems is HIV then your only response is to give them anti-retroviral drugs. There’s no point in attending to this TB business because that’s just an opportunistic disease. What is fundamental is the AIDS. So much so that even in everyday language AIDS is said to be a disease. It’s no such thing. AIDS is a syndrome. It’s a whole variety of diseases which affect a person because something negative has happened to the immune system. If the scientists come back and say this virus is part of the variety of things from which people acquire immune deficiency, I have no problem with that. But to say this is the sole cause therefore the only response to it is anti-retroviral drugs, I am saying we’ll never be able to solve the AIDS problem.

Peter Bruce commented in an editorial in Business Day on the 12th:

President Thabo Mbeki has once again brought ridicule on himself and his country by repeating his eccentric views on HIV/AIDS. … His view, unacceptable to all but a handful of crank scientists, has desperate consequences for South Africans’ health. It implies that the HIV virus is but one minor cause among many, hence discouraging the single-most important preventive measure needed to turn the pandemic around, namely, a change in the sexual behaviour through which the deadly virus is transmitted

– black sexual behaviour, he implied, having regard to the virtual absence of ‘AIDS’ among the other race groups in South Africa, white particularly.

Mbeki’s remarks were ‘clearly nonsense’, commented Southern African HIV-AIDS Clinicians Society president Desmond Martin. Although, yes, ‘False positive tests do occur with antibody testing in patients with TB. But confirmatory testing rules out this false test.’ (Really?) And yes, ‘TB does cause some – and I’d stress some – immunosuppression. But to say it “destroys” the immune system is wrong.’ To say that when you don’t have enough proper food to eat and your health collapses and you are over-run by colonising TB bacilli is wrong. Martin went on: the statement that ‘the test is meaningless … coming from a highly respected source … put our education campaigns back,’ he complained; they are ‘being disbelieved’. Children are responding to safe sex programmes with derision, he said. We don’t like our youngsters discovering sex, he meant.

Adding its voice to the storm over Mbeki’s statements in the Time interview, the communists came out in support of the capitalists of the medical industrial complex. The SACP referred to general secretary Blade Nzimande’s appeal to Mbeki in April: ‘Comrade President, let us not cheat ourselves. We know that AIDS kills, and that AIDS is caused by the HIV virus.’ We know it because it’s what doctors say, and as communists we prefer modern scientific doctors to backward unscientific priests when it comes to explaining life.

The day after publication of the Time interview, there was another, in a rather more modest forum, the Johannesburg studios of Radio 702, where a crass sports jock called John Robbie interviewed Tshabalala-Msimang. When he addressed her by her first name, and she objected, he contemptuously persisted – ‘behaving like the “baas” talking to the “maid”’, chided Business Day afterwards. He tried forcing a statement from her concerning whether she believed HIV caused AIDS, but she would not be compelled: ‘You will not pressurise me to answer that.’ To which he responded, ‘Go away. I cannot take that rubbish any longer. Can you believe it? ... I have never in my life heard such rubbish.’ Similar contempt was expressed on a Capetalk 576 community radio billboard in Rondebosch, Cape Town in 2002: ‘Why did the chicken cross the road? Chicken? There’s no proof that there’s a chicken to begin with – Health Minister.’

Unwittingly, like a child with matches, Robbie had ignited an inquisition into the beliefs of members of government concerning AIDS – entailing the requirement that they make public avowals of subscription to the dominant creed. Education Minister Kader Asmal was examined next. But at a media conference on the 12th, he refused to be ‘pushed into a corner over the issue’. This gave the Mail&Guardian an idea. Not content to report the news, it decided to make it, by submitting a questionnaire to each of the Cabinet’s twenty-seven members, inquiring whether they believed HIV caused AIDS. And published what responses it drew later in the month.

The 16th was the start of Cosatu’s annual four-day conference. About a week in advance of it, a white paper concerning AIDS policy, prepared for tabling and discussion at the conference, was tactically leaked to the Mail&Guardian, and the weekly duly obliged with an article about it on the 8th: Cosatu: End scientific speculation on HIV/Aids. The policy paper called on the government to do just that, and to turn its attention instead to supplying cheap AIDS drugs – especially to rape victims and HIV-positive women, something that was ‘morally and medically right’. Cosatu president Willie Madisha was approached for comment: ‘We believe that indeed HIV causes AIDS and that is not disputable. All this talk and debate about the cause of AIDS prevents people from trying to deal with the problem.’ We believe.

The AIDS controversy was hardly a shop floor issue, but the unionists, I suggest, seized it for its practical political value. When the Tripartite Alliance between the ANC, the Communist party and Cosatu was formed ahead of the first democratic election of 1994, Cosatu had wielded considerable clout within it, but its influence over ANC policy since had been in steady free fall. I surmise that AIDS presented to Cosatu as a politically useful issue with which to leverage itself within the axis and to pressurise the ANC in government in an attempt to arrest its slide from power-player to minor participant in the alliance. And perhaps juggle for a position closer to the heart of the masses than the ANC. Caring. Unlike the ANC. But the credulity of Cosatu’s leadership concerning the racist AIDS scare and its decision to support the TAC agenda might have had the opposite effect and have exacerbated the erosion of union power and influence within the alliance. Because by indulging in such foolish populist talk, and by throwing in its lot with the TAC, Cosatu’s voice has become more difficult to take seriously by Mbeki and his senior ministers and aides.

And then there was the money in it. In 2002 the investment arm of Cosatu-affiliated CEPPWAWU bought stock in local drug manufacturer Aspen in a black empowerment deal. Announcing an increase in revenues of forty-one per cent in August that year, the company press release quoted CEO Stephen Saad: ‘Aspen’s strategic approach towards providing quality affordable generic antiretrovirals for HIV/AIDS sufferers has progressed significantly, firmly positioning us to deliver on this initiative in the foreseeable future.’ Nothing strange for Cosatu getting involved in the business with disease: in July 1997 its investment arm Kopano ka Matla had already bought into Netcare, a private hospital company. Along with thirty thousand black doctors making up the South African Medical and Dental Practitioners. All enjoying the profits together. And hopelessly compromising Cosatu’s voice in health policy, especially concerning the provision of AIDS drugs. We lawyers call this a conflict of interest.

At about the same time as the rigged Cosatu press-leak, a nine-page document drawn by the deputy chairperson of the ANC’s national health committee, Confidence Moloko, helped by committee secretary Saadiq Kariem, was delivered to the Cape Times. It asserted: ‘... we do not have the luxury of fiddling whilst the masses are dying. … We have identified the cause [of AIDS]. The infectious agent is HIV, which is a retrovirus. The predominant scientific view that HIV causes Aids is the view that the ANC, its leadership and its membership has to publicly express.’ Tshabalala-Msimang was annoyed about not having been consulted. Understandably, since she chairs the committee – an advisory body formed in 1990 to report to ANC Secretary-General Kgalema Motlanthe. Not circulate rearguard broadsides. She accordingly demanded that the document be withdrawn. A member of the committee speaking anonymously explained why it had refused: ‘This is a moral stand that we need to take.’ Against the government’s immorality. In a statement on the 13th the ANC emphasized that the document was a discussion paper that did not reflect the views of the party. Indeed, speaking for the ANC, Smuts Ngonyama noted that ‘It wasn’t even a subcommittee document, it was one man’s opinion on the subject.’ Moloko admitted as much: ‘This is a confidential discussion document intended to stimulate debate within the organisation. … We hope this will raise the level of debate.’ Hardly: it simply recited and urged the conventional wisdom, in a fifth column manoeuvre by medical doctors in the ANC. ‘There is nothing secretive about it but it is only intended for people in the ANC. We are not ready to release it to the public yet.’ Yet it was deliberately leaked to a white conservative newspaper. Very likely by Kariem. There were no ‘holy cows’ in the ANC, Moloko added, and the debate about Mbeki’s position on AIDS demonstrated this. That wasn’t the point. The doctors were subverting Mbeki. Their first loyalty to the medical-industrial complex. They were playing into the hands of his detractors. So that in reporting the matter, the Independent Online could claim on the 13th: ‘The document ... reflects dissatisfaction in the ruling party about Mbeki’s ambiguous statements on the disease that affects over four-million South Africans.’

According to a report in the Mail&Guardian on 13 December 2002, Moloko and Kariem had not been forgiven for their treachery more than two years later, with Tshabalala-Msimang allegedly moving to block their accreditation applications to prevent their attendance at the ANC’s annual national conference set to start the following week.

On 15 September the Mail&Guardian backed the two discussion papers’ calls with one of its own in its inspiring Just say yes, Mr President editorial:

President Thabo Mbeki either gets his act together on HIV/Aids very soon or he places his presidency at risk. We South Africans are losing the battle against this disease. This is, in no small measure, the result of the refusal by Mbeki to accept the guidance of best science. That refusal is irrational and perverse. More than four million South Africans are infected with HIV. These four million-odd South Africans will die as a result. Families and communities across the country are being decimated. More South Africans are being infected with HIV – at the rate of one a minute. Worse, the rate at which South Africans are being infected is rising. Worse still, the African National Congress – the first party to be democratically elected in our country – has allowed this rate of infection to continue to rise every year since it came to power. … It is not too late for Mbeki to change the growing perception of him as an extremely intelligent man, but one whose intellect contains islands of irrationality that are impervious to reason, who has difficulty in conceding an error of judgement, and who prefers verbal play to the practical tasks at hand. An encouraging start would be for Mbeki to say as little as this: ‘Deficiency in immune systems is due to more than just HIV. But we have to recognise that there has been a huge increase in the number of illnesses and deaths among our adults and children. What we know is that there is a new virus and that it is, primarily, causing this increase in deaths.’ Just say it, Mr President.

Just say it like Gerhart Hauptman, the 1912 Nobel Prize winner for literature, declaring his support for the Nazi regime in 1933 in an article he published under the title: ‘I say yes!’

On the same day that the Mail&Guardian was enjoining Mbeki to just embrace the faith, PAC health secretary Costa Gazi made a call at the same level, demanding Mbeki make a public apology for his stance on AIDS. And he should also take responsibility for the tens of thousands of children’s lives that have been unnecessarily lost because of his policies, he said.

The following day, on the 16th, Mbeki attended the first day of Cosatu’s annual congress. Union boss Madisha opened by repeating what he’d said earlier in the month:

We need to put the current controversies behind us and develop strategies to obtain cheap drugs, either through hard negotiations with producers or through parallel importation of generics and compulsory licensing. For Cosatu the link between HIV and AIDS is irrefutable, and any other approach is unscientific and, unfortunately, likely to confuse people. The current debate on the causal link between HIV and AIDS is confusing. As a result, it can undermine the message that all South Africans must take precautions to avoid infection. Government’s unwillingness to provide anti-retrovirals, particularly to prevent mother-to-child transmission, is unfortunate. Concerns around cost are understandable but often exaggerated. In any case, they cannot be used to deny treatment for the millions of victims. This is tantamount to condemning HIV/AIDS victims to early deaths.

Alert to how AIDS was being worked by his opponents not only as a cudgel to discredit him personally, along with his vision for radical national transformation, but also as a wedge to separate him from his allies, Mbeki answered elliptically:

In trying to define a role for the trade union movement, we must never forget that there are forces for change, and then there are reactionary forces bent on retaining at all cost the privileges and power acquired under apartheid. They want us to become a house divided against itself, concentrating on a campaign to destroy one another. Those [the ‘beneficiaries of our racist past’] who want to set the national agenda in their own interest want us to forget about 84 percent of these killer diseases [‘heart disease’ and ‘malaria’, for example, as he would explain in Parliament later in the month] and concentrate on the remaining 16 percent. We must not allow ourselves to be misled.

(Apropos of heart disease, Mbeki laughs privately that coronary thrombosis among whites, no matter how many it takes under, doesn’t draw any media interest, because, unlike black AIDS, it’s a ‘first class disease’.) He urged the Tripartite Alliance to ‘intensify the struggle against racism’. But the subtlety of Mbeki’s answer to Madisha was lost on SACP general-secretary Blade Nzimande. Asked by the media to comment, he went for the lazy sound-byte: His party ‘accepts the view of the scientific community that the HI virus causes AIDS’, he said. ‘We need to fight against HIV-AIDS with the same intensity as we struggled against the criminal apartheid system.’ We need to fight it with condoms and drugs.

On the 19th, having just refused to distance herself from Mbeki’s open, questioning stance at a parliamentary media briefing a couple of days earlier, and unwilling to answer yes or no to journalists’ questions about HIV as the cause of AIDS, Tshabalala-Msimang attended a meeting of the parliamentary Health Committee. A group of about fifty TAC members in ‘H.I.V. positive’ tee-shirts led by Achmat gatecrashed the meeting to show their ‘dismay and anger’ at the government’s AIDS stance. After the manner of Hare Krishna devotees, they sat murmuring ‘Just say yes, just say yes’ throughout her address. On the steps of Parliament afterwards, as journalists hovered, having been called out to cover the staged event, they pressed their plea on her again. Achmat put it to her that she’d accepted HIV caused AIDS in the past, and she should now say so publicly. Her answer was that she’d ‘never said HIV did not cause AIDS’. The government’s stance was causing confusion, someone cheeped. She retorted: ‘Who is causing confusion? I say one and the same thing all the time and you refuse to listen. In rural areas where I operate, people are not confused.’ Recognising where that was going, Achmat countered that while poverty helped to spread HIV, it did not cause AIDS.

The London Observer reported the upshot of the Mail&Guardian’s poll of Cabinet members’ beliefs on the same day. Silent or evasive, most wouldn’t play. Labour Minister Membathisi Mdladlana answered, ‘Yes, of course HIV causes AIDS.’ Another report included his rider that ‘poverty also damages the immune system’. Finance Minister Trevor Manuel uttered cagily: he did not want to get into the subject, he said, but he understood ‘there is evidence to suggest’ HIV caused AIDS. But equally there was also evidence that other factors, such as poverty, ‘accelerate’ the conditions associated with the disease: ‘Bodies that are weaker are more susceptible to that condition.’ Public Enterprises Minister Jeff Radebe appears to have had a surprise in store for reporters on the 14th, but they didn’t ask him: ‘I was waiting for the HIV and AIDS question, but you disappointed me,’ he said with a smile. (‘We support the President,’ he said two weeks later.) Tshabalala-Msimang’s office responded on her behalf: ‘The minister is working on the assumption that there is acquired immune deficiency. There is a variety of things that causes the collapse of the immune system and it cannot be attributed solely and exclusively to the virus.’

At separate media briefings on the 19th, the Inkatha Freedom Party’s Ben Ngubane, Minister of Arts, Culture, Science and Technology, and Correctional Services Minister Ben Skosana both agreed HIV causes AIDS, but defended what they described as ‘the government’s decision to enquire into other factors escalating the epidemic’. Ngubane had a curious comment though: ‘The link between HIV and Aids is indisputable. The current debate is at a much bigger level, about the nature of investigation in laboratories.’ The value of the tests on which the whole show was being staged? The link between a meaningless test result and ancient diseases?

The Panafrican News Agency wired a report on the 20th, Furore Over Government’s AIDS View Continues:

As the government continues to prevaricate on HIV/AIDS and the nation becomes more desperate, Archbishop Njongonkulu Ndungane on Wednesday called on all religious leaders and organised society – including the unions – to take the initiative. ‘We need an urgent strategic planning meeting of all interested parties so as to develop a plan of action and we need to move fast. We believe that history will measure this country’s slow response to the pandemic in human, not in statistical terms, and that the inherent injustices will be judged as serious a crime against humanity as apartheid,’ he said. [And history will tell how AIDS revitalised the South African Anglican Church.] Ndungane said the government’s stubborn refusal to work within scientifically accepted parameters is the greatest existing threat to the political and economic stability of the region. ‘It impacts on the entire global family and entrenches the insidious effects of poverty, which is the greatest known form of violence. What is becoming increasingly clear is the futility of looking to government for a solution. At the very least, we need to apply pressure on our political leaders to change this situation,’ he added.

In a private note Gerrit Brand, a theologian with a PhD from Utrecht, pertinently explained South African Christian enthusiasm for AIDS from two tacks:

The Church was very active in the struggle against apartheid and found its whole meaning in that stance for a long time. When apartheid was gone, the Church was suddenly left with a feeling of disorientation. The abnormality of apartheid had become normal to it, and so it couldn’t cope with a more normal situation. In this sense there was a sort of nostalgia for apartheid, for some great evil against which the Church could once again take a principled stand. This is what caught both Tutu and Ndungane in the end. Among white Christians, especially in the NG Kerk, who had supported apartheid, the need for a new struggle was even stronger because it would afford them the chance to redeem themselves by, this time around, joining in the struggle with no holds barred. So, interestingly, AIDS has become the absolute top priority of the NG Kerk. It is terribly sad to witness how so many people’s sincere wish finally to do something good is ravishing their immunity to the ideology of AIDS.

And terribly sad it was to see that most heroic of anti-apartheid clerics the late Beyers Naude sipping cocktails with AIDS Law Project director and TAC national treasurer Mark Heywood on 14 October 2003 at Monte Casino in Johannesburg, where the AIDS documentary A Closer Walk had its premier screening. Director Robert Bilheimer, nominated for an Oscar for his 1989 film about Naude, told the audience that nothing less than ‘igniting a revolution’ was his intention in making the film: ‘Its time for the people to take control ... Kennedy once spokes of a ripple effect. We are all here tonight and this is where the ripple begins. ... When you have people in the back doing something ... then you can be damn well sure leaders in the front will take notice.’ Revolutionary people in the back like Heywood. Useless leaders in the front like Mbeki.

In Parliament, on the same day that PANA published Ndungane’s excoriations, Tony Leon pressed Mbeki for a personal affirmation of orthodox belief. He answered: ‘The programme of the government in this country is based on this thesis that HIV causes AIDS and everything in the programme says that.’ They liked that bit. But hated the next: ‘AIDS stands for Acquired Immune Deficiency Syndrome,’ but ‘A virus cannot cause a syndrome. A virus can cause a disease, and AIDS is not a disease, it is a syndrome.’ A syndrome that includes ‘twenty nine diseases’. Questions about HIV and AIDS had been raised by ‘very eminent scientists’, and while he had ‘no problem’ with the argument that HIV contributed to the collapse of the immune system, other factors such as malnutrition and malaria were also involved. All these had to be studied so that ‘we can respond to them all and be more effective’. Reiterating his point in his April letter to Clinton, Blair, Annan and others that ‘Reciting comfortable catechisms on AIDS is not good enough’, Mbeki commented. ‘The basic problem is that many people don’t want to study these questions. They are perfectly happy to repeat what is said to be the conventional wisdom.’ He then raised a crucial issue: ‘When somebody is tested, HIV positive or negative, what is being measured? … What do HIV tests measure?’ An advisory panel established to research the link between HIV and AIDS would report back by the end of the year, he said. And as for nevirapine for HIV-positive pregnant women, tests were continuing in South Africa, and anyway, he said, it hadn’t been approved anywhere else in the world for that indication.

Leon responded that Mbeki had ‘snatched confusion from the jaws of clarity’. New National Party AIDS spokesman Kobus Gous said that whoever had advised Mbeki that a virus could not cause a syndrome should ‘be fired’. Heywood pronounced Mbeki’s exposition ‘devious and dishonest’. Barney Pityana, then chairman of the Human Rights Commission, said his HRC was considering legal action in the light of a number of complaints by AIDS sufferers claiming that their constitutional right to be provided with potentially life-saving drugs was being denied by the government.

As Cameron put it later on in the PBS Frontline television documentary The Age of AIDS screened in the US on 30 and 31 May 2006 : ‘It was clear from his speech that he’d had access to denialist literature on AIDS, denialist literature that queried whether HIV was, in fact, a virally caused condition, and that queried, most significantly, whether the anti-retroviral drugs were of any use in treating what the denialists claim is an environmental and social condition, not a viral condition.’ To which Glenda Gray added, ‘What we had was a president who was a dissident. We had lackeys in the health department that would do anything that their master said, and even if it meant not giving women interventions to save their children’s lives.’ You see, they’re all savages.

The following day, on the 21st, journalists tried pinning down Public Works Minister Stella Sigcau on the AIDS causation issue at a media briefing. She wriggled: poverty relief was her concern, she said, and since poverty made people susceptible to disease, the government should focus on ensuring people emerge from it. And later in the day, the last day of Cosatu’s national congress, more than two thousand delegates adopted a unanimous resolution urging the government to end its speculations about the cause of AIDS, give attention to AIDS orphans, and to provide AIDS drugs to HIV-positive pregnant women and rape victims. The resolution called on the government to approach the pandemic as a ‘national disaster requiring extraordinary measures’. Cosatu congress closes with Aids crusade reported the Independent Online next day, with Madisha appealing to the union to ‘mobilise our family and friends, the bosses and even the government to ensure that we act as a unified people to defeat this scourge. What would be the use of all our resolutions if we were to pass them and then have to listen to the agony of our fellow South Africans, our mothers and fathers, brothers and sisters and children, who are dying as we speak.’ Cosatu was well and truly onside. The TAC’s. The pharmaceutical industry’s.

As Mbeki was sceptically summing up for the ANC what was going down between Cosatu, the TAC and the drug corporations, his predecessor was declaring himself a believer. Interviewed by the Daily News on the same day, Mandela said he shared the ‘dominant opinion which prevails throughout the world’, and would only give it up if it was shown ‘conclusively that that view is wrong’. But, he said,

I am not a specialist; I’m not a doctor. It is known that in medicine there will be a particular viewpoint, which is embraced by experts throughout the world. But some research then shows that that view requires qualification, sometimes to be abandoned altogether. … [Mbeki] has said that government action is based upon the fact that HIV causes AIDS, but he himself as an individual has got certain reservations. … I would like to be very careful in saying so and so is right and so and so is wrong. … I would like to be careful, because [for] people in our positions, when you take a stand, you might find that established principles are undermined, sometimes without scientific backing, and so I would like to be very careful.

For all the soft soap, Mandela’s implication was obvious: Mbeki was undermining good science without good reason, so it followed that he must deservedly ‘now and again ... come under severe criticism’. But he respected him nonetheless, he said. ‘We are very, very close indeed.’ Not really, truth to tell.

The annual three-day conference of the National Executive Committee of the ANC began on Friday the 29th. The political dynamics of the AIDS controversy got a close look and featured in its report released early the following month. The Mail&Guardian endeavoured to dictate the agenda on the front page of its Just say yes, Mr President issue, charging: ‘The vast majority of scientists are in agreement that HIV causes Aids. South Africa is gripped by a catastrophe that is killing millions of our people. The government’s questioning of the link between HIV and AIDS is crippling the campaign to combat the scourge’ – but the newspaper would be rebuffed by the NEC in its closing statement. Making ironic use of the Mail&Guardian’s apocalyptic imagery to justify his consideration of politically incorrect perspectives, Mbeki answered the accusation in the Star on 10 October, feigning humble ignorance along with pretended awe: ‘I personally want to understand this matter better … We are looking for answers because all the information shows that in reality we are faced with a catastrophe and you can’t respond by merely saying “I will do what is routine”. We need to respond in a way that recognises that it is a catastrophe.’

September ended on a happy note. Achmat was awarded a ‘Spirit of Hope Award’ from the SA NGO Coalition for his ‘special contribution’ to civil society.

From the AIDS storm pelting Mbeki and Tshabalala-Msimang, October offered no respite. The month began with a statement by the South African Medical Association, reported on the 2nd, deprecating the confusion Mbeki was causing. And not only about whether HIV caused AIDS; SAMA was concerned at the ‘growing number of people now questioning the existence of HIV’. Like the Devil. Chairman Zolile Mlisana commented:

The point we want to raise is that at this point in time there shouldn’t really be discussion about whether HIV causes AIDS. It was SAMA’s responsibility to end [it]. … Whether HIV causes Aids or not is not a matter of speculation, it’s a question of scientific fact. As professionals and scientists we want to make that statement very clear. It’s our responsibility to do so. … HIV does cause AIDS. It is not a matter of political opinion. … President Mbeki is wrong if he implies doubt about HIV causing AIDS.

All the same, he was a ‘sound and highly intelligent man. … Perhaps he has not consulted enough, or has somehow undermined that consultation process.’ But he wasn’t all wrong: ‘Especially in the cases of medical disasters and epidemics it is important to note and emphasise that these are not arrested by the administration of medicines, but by social re-engineering, prevention, and public health measures. The president is right if he is attempting to force us to consider more than just the virus and administration of medicines on the issue of HIV/AIDS.’

The next day, following the conclusion of its meeting, the ANC NEC issued its closing statement. It mentioned the ‘massive propaganda onslaught against the ANC, its President and its government on fundamental questions facing the country’ – and one would think Mbeki was Mobuto or Bokassa the way he was being attacked; it regretted ‘the practice of Alliance partners of debating matters central to the transformation of our country in the media, rather than engaging with each other in a comradely manner and in appropriate fora’; and it ‘reaffirmed its policy and programmes on HIV/AIDS [‘based on the thesis that HIV causes AIDS’] as articulated by the President and carried out through the structures of the movement and those of government’. After reviewing them, it concluded:

The NEC lends its full support to the initiatives of the government to support further scientific enquiry into this very complex pandemic and towards efforts to find a cure. In this context, we should refuse to surrender to populism, dogma and sales pitches of some pharmaceutical companies and their agents. Fighting the HIV/AIDS pandemic is a national priority. As the movement that embodies the aspirations and hopes of our people, the ANC, its members and cadres should not allow themselves to be distracted from pursuing the programme to turn around the tide of the pandemic with vigour, commitment and dedication. Neither should we pander to the agenda of those whose occupation it is to extract the most sensational sound byte. In the final analysis, our responsibility is to the mass of our people.

At the Pretoria Sakekamer’s annual dinner on the 4th, Leon said Mbeki’s ‘brand of pronouncements to the ANC caucus [a week earlier] does violence to the facts. … Aside from the diversionary nature of his contribution in the AIDS debate, President Mbeki has done great damage to South Africa as an investment destination.’ His ‘effective declaration of war on the international drugs and pharmaceutical companies was a case in point’. He should ‘make love, not war’ on international investors. ‘President Mbeki should stop surfing the Internet on immunology and start fixating on improving investment flows into South Africa. In short, government should stop blaming and start delivering. They should prioritise, rigorously, not politicise endlessly.’ There was another scolding for Mbeki earlier in the day: Makgoba told a meeting at Rhodes University that South Africa couldn’t ‘afford any more mixed messages and blunders’ in its fight against AIDS. We – he meant Mbeki – had to make careful ‘political and scientific choices’ or history would record collaboration in the ‘greatest genocide of our time’. South Africa would still be facing ‘the explosive and unrelenting HIV/AIDS epidemic’ when the dissident scientists that he’d invited to the country had gone home.

Government spokesman Joel Netshitenzhe announced the following day that starting the day after, an ad campaign would be running for two weeks on the premise that HIV causes AIDS. Mbeki had been fully consulted, and it had ‘his seal of approval. … The current debate might have introduced doubt about the government’s position on AIDS. This campaign is about reinforcing government’s stance on the matter.’ He said the focus of the advertisements would be on promoting the ABC programme: ‘abstinence from sex, being faithful to one partner, and condom use’.

As he spoke, journalists were studying a bundle of correspondence released to them on the same day. It was the full exchange between Mbeki and Leon over AZT for rape, excerpts of which had been published in the Sunday Times in July, and they contained enough acid to strip paint.

Leon:

You have misrepresented your opponents, twisted their words and tried to impose your own meaning on what they said, all in an attempt to blindside your critics. I cannot judge whether this is merely a cynical attempt to silence debate, or whether you really believe that anyone who criticises you or your government is (by definition) a racist. … I would far rather, Mr President, that you and I should work together on this supreme crisis facing our country ... I would be only too happy to stand on the same platform with you to back a campaign for the eradication of sexually transmitted diseases whose prevalence does so much to help spread HIV/Aids. I am not interested in whether my [largely white] supporters or yours [largely black] suffer more from STDs [sexually transmitted diseases] ... We both want the best for our country and for all our countrymen and women. I will be only too happy to meet you at your earliest convenience to discuss how we may work together to dramatise that this is a crisis for all of us, that death and disease know no distinction of politics, creed or race.

Mbeki answered:

I also note that you make no comment whatsoever against the gravely insulting statement made by Charlene Smith about rape being ‘endemic’ in African culture. Rather, you attach footnotes to your letter, which, by trying to talk the rape figures upwards, seek to imply that she may, after all, be right. My attention has also been drawn to Ms Smith’s denial, in a recent publication, of ever having written the passage I quoted in my letter to you. In the event that you did not understand its true import, let me cite it once again. ‘Here, (in South Africa), (AIDS) is spread primarily by heterosexual sex spurred by men’s attitude towards women. We won’t end this epidemic until we understand the role of tradition and religion and of a culture in which rape is endemic and has become a prime means of transmitting the disease, to young women as well as children.’ The article in which this appears is subtitled ‘Their Deaths, His Doubts, My Fears’. It appears in the Washington Post edition of June 4, 2000. Datelined Johannesburg, the newspaper says it is ‘By Charlene Smith’, described by the newspaper as ‘a South African journalist who writes about HIV, (who) will speak at the International AIDS Conference in Durban in July.’ Since she denies having made this nakedly racist statement, which you seek to justify in your footnotes, time will tell who between her and the Washington Post is prone to the shameless propagation of unembellished untruths. The racist stereotype of Africans that many South Africans carry in their heads has nothing to do with ‘civil society’. The subterfuge of seeking to hide behind the skirts of ‘civil society’ will not pass. Your comments suggest that you are not aware of the fact that the figures published about the incidence of HIV in our country and the rest of our continent are estimates. Mathematicians and statisticians have questioned the reliability of these estimates and the correctness of making extrapolations, in our country, from information gathered among pregnant black (African) women at antenatal clinics, using highly questionable mathematical models. To understand the extraordinary distortion this creates, please try to get figures about the incidence of HIV-AIDS among the white population of our country! I am certain you will find the search very frustrating and the result very illuminating! But, of course, I am likely to be quite wrong in assuming that a person as well informed as you are about HIV-AIDS does not already have this information. You may also be unaware of the desperate attempt made by some scientists in the past to blame HIV-AIDS on Africans, even at the time when the USA was the epicentre of reported deaths from AIDS. To me as an African, it is both interesting and disturbing that the signatories of the so-called ‘Durban Declaration’ return to the thesis about the alleged original transmission of HIV ‘from (African) animals to humans’, given what science has said about AIDS during the last two decades. I accept that it may be that you do not understand the significance of this and the message it communicates to Africans, hence your queer observation that I seek to silence our critics, without responding to their arguments. … Possibly we do originate from different planets with radically different value systems.

It seems clear that you are determined that neither established fact, nor anything else whatsoever, will deter you from pursuing your set goal of ensuring that rape victims use AZT ... I still find it completely unacceptable that the leader of the opposition should, in a democracy, blatantly urge defiance of the law. … You would do well to listen to those who have been and continue to be victims of the most virulent racism. Difficult as it may be, the least you might try to do is to fight against the tendency to hold in contempt those whom white South Africa has held in and treated with contempt for many centuries, even if you do not quite understand everything they mean when they speak. … You state that the appearance of the president and the leader of the official opposition on the same stage, campaigning on the same health issue, would make ‘a very great public impact.’ You may very well be correct. But I can also imagine how many people there would be, at home and abroad, who would ask ... why does the elected president not have sufficient courage to discharge his responsibilities about the health challenge we face, without requiring that the leader of the official opposition should hold his hand? … You are entirely wrong to claim ... that ‘death and disease know no distinction of politics, creed or race.’ Perhaps this illustrates graphically the point that we do, indeed, occupy different planets. Contrary to what you say, even a child, from among the black communities, knows that our own ‘burden of disease’ coincides with the racial divisions in our country.

In this regard, you might care to consider what it is that distinguishes Africa from the United States, as a consequence of which millions in sub-Saharan Africa allegedly become HIV positive as a result of heterosexual sexual intercourse, while, to all intents and purposes, there is a zero possibility of this happening in the US. I imagine that all manufacturers of antiretroviral drugs pay great attention to the very false figures about the incidence of rape in our country, that are regularly peddled by those who seem so determined to project a negative image of our country. The hysterical estimates of the incidence of HIV in our country and sub-Saharan Africa made by some international organisations, coupled with the earlier wild and insulting claims about the African and Haitian origins of HIV, powerfully reinforce these dangerous and firmly-entrenched prejudices. None of this bodes well for a rational discussion of HIV-AIDS and an effective response to this matter, including the use of anti-retroviral drugs.

I trust that our discussion about AZT and rape will convince you that despite the fervent reiteration of various assertions, supported by many scientists, medical people and NGOs, about the existence of some unchallengeable and immutable truths about HIV-AIDS, as public representatives we have no right to be proponents and blind defenders of dogma. Whatever the intensity of the campaign to oblige us to think and act differently on the HIVAIDS issue, the instinctive human desire in the face of such a barrage, to obtain social approval by succumbing to massive and orchestrated pressure, will not lead us to become proponents and blind defenders of dogma. The cost of AIDS in human lives is too high to allow that we become blind defenders of the faith. Once again, I would like to suggest that you inform yourself as extensively as possible about the AIDS epidemic. Again, for this purpose, I would like to recommend that you access the Internet. On the various websites, you will find an enormous volume of literature, including CDC, WHO and UNAIDS documents, editions of various highly respected science journals as well as ‘dissident’ articles. I believe that it is imperative that all our public representatives should base whatever they say and do on the HIV-AIDS matter, on the truth and not necessarily on the comfort of fitting themselves into the framework of whatever might be considered to be ‘established majority scientific opinion’.

But it was all lost on Leon: ‘I do not think that politicians are under any “moral obligation” (in fact quite the opposite) to claim the right to deliver final judgement on questions of scientific fact. It is a totalitarian principle that political leadership is somehow on a higher plane to technical expertise and is thus entitled to override the autonomy of all institutions in society.’

Mbeki replied:

Let me assure you that as long as I have to occupy a decision-making position within out politics, so long will I take such decisions as may be necessary and morally defensible, whatever institution makes recommendations according to its mandate and possibilities. The idea that, as the executive, we should not take decisions we can defend, simply because views have been expressed by scientist-economists, scientist-agriculturists, scientist-environmentalists, scientist-pedagogues, scientist-soldiers, scientist-health workers, scientist-communicators etc, is absurd in the extreme. It is sad that you feel compelled to sink to such absurdity, simply to promote the sale of AZT. ... I think that it is dangerous that any of our public representatives and political parties should allow themselves to be used as marketing agents of particular products and companies, including drugs, medicines and pharmaceutical companies. … In my letter of July 1, 2000 I took issue with you about the matter of double standards. In one instance this related to the matter of the rule of law, about which you campaigned with regard to the land question in Zimbabwe. In this regard, you accuse me of making ‘a nonsensical comparison’. Since the issue of the rule of law is a matter of principle, I believe that it is fundamentally incorrect to argue, as you did, that AZT should be prescribed for rape, despite the fact that the existing legal procedures had not been followed enabling this drug to be registered and legally dispensed for this purpose. Strangely, you, the Leader of the Official Opposition, argue that my insistence on the observance of the rule of law is nonsensical. Whereas you would not accept what I said in the National Assembly about the fact that Glaxo Wellcome neither asserted the anti-HIV efficacy of AZT in cases of rape and had not applied for its licensing for such a situation, I trust you now accept the truthfulness of these statements, since they have been confirmed by representatives of the company. After all, relative to them, you do not occupy the position of ‘an effective opposition’. Whatever your personal views, I trust that, as Leader of the Official Opposition, you will understand and accept the proposition that it is incorrect to argue for the observance of the rule of law in Zimbabwe and to categorise its observance as ‘irrelevant’ and ‘nonsensical’ in South Africa when AZT is affected. What I have said in this and the previous letter about the efficacy of AZT in rape cases does not constitute a ‘personal opinion’, as you assert. Unless they indicate otherwise, I would also assume that the manufacturers of AZT, Glaxo Wellcome, do not consider what I have said about what the CDC says about AZT and AIDS as constituting a ‘personal opinion’. If there were any dispute about this, I would be very willing to ask the CDC whether it has changed its mind since 1998. On this matter, our government will therefore continue to act in a manner that is consistent with available scientific evidence. I have a political obligation to ensure that this happens, regardless of your own personal opinions. I am certain that, as government, we are perfectly aware of the interests of the people we represent. We will continue to do everything we can to ensure that these interests are addressed, naturally within the context of the constraints imposed on us by the stubborn legacy of colonialism and apartheid. That legacy includes the persistence of racist ideas in the minds and the psychology of many of our people and others elsewhere in the world. I spend the amount of time and effort I do on the issue of AIDS because as a government we have to do everything necessary to deal with this syndrome and the destructive health crisis in our country and the rest of Africa. None of this constitutes ‘shadows’, as you allege, which allegation might be informed by the fact that throughout their lives the majority of those you represent have had the ‘good fortune’ of being perhaps unwilling beneficiaries of racist practice and recipients of supremacist racist prejudice, and ideology. I must also make the point that the formulation of correct policies and programmes makes it imperative that, as government, we proceed from the most accurate information we can access. We will therefore always seek to obtain the accurate figures about such matters as rape and AIDS so that we adopt correct policies with regard to these important challenges. We do not have the luxury to play political games with information, merely to advance party-political objectives. As a government, we will not abdicate our responsibility to work for the health of all our people, leaving this matter exclusively to ‘the physician and the patients’, as you suggest. I may have no medical expertise, but I have grave doubts that the fact of being the largest opposition party means that you are best placed to advise our government about the medical decisions it should take. All of us have a moral obligation not to do anything we believe to be fundamentally wrong. This applies as much to Presidents as it does to Ministers who might feel that decisions of the President or the Cabinet are wrong. No amount of pressure, however virulent, strident and sustained, will persuade me to betray this principle. If nothing else, this is what many of us have learnt from a very long history of struggle by our people from liberation from oppression, contempt and lies. I believe that common courtesy required that you inform me that you intended to release our correspondence to the media, as I would if I were handing this letter to the media. The only thing we had agreed was the principle that the National Assembly and the general public should have access to the communications between us. But, again, possibly we do originate from different planets with radically different value systems. Yours sincerely Thabo Mbeki.

Mbeki’s repeated reference to ‘radically different value systems’ rings, at first blush, of rhetorical conceit. But to appreciate that there’s much more to it is to get the full chill of the icy slight. As Mathebe elucidates it in Bound By Tradition: The World of Thabo Mbeki, Mbeki’s estimation of pragmatism and inclusivity in his hierarchy of values over characteristically Judeo-Christian tendencies to ideology and narrow constructions of truth in human affairs mark his outlook as traditionally African. And fundamentally distinct from Leon’s characteristically judgmental and intolerant European one.

As I read their exchange, I sensed in Leon’s manoeuvring that extra effort that lawyers sometimes put into a bad case that they’re committed to pressing. Because the client is watching. It was clearly exemplified by the following morsel:

You dismiss Charlene Smith’s defence of herself in the Mail&Guardian and once again re-quote her as saying in The Washington Post (June 4): “Here [in South Africa, AIDS] is spread primarily by heterosexual sex – spurred by men’s attitudes towards women. We won’t end this epidemic until we understand the role of tradition and religion – and of a culture in which rape is endemic and has become a prime means of transmitting the disease to young women as well as children.” You claim that his is a “nakedly racist statement.” Yet nowhere in this quote does Charlene Smith make a racial distinction between black, coloured, Indian or white South Africans. You are reading into the statement a racial intention that is by no means evident.

The reek of Leon’s white liberal hypocrisy burned our eyes. At so many levels. There is no common South African culture; it is tremendously variegated. The only rape that hits the liberal papers is black on white or child – burnishing Smith’s stereotype. In an article we’re still to treat, liberal journalist William Saunderson-Meyer was rather more frank in laying out his prejudices: ‘South Africa has the world’s highest incidence of child abuse and rape. [Like South Africa has the world’s highest HIV infection rate.] Uniquely, this is the only country where the two outrages are combined in that savage speciality, the rape of babies in the belief that it will cure Aids. … Of course, it is politically embarrassing that this is almost exclusively a black South African practice.’

Is it? And Cameron, we’ll later read with astonishment, openly blames the ‘AIDS epidemic’ on ‘sexual practice among African men’ – on their ‘promiscuity’. There is no AIDS seen among whites, ‘coloured’ or Indian people in South Africa on any significant scale, and when ‘AIDS experts’ talk about the ‘AIDS epidemic’, they always mean among blacks. Even if they don’t say so. In claiming that the rape of young women and children is ‘endemic’, thanks to ‘the role of tradition and religion’, Smith certainly wasn’t intending to include Jewish ‘tradition and religion’, WASP ‘culture’ in the KwaZulu-Natal Midlands, and so on. Leon was transparently dissembling in suggesting otherwise. But I’m a liberal. Race doesn’t matter to me. I don’t see it. For as long as I’m boss of the show.

Mbeki was too quick for the debating crook:

All rape is reprehensible. I was as distressed when I heard about Ms Smith’s rape as happens whenever I hear of any incidence of rape. Accordingly and unreservedly, I sympathise with her. In Ms Smith’s case, I immediately spoke to the then minister of safety and security to take all necessary measures to ensure that the culprit was apprehended and charged. The minister kept me informed about this matter constantly, relating even to the means the [police] used to identify the culprit. I know that none of this could ever undo the grave harm and damage done to Ms Smith. Over this specific incident I have no influence. I, like other people, did what I had the power to do. I have not sought to vilify Ms Smith. But neither do I accept that her terrible and unacceptable ordeal gives her licence to propagate racism, as I am convinced her published Washington Post comments do.

Outclassed and against the ropes, Leon slipped in an unrelated whinge as a decoy: ‘... you have treated me, as elected leader of the opposition, with basic discourtesy since June 1999. … you might wish to reflect on the fact that you have never once issued an invitation to the opposition to discuss matters of common concern to the country. It is only when the opposition has sought a meeting with government that same has been acceded to.’ (Leon’s public grievance over this would repeatedly break out like a cold sore.) Mbeki saw the trick and snapped back: ‘The broad issue you raise about how the president of the republic and the leader of the official opposition should relate to each other is completely irrelevant to the matter we have been discussing.’ But not before explaining: ‘I think you have made your point about your importance when, in the National Assembly, to depart from the physical position occupied by FW de Klerk, the first democratically elected leader of the official opposition, you moved from the bench opposite the deputy president’s to the bench opposite the president’s bench.’ The better to keep an eye on the boy.

Mbeki had more to say in his ZK Mathews Memorial Lecture at Fort Hare a year later, evidently perceiving Leon to represent the stereotypical facile political operator, his vulgar domineering and arrogant manner an anathema to him, all the more offensive for its chrome-plate of quasi-reason: ‘This white politician, who practises his craft on the African continent ...’

Leon has never deigned to learn the correct pronunciation of Mbeki’s name, a reminder whenever he utters it of his personal distance from and lack of sympathy with African culture. He Anglicises it, so instead of ‘Tuh-bor Mbeh-gie’, we hear ‘Tar-bow Mbe-kee’. Talk about ‘basic discourtesy’. But then Leon hadn’t even thought of that. And Leon seems to derive a particular satisfaction from calling that mispronounced first name along with the second when dressing him down. As he might his garden boy, who’s just pulled the seedlings out with the weeds. Now look here, Tarbow – in the style of certain snooty circles among the Natal English, whose pointed Anglicising of vernacular names is considered a mark not of ignorance but of social distinction. It was clear that in their debate over AZT for rape, Leon could not countenance the possibility that he might be wrong. As even GlaxoSmithKline later pointed out. And that Mbeki, a confident black man, might know better than he did. Than the smug South African white man.

On the day that the full correspondence between Mbeki and Leon was released, the Mail&Guardian claimed Mbeki fingers the CIA in Aids conspiracy ‘to promote the view that HIV causes AIDS ... in what was described as a “rambling” address’ to the ANC caucus meeting (the one mentioned by Leon two days earlier).

Mbeki reportedly noted this a week later. Some anonymous ‘outraged’ ANC MPs told the Mail&Guardian afterwards that he’d said at an ANC caucus meeting on the 28th that the TAC had ‘infiltrated’ the unions to widen the call on the government to buy AIDS drugs. He allegedly repeated that HIV had never been satisfactorily isolated, and said that the pharmaceutical companies promote the HIV theory of AIDS because they make huge profits out of AIDS drugs. What’s more, they said, he’d alleged that the CIA was ‘working covertly alongside the big US pharmaceutical manufacturers to undermine him because, by questioning the link between HIV and AIDS, he is thought to pose a risk to the profits of drug companies making anti-retroviral treatments’. This story took off like a rocket on the newswires, and was splashed all over the world’s newspapers. Mbeki’s office declined to confirm or deny the reports, explaining that discussions at caucus meetings were ‘not intended for public consumption’. Achmat’s response was to protest; he didn’t want to fight with Mbeki, but it was time he called off his AIDS

side-show … Those of us who have HIV cannot afford to die in silence while our disease is denied a name by our government. We believe it was wrong for radio talk show host John Robbie to tell Health Minister Manto Tshabalala-Msimang to ‘get off my show’. It was disrespectful. But the greater disrespect is shown to the poor and black people of this country by our government. We are dying in large numbers and the President won’t acknowledge that we are dying of HIV/AIDS.

He won’t just say it.

Later, on 6 August 2001, Mbeki was asked about the allegations during an interview by Tim Sebastian on BBC HARDtalk:

TS: You were quoted last year in relation to the AIDS policy in South Africa, as saying that the CIA was working covertly with American drug companies to discredit you.

MBEKI: Never said any such thing.

TS: Never said it?

MBEKI: Never, ever said such a thing.

TS: It was wrongly reported?

MBEKI: I don’t know where they got it from, it’s completely wrong. It was not even from the point of view of inference; I hadn’t said anything that relates to that matter at all.

TS: And you were quoted at a meeting last Autumn of 200 ANC MPs and Cabinet Ministers as saying that criticism of your AIDS policy was a foretaste of foreign attempts to undermine your government to protect the existing balance of economic power. Is this mischief making?

MBEKI: Absolutely.

TS: You never said this?

MBEKI: Absolutely, yes. That’s part of what I was saying earlier about the press here. I have absolutely no problem with the press criticising policies and the things that we do, the things that we say, but you then find that kind of thing happens. It’s pure invention.

The media’s representation of Mbeki as a paranoid lunatic was useful as a psychological trick: it justifies normal thinking. Suggesting that Mbeki is certifiable puts him into a medical category, to be boxed off as one of them, not one of us. Safe, no longer threatening. It’s much easier to call a man mentally sick for talking differently than do the hard work of trying to figure him out. And taking what he says seriously into account. Especially when his talk involves an upsetting challenge. And you don’t have to be an Einstein, sitting thinking while processing boring patent application files (having been refused enrolment for a postgraduate science degree – not clever enough) and discovering it’s all wrong, as Nobel laureate Albert Szent-Gyorgyi observed, by a process of ‘seeing what everybody has seen and thinking what nobody has thought’. Because it’s surely perfectly obvious that the ‘everyone’s at risk’ dogma of ‘AIDS experts’ finds no match in the real world. And that claims of a ‘33.5 per cent’ HIV infection rate among blacks in KwaZulu-Natal (according to the Department of Health’s 2002 figures), but ‘negligible’ and ‘less than one in a thousand’ among whites (according to the Natal Blood Transfusion Service, in my private communications with it) are manifestly risible. But the former is repeatedly printed in the white liberal media all the same.

There was some fuss around 9 October as Mbeki’s liberal critics in journalism tried to get a fire going over the discovery that parliamentarians qualified for antiretroviral drug cover in terms of their official medical aid schemes. The Star attacked him with a headline: Hypocrite. Ever hungry for negative copy with which to bash Mbeki, the London papers followed. Mbeki allows anti-Aids drug for elite, was how the London Times worked it that day: ‘Mr Mbeki’s government was accused of blatant hypocrisy.’ The empty story petered out. For all his faults, Mbeki hadn’t been in charge of drawing the parliamentary medical aid scheme’s rules.

The 10th saw a formal parliamentary debate about AIDS. Leon sued for peace. But on his terms – offensively, insultingly, presumptuously, à la Tony Leon, vintage edition. With Mbeki having rejected his request to join a shared platform for the fight against AIDS, as revealed in their just-released correspondence, Leon now called for the formation of a ‘mighty coalition’ of celebrities from politics, sport, glamour, business and civil society, relying on ‘the best wisdom that science has to offer’. The jeering from ANC benches drowned him out. (I can just imagine: professionals, intellectuals and politicos among blacks to whom I talk all think he’s ridiculous, a figure of fun.) Speaking later on the same day at the launch of his party’s AIDS policy programme in nearby Khayelitsha, Leon promised that all metropolitan councils falling under his party’s control would be offering AZT to rape victims and HIV-positive women.

The time has come to declare a truce on this issue, to stop acting against the people’s best interests and for South Africa to take a united stand in the fight against AIDS. … I think we’ve won the war with the President on AIDS, but the problem is it’s a war without victors or victory because the people are dying. … Fifteen hundred South Africans every day are being diagnosed as being contaminated with this terrible virus. … And we have started doing it today. HIV does cause AIDS, finished and klaar, case closed. … While President Thabo Mbeki continues to confuse the issue with his misguided state of denial about the exact cause of HIV/AIDS, the Western Cape government has taken the bull by the horns. The Western Cape is the only province in South Africa where AZT is officially administered to HIV-positive expectant mothers. … Of all countries, South Africa has proved to be the most susceptible to infection and one of the most impotent in response [due to Mbeki’s] misplaced intellectual arrogance.

The base politician to the last. Talking such talk, no wonder Mbeki scorns him.

Archbishop Ndungane went for a public HIV test the next day. He was the first of his priesthood to do this; an Anglican synod in September had unanimously resolved that all bishops would submit to HIV tests in the hope that the rest of the clergy would follow. It was a publicity stunt, they admitted in as many words at the time, because they’d been moved by the concerns of some that the Church had not been seen to be in the frontlines in the fight against AIDS. ‘We hope, by setting an example, to encourage others to be tested ... [because] early detection helps.’ You die, he could have added. ‘As community leaders, we also hope to remove the stigma attached to HIV/AIDS.’

The Washington Post ran another derisive piece about Mbeki on the day, captured in gist and tone in a concluding comment by Wits bioethics professor Udo Schuklenk: ‘The President has dug a huge hole for himself. Unfortunately, he’s sacrificed the lives of babies all for some misguided notion of solidarity.’

The day after that, on the 12th, Rob Dorrington, a professor of actuarial studies at the University of Cape Town, told a meeting of insurance assessors that ‘South Africa has all the ingredients to make sure the HIV and AIDS pandemic will be the most explosive of any country in the world. … About 45 percent of adults will become infected with HIV unless there are significant changes in South Africa.’ With a pitch and a vision like that, Rob, you should have stuck to selling insurance.

ANC Head of Presidency and Communications Smuts Ngonyama disclosed on the 16th that Mbeki had decided to scale down his participation in the public discourse about AIDS. But he was not backing off, he said; he would still be involved in public debate. This had been decided at a recent ANC NEC meeting – at which he persisted in questioning the HIV theory of AIDS on the basis that ‘a virus cannot cause a syndrome’, and again asserted poverty and malnutrition to be the principal causes of broken health in Africa. Ngonyama said a committee of members of the Cabinet, led by Deputy President Zuma would lead the debate on the causation question, and would be tabling a report.

Mbeki’s defiant rejection of the HIV theory of AIDS, was again in evidence in a remark Ngonyama made to journalist William Gumede on 16 July the following year: ‘It’s based on a scientific assumption, and like all assumptions it can be disproved.’ And that his withdrawal had been a party decision, rather than his own, appeared from a letter to Business Day a bit earlier: on 18 August Essop Pahad had referred to ‘the collaborative debate and decision-making in the African National Congress, where even Mbeki can find himself having to accept the collegiate view on events’. Pahad’s next line indicated the subject to which he was referring: ‘On  AIDS , it has been emphasised time and again that, far from having a flirtation with dissidents, the president appointed an expert panel and awaits the response prior to making decisions.’ And as for the suggestion that Mbeki was a tyrant closing down all controversion: ‘Far from a climate of trepidation, there is in the presidency a remarkable degree of openness to debate. In fact, it was the presidents willingness to debate the  AIDS  issue that led to such a fuss.’

The London Guardian claimed Mbeki’s Aids stance cuts poll ratings on 20 October, reporting ‘a large and sudden fall in public support almost certainly attributable to his controversial stance on the cause of Aids’, with the rest of the article making a song and dance about it. But an article in the London Independent the next day, bristling with even more animosity, contradicted that claim amidst all its poisonous froth:

Central to his popularity decline is rising unemployment but also, many believe, his loss of stature internationally. [He has] made himself a laughing stock for suggesting that HIV may not lead to Aids. A US diplomat said: ‘In Washington, jaws are on the floor at some of the stuff he has said or is supposed to have said about Aids. Recently, when the White House has raised the issue in phone calls, Mbeki’s aides have changed the subject.’ European governments are equally at a loss; one diplomat, referring to President Mbeki as ‘Stalinist’, went as far as to suggest he had used his unorthodox views on Aids to test the loyalty of his entourage. … There has been no apology from President Mbeki’s office for the months of confusion he has sown in a country where panic and prejudice have taken hold. Ten per cent of the population is HIV positive. Indeed, given his lack of leadership and the lack of government medication or advice, it is no wonder that men in the KwaZulu-Natal and Mpumalanga provinces follow their mates’ advice and ‘cure’ themselves by raping virgins. On Monday, because he could not bring himself to say sorry, President Mbeki made known that he would no longer speak about Aids and that he had appointed a committee to replace himself in the ‘debate’ on the causal relationship between HIV and Aids.

A concurrent article in the London Times, however, laid bare the AIDS-obsessed dishonesty of the Guardian’s and Independent’s writers:

The issues which concerned more than 10 per cent of South Africa’s 42 million population included job creation (76 per cent), crime levels (60 per cent), inadequate housing (25 per cent), education standards (13 per cent), HIV-Aids (13 per cent), health (12 per cent), poverty (11 per cent), and corruption (10 per cent). This is the first time that more than 10 per cent of the population have identified HIV-Aids as an issue of significant concern. Critics of the Government’s position on HIV-Aids insist, however, that it is woefully inadequate in a country where more than one in ten people is estimated to have been infected by the disease.

In other words the South African public couldn’t be bothered. Enough for the English liberals.

Ngonyama stirred things up on the 23rd by condemning the Western Cape DA’s programme to supply AZT. ‘We find it quite outrageous that this issue ... can be exploited for political grandstanding. [People] are being used as guinea pigs and conned into using dangerous and toxic drugs that are detrimental to their own health. … [It was] reminiscent of the biological warfare of the apartheid era.’ Again the London papers published reports about this to make the ANC look bad. Médecins Sans Frontières, the Treatment Action Campaign, Life Line, and Rape Crisis, among others, were upset and responded in a joint statement: ‘To suggest that the programme bears any resemblance to biological warfare is a grotesque distortion of the truth. What is truly obscene are the efforts of all politicians to use the lives of people with HIV and Aids as political pawns to score points with voters. … No experimental drugs are used. The pilot project uses only one anti-retroviral drug – AZT – which has been conclusively proven safe and effective.’

But on the 24th Tshabalala-Msimang announced the government’s new guidelines for the treatment of HIV-positive people, and they left AZT clean out: ‘There is a narrow view again that continues to associate prevention of mother to child transmission of HIV with the use of antiretrovirals only. … We know they are toxic. … We know there are other medical interventions. … At no time has South Africa said it will never use anti-retrovirals, but there are [cost] constraints.’

And then suddenly, on the 26th, Parks Mankahlana, Mbeki’s spokesman, and previously Mandela’s too, was announced dead at thirty-six. Killed, it later emerged, by the ‘conclusively proven safe and effective’ drug. It was severe anaemia, said his family. Which Sigma’s AZT label warned about: ‘Target organ(s): Blood Bone Marrow.’ GlaxoSmithKline’s package insert too: ‘AZT ... MAY BE ASSOCIATED WITH HEMATOLOGIC TOXICITY INCLUDING ... SEVERE ANEMIA.’ A condition that increases risk of early death by thirty to ninety times, reported Mocraft et al. in AIDS in 1999 in Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe: ‘Patients with mild or severe anaemia were significantly more likely to have taken zidovudine [AZT] at some stage. ... In addition, patients with anaemia, mild or severe, were much more likely to have been diagnosed with AIDS.’ One can imagine Mbeki’s emotional reaction to his death. Someone so close, poisoned by the very chemical that he’d warned the world against almost exactly a year earlier, and for which he’d paid such an enormous political price – with just about everyone calling him a meddling, ignorant, cyber-surfing fool, who’d ‘made himself a laughing stock’, as the London Times described him, repeating the Independent’s insult, five days before his spokesman died.

At Mankahlana’s funeral Peter Mokaba said: ‘The media has disappointed us and I do not know how they are going to repair the damage. A comrade passes away, a comrade who served them well … and they want us to bury him with diminished status.’

CHAPTER

Speaking at the launch of the South African Mayors’ Chapter on HIV/AIDS in Durban on 7 November, part of the UN Development Programme-sponsored Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa, Tshabalala-Msimang again expressed her antipathy towards AIDS drugs – and those promoting them. As to the impression they were engendering, that the government’s AIDS programme would founder unless it provided AZT and nevirapine in the health system, she said: ‘Today I want to dispel this myth, because it is absolutely not true. The pharmaceutical industry and those who have a vested interest in the drug industry fuel this propaganda.’ She pointed out that ‘without necessarily implementing a large scale anti-retroviral programme, many poor countries, including Uganda and countries within the Southern African Development Community, had ‘implemented basic public awareness programmes, and the treatment of opportunistic diseases successfully addressed the disease’. (The ANC Youth League sized the TAC up in the same way about a year and a half later: in Pagad and TAC: Two Sides of the Same Coin in the Sowetan on 22 April 2003, spokeman Khulekani Ntshangase wrote spot-on that the TAC was ‘a pressure group whose salaries are paid by Americans. This is a conglomeration of drug-dealers who serve as marketing agents of toxic drugs.’)

As late as November, Essop Pahad still hadn’t covered the intellectual distance that Mbeki had in seeing right through the AIDS scare. Responding to an editorial in the Financial Mail three weeks earlier under the fantastic title, Until Mbeki believes, Aids will thrive, the President’s closest confidant wrote a surprisingly sloppy response on the 10th, referring to the ‘unexpected cataclysm’ – as if there really was something new on the go – and asking the magazine’s editor: ‘… accepting that HIV/Aids is a catastrophe in waiting, what have you done for your country in fighting it? Will the newspapers stand aloof as the horror mounts? There are, admittedly, some efforts, which are commendable. I like the permanent red ribbon on the Sowetan, and some sustained and systematic campaigning in other papers.’ In Pahad’s invocation of the breathtaking imagery of the contemporary sex-plague folie there wasn’t any evidence of irony – with the result that he came through sounding as silly as Charlene Smith.

To Tshabalala-Msimang’s slight on the drug agenda, the South African Paediatric Association responded with an emotive public statement on the 21st: ‘For too long now we have remained silent and almost sidelined from the issues we deal with on a daily basis. It is us, and not the politicians and policy-makers who care for the ever-increasing numbers of sick children with HIV/AIDS each day. We insist that the health ministry accepts its responsibility in helping to prevent innocent newborns acquiring the disease from their mothers.’ In other words buy the drugs. Pretending to know what they were talking about, like patent lawyers holding forth on the law of the sea, the paediatricians lined up behind the WHO’s conclusions announced the month before that transplacental genotoxic and carcinogenic cell-poisons are safe and effective during pregnancy, to prevent mothers from making their babies sick by nurturing them in their wombs, and by feeding them after birth the natural way as the Lord intended.

The paediatricians were a bit late. A month after their statement, and a little over a year after Mbeki voiced his concerns about the toxicity of AZT in Parliament, and had been attacked ferociously from just about every quarter for doing so, New Scientist reported on 16 December 2000, under the headline, No More Cocktails, that: ‘Four years of “hit hard, hit early” HIV treatment may be on the way out in the US, as evidence mounts of the drugs’ serious side effects. AIDS experts in the US are about to complete a humiliating U-turn when the Department of Health and Human Services launches its revised HIV treatment guidelines in January.’ The language couldn’t have been stronger in a popular science magazine characterised by its allegiance to the commercialised scientific establishment.

As leading US AIDS journalist Laurie Garrett put it in Newsday on 17 January 2001, ‘Instead of telling American physicians to “hit early, hit hard”, a policy in effect since 1996 that calls for giving HIV-positive patients powerful drug cocktails before the patients actually experience any symptoms of illness, the new National Institutes of Health guidelines will call for caution and delay in treatment.’ She mentioned an epiphany arrived at by ‘prominent AIDS physician’ Charles Carpenter of Brown University, a member of the AIDS advisory committee to the NIH, which he shared with the Royal Society of Medicine in London in a speech he had given in December: ‘In retrospect, we now realize the risk of drug toxicity is greatly enhanced by taking these drugs early.’ Which your regular guy might suppose means that the sooner you start taking your poison, the sooner you flake. NIAID’s Anthony Fauci, one of the Co-Chairs of the panel convened to review the official treatment regime, agreed, more or less, that not only is the medicine dangerous, it doesn’t even work: ‘It’s clear we’re not going to eradicate the virus with the drugs we have now. And we’re starting to see a greater and greater realization of the accumulation of toxic side effects.’ It’s sinking in at last.

Garrett then dashed off a litany of some of them: ‘death of hip bone tissue, increase in blood cholesterol levels, neuropathy or loss of nerve sensations, kidney failure, radical alterations of liver metabolism, diabetes, skin rashes, pancreas failure, severe anemia, liver dysfunctions so acute as to require transplants and near-instantaneous death due to buildup of lactic acid.’ With this degree of toxicity, who needs to blame a crafty mutating virus lurking in all sorts of hide-away places? But dully she did: ‘Most [people on the drugs] are overcome by drug-resistant forms of the virus.’

Breaking the news on 4 February, Lawrence Altman on the New York Times quoted Fauci: ‘We are adopting a significantly more conservative recommendation profile’ – the idea being, as Altman paraphrased him, to allow ‘the virus to remain in the body longer in return for sparing the patient the drug toxicities’.

The Americans released their HIV Treatment Guidelines Updated for Adults and Adolescents the next day. They were a remarkable vindication of Mbeki’s position. In fact his parliamentary fiat at the end of 1999 that AZT’s safety be investigated, and his and Tshabalala-Msimang’s persistence in publicly stating that the drug was dangerously toxic, possibly precipitated them. Because until then, outside of highly specialised, relatively obscure scientific journals, mention of AZT by ‘AIDS experts’ had invariably been accompanied by singing and dancing. Even as they reported chilling toxic effects. Like Mbeki’s political intervention concerning AZT, the new treatment guidelines were the fruit of another initiative from outside the cloister. Galvanised, I venture, by the attention that Mbeki had very publicly drawn to the toxicity of AZT in 1999, the Henry J Kaiser Foundation convened an official panel in the US the following year to review David Ho’s universally accepted treatment model, namely, promptly administered big doses of AZT and its ilk for the HIV-diagnosed. The accumulated toxicity data on the deadly consequences of that approach had piled too high to disregard any longer.

In a write-up of the 9th Annual Retrovirus Conference in 2002 in the AIDS Reader, Jeffrey Laurence spelt out the reason for the rethink as being ‘the side effects of all HAART regimens and the limited evidence of survival benefit for initiating therapy in asymptomatic persons even at relatively low CD4 cell counts … Much of this is being driven by some prominent cardiovascular, endocrine, and bone metabolism effects of HAART.’

Fauci explained the reason for the turnaround in his characteristically clueless manner:

We are very concerned about a number of toxicities associated with the long-term use of anti-retroviral drugs. Particularly alarming is the alteration of fat metabolism that can emerge during treatment. We are seeing an increasing number of patients with dangerously high levels of cholesterol and triglycerides. The good news is that new anti-HIV treatments have dramatically improved the quality of life for many patients, and the incidence of AIDS and AIDS-related deaths has dramatically decreased. The bad news is that we now must find ways to deal with unanticipated toxicities, including the potential for premature coronary disease.

Only a country with the sense of humour to elect Ronald Reagan and the Bush dynasty to the Oval Office could have got an idiot like this to run their AIDS research operation as director of the National Institute of Allergy and Infectious Diseases. On second thoughts, he’s their ideal man. Inasmuch as clowns suit circuses. The grave toxicity of ‘antiretroviral’ drugs is not apparent only after ‘long-term use’. As scores of published papers reviewed in Debating AZT make clear. Certainly, normal fat deposits melting away, sometimes showing up in permanent hard humps on the neck or in swollen abdomens, are graphic pointers to the drugs’ serious metabolic toxicities. As confirmed by the laboratory markers Fauci mentioned. But also causing massive unseen damage to blood, organs and tissues – under the skin. For Fauci to suggest as he does that deadly toxins like AZT make you feel better and bestow a radiant quality of life on you that you never had before, is proof that what counts for thinking with this guy is remembering what he read on the billboard. That AZT prevents AIDS and gives you a better crack at living than dying. Fauci’s expression ‘unanticipated toxicities’ would have you think that they weren’t apparent right from the beginning. They were. What has been happening is that reports of new toxicities are coming in to worsen the picture. Such as the latest: osteonecrosis (bone-death), newly noticed. He skipped that one.

Mbeki’s reaction to the big news about the ‘significantly more conservative’ treatment approach, as Fauci called it, was to send a note to Tshabalala-Msimang asking: ‘Have we looked at the radically revised guidelines the US government issued at the beginning of the year about treatment with antiretroviral drugs, where they have said that these drugs are becoming as dangerous to health as the thing they are supposed to treat?’

The fundamental turnabout in AIDS treatment policy by the ‘AIDS experts’ – accurately described as a ‘sea change’ by Mark Harrington, senior policy director of the New York-based Treatment Action Group – ought to have been a clue to the mess the science was in, but the FDA evidently missed it. Garrett reported that in the light of these radical treatment policy reversals, the FDA was considering not tightening but relaxing drug-testing requirements in order to get new AIDS drugs onto the market: ‘That makes activists like Harrington and Gregg Gonsalves, policy analyst for Gay Men’s Health Crisis in New York City, angry.’

Now anger is a tediously familiar emotion to which AIDS activists resort, and the media loves to report, whenever they can’t get their druthers. You should have seen Professor Alan Whiteside and professional Boston AIDS activist David Scondras at the second meeting of Mbeki’s AIDS Panel in Johannesburg in July 2000, doing comic impersonations of Kruschev pounding the table with his shoe. As we watched in vicarious embarrassment. Or Charlene Smith hissing on the television show, Carte Blanche, on 7 November 1999: ‘I’d like to know where President Mbeki got the information in his speech. Last year government spent R54 million treating prisoners who had AIDS related illnesses in private hospitals. And yet they are denying women and children who are often gang raped – a brutal violation to any woman. And these women are denied the opportunity to save their lives with this drug. How dare Mbeki!’ Dare I give her the answer? The sight and sound of this woman fulminating is to bring Shakespeare to mind always: ‘A woman moved is like a fountain troubled: muddy, unseemly, thick, and bereft of beauty.’ Saving the lives of rape victims with AZT is a subject for later.

Zackie Achmat even makes being angry an essential part of his movement’s profession of faith. The Treatment Action Campaign Pledge reads:

I am scared and I fear tomorrow, because my friends, my family members, my schoolmates and colleagues, and even I may have HIV/AIDS. I do not have enough knowledge about treatment and care. I want to learn more. I care about my life and the lives of my friends. I am angry. Millions of people have HIV/AIDS and they will die for no reason other than the fact that treatment costs are too high. I will use my anger, fear, knowledge, emotions, and care to win affordable treatment and care for people with HIV/AIDS.

And so forth. The sort of infantile cant that only an NGO person who’s never had a real job could spew without laughing. But Cameron apparently thinks the TAC pledge just spiffing: ‘For four million South Africans living with HIV who have no present access to treatment, the TAC has offered a focus for their activism, a channel for their energy, and an outlet for well-justified anger about the awesome spread of HIV infection.’ An outlet for all their hysterical excitement too – noted by Constitutional Court Justice Sandile Ngcobo in his judgment for some plaintiff discriminated against in his mention of ‘the devastating effects of HIV infection [reported in the newspapers, but not by statisticians] and the widespread lack of knowledge about it have produced a deep anxiety and considerable hysteria.’ You’re on the money there, Judge. With respect. How angry Cameron himself can get, when you have a laugh on him, we’ll later see.

But to return to the angry yank activists, anyone will allow that they were justifiably pissed off for once. A couple of weeks earlier, on 20 December 2000, the Los Angeles Times had run a string of articles telling how the already lax drug approval regime in the US – extant since the Reagan presidency, when the FDA buckled under intense political pressure to approve AZT – had led to the passage of seven major new drugs, all of which were subsequently pulled after proving to be lethally toxic. And told of other dangerous drugs still selling. Bang-on target, Gonsalves complained: ‘I would argue that the drug companies and the Food and Drug Administration have been negligent, retrospectively, in not conducting or requiring long-term studies of the effects of these drugs so we can answer basic questions like these about their use. Thousands of patients like me don’t have the data to make an informed decision about when to use these agents, and the drug companies are laughing all the way to the bank.’ You betcha, Greg.

According to an Economist report at the time, The World in 2001, the pharmaceutical industry was already turning over $350 billion annually, typically enjoying profit margins of over thirty-five per cent, growing by 10 per cent a year. (Without indicating its source, Médecins Sans Frontières claimed it’s a paltry $117 billion.) Of that sum, according to a Reuters report on 7 October 200, the global AIDS drug market is worth $4 billion, and that it’s dominated by GlaxoSmithKline, the world’s biggest-selling pharmaceutical manufacturing corporation. That’s about thirty-eight per cent of the market, said the UK Financial Times on 21 August 2000, worth £982 million out of total group sales of £8.5 billion. IMS Health, a US drug marketing-research firm, reported that total sales of AZT, 3TC (a similar drug), and Combivir (a combination of the two) topped $1.1 billion worldwide in 2000.

No slouch when it comes to peddling its wares, GlaxoSmithKline told us in its published financial reports that it spent $4.7 billion on marketing them all in 2000. Combined with ‘administrative costs’ that figure comprised 37.2 per cent of its revenues. That’s about three times what it spent on research: 13.9 per cent. (And three times in percentage terms what that famously aggressive marketer Microsoft allocates to pushing its buggy codes.) But after manufacturing costs and these outlays, it still succeeded in pocketing a phenomenal 27.8 per cent of its revenues as profit – a relatively modest return in the pharmaceutical sector, the most lucrative legal enterprise on earth at the time. (Commercial banking has since pushed up to number place.)

US consumer lobby Public Citizen reported on 18 April 2002 that whereas the profits of America’s top 500 companies, as rated by Fortune magazine, had declined by 53 per cent in 2001 over the year before, the second sharpest drop in nearly fifty years according to an analysis by that journal, the country’s top ten drug companies had upped theirs by 33 per cent: 18.5 cents for every $1 of sales, eight times higher than the average profits of the 490 top companies in their wake, ahead of second-place banks, which made just 13.5 per cent. And pulling a return of 16.5 per cent on assets, nearly six times the average of the other losers.

Those maimed and killed by AIDS drugs have at last been noticed by British doctors too. With the deadly toxicity of AZT and its relatives dawning on them finally, like surgeons having second thoughts about the long-established benefits of drilling holes in their patients’ heads, bleeding them, burning them, and administering mercury and arsenic, English AIDS activist Edward King reported in his piece, British Physicians Contemplate Even Longer Deferral of Antiretroviral Therapy in Medscape (online) on 30 May 2001 that ‘The initiation of antiretroviral therapy may be delayed even longer than advised by current [recently revised American] recommendations, according to draft guidelines currently being considered by the British HIV Association (BHIVA).’ But dismayed by the independent line, ‘prominent US physicians expressed concern at the British proposal’, with David Hardy, associate professor of clinical medicine at the University of California, Los Angeles, spluttering hilariously that he thought the British proposals ‘premature and perhaps too avant-garde’. Just as long as we don’t jazz them up too much, Dave. But the Poms have a friend in veteran American ‘AIDS expert’, Jay Levy, Director of the Laboratory for Tumor and AIDS Virus Research at the University of California at San Francisco. In his article, The Big Question Now in Anti-HIV Therapy – When?, written for the San Francisco Chronicle on 23 February 2001, he predicted ‘future recommendations that will raise the threshold even higher before beginning current anti-HIV therapies’, having regard inter alia to ‘toxicity which may lead to damage of the pancreas, heart, kidney or brain’.

It was a black Monday for GlaxoSmithKline’s English board when it heard of the official American misgivings about the toxicity of its AIDS drugs. On 11 February 2001 the London Independent on Sunday reported HIV rethink to hit drug sales: Glaxo faces lower profits as doctors decide to alter treatment for patients. The numbers told why: ‘GlaxoSmithKline, which derives a massive 7 per cent of pharmaceutical sales from HIV and Aids drugs, could be particularly hard hit by the new recommendation.’ The company feigned indifference: ‘... it does not believe revenues will be hard hit.’ But that didn’t fool the accountants: ‘... experts are not convinced. “You’ve got to see this development as a big risk,” said one Wall Street analyst. “The company ... thought it could rely on doctors starting the treatment early on. The prescriptions to new patients represent about a third of the sales for these drugs; strip that out and you are going to find profits cut.”’

Hats off to the African National Congress for its statement about the Americans’ revised treatment recommendations. An extensive discussion comprising one thousand six hundred words in its mouthpiece, ANC Today, on 20 April 2001 put our local ‘AIDS experts’ to shame. After reciting the salient articles of the new guidelines, it quoted John Bartlett MD, of Johns Hopkins University Medical Centre and co-chair of the panel that produced them, saying in a state of evident deep confusion: ‘The updated guidelines recognise that we do not yet have the data we need to make definitive recommendations about the optimal time to start treatment. We highlight the uncertainty, allow for flexibility, encourage an individualised approach to treatment, and, at the same time, try to provide guidance.’ Amounting to: Ease up, guys, not so fast anymore. And your guess is as good as mine. We’ll do this thing together. We’ll experiment. On you. And if smoke comes out your ears, we’ll try another one. It was quite a shift from what he said in the New York Times on 6 April 1993: ‘... if somebody asked me, is it better to start early or late on AZT, I’d say there are some compelling reasons to start early’ – hot after the Concorde Coordinating Committee’s letter to Lancet, urgently anticipating its full report, alerting doctors to the fact that the drug had been found to be useless for asymptomatic HIV-positive people.

The ANC press release commented on the new guidelines it quoted:

The reader should bear in mind that these guidelines were drawn up by US scientists, based on US experience. Nevertheless their applicability extends beyond the US, in as much as the drugs used in the US are the same as those used in the rest of the world, including South Africa. The reader should also note that the US scientists take great care to emphasise that not enough is known about HIV/AIDS for them to set guidelines without qualifying these with many observations intended to introduce as much ‘flexibility’ as possible. Accordingly, they advise that everything is relative and provisional and requires specific responses to each individual patient, under the supervision of experts on the use of anti-retroviral drugs. Furthermore, they advise a comprehensive diagnostic approach for each patient to establish the overall health status of each patient including sustained hi-tech medical, psychological, social and nutritional support for each patient. In sum, the US scientists argue that the certainties about HIV/AIDS that are trotted out in our country everyday rest on a very shaky scientific basis. They further assert that the use of anti-retroviral drugs requires the very sophisticated medical supervision that the US as a highly developed country has, but which we do not have, as a developing country. They further warn that the ‘alarming’ toxicity of these drugs is such that they cause both known and as yet unknown diseases. As has been publicly stated by both Drs Robert Gallo and John G. Bartlett of the US, under certain circumstances these drugs may create more problems than they solve. The problem with all this is that it refers to questions of life and death for individual human beings. Such a situation does not admit of inhuman games or clever intellectual point scoring. It also does not allow for the propagation of unscientific slogans that the time for scientific inquiry is over. The uncertainties admitted and explained in the Guidelines and the New York Times and Business Week articles mean that further and urgent scientific work and debate is required to confront the serious problem of AIDS. We can only hope that our government and the scientists concerned with AIDS do everything in their power to speed up the experiments explained in the report of the Presidential Panel. In the meantime, this we must say, that it is time that our scientific establishment stops treating the issue of HIV/AIDS as a political issue rather than a medical/scientific matter. Morality and human decency dictates that all our scientists should adopt this position and refuse to join in the propagation of lies.

On 12 May 2001 the British Medical Journal reported an FDA warning to manufacturers of AIDS drugs in view of their persistence in marketing them with the same old happy spin, as if nothing had changed:

The US Food and Drug Administration (FDA) has issued a warning letter to manufacturers of AIDS drugs cautioning them to tone down the optimistic tenor of their antiretroviral ... billboard and magazine ... drug advertisements. Thomas Abrams, director of the FDA’s division of drug marketing, advertising, and communications said that current antiretroviral advertisements directed at consumers are misleading as they fail to depict the limitations of AIDS drugs and also feature healthy looking people … sexy and athletic models in the prime of health who were climbing mountains, sailing boats, and riding bikes. These are pursuits which are quite difficult for people with HIV infection, who have to take drugs several times a day that have debilitating side effects … The advertisements therefore violate the Federal Food and Drug Act.

About which ANC Today had this to say the following week: ‘Most unfortunately, there is little chance that the politicians, corporate, medical, non-governmental and media people in our country, who are involved in a campaign that is not different from the one which the US FDA seeks to prohibit, in the public health interest, will listen and respond to the message of the US FDA. In the consequence, innocent people in our country will continue to suffer, even to the point of death, thanks, in part, to the wilful behaviour of these fellow South Africans.’

Predictably, following the US health officials’ change of mind about the safety of AIDS drugs like AZT and its relatives, ‘AIDS experts’ have started publishing papers finding that it does no harm to begin them much later. Doctrinaire by the day, fickle by the week. In December 2001, in Proceedings of the National Academy of Sciences, Dybul et al. came up with another idea to reduce poisoning, and save money too. Take the drugs a week on, a week off. This would cost less and reduce side effects, they said. As if it needed saying. They even gave it a fancy name: ‘structured intermittent therapy’. Patients fared well according to viral load and cell counts, these ‘AIDS experts’ reported. But on no account start exploring unsupervised whether reducing the number of poisonous pills swallowed yet further might make you feel even better: ‘It is important to stress, however, that the results of randomized, controlled clinical trials – currently under way – are needed to prove the benefits of this experimental approach before it can be recommended to patients outside the setting of a controlled clinical trial. Don’t try this at home!’ In the AIDS age, feeling better is misleading. We’ll tell you if you are getting better or not. Because if we’re not in charge of your health, who’ll pay our mortgages?

CHAPTER

Following the big antiretroviral turn-around in the US and in Britain, the next act in the South African AZT drama was the crucifixion of an African child, played out slowly in the media to the exquisite delectation of the AIDS activists. The decline and demise of their stolen mascot, little Xolani Nkosi, was celebrated as a concrete illustration somehow of what was wrong with government AIDS policy, specifically its reluctance to hand out AZT. That Nkosi Johnson, as the white media better knew him, died on ample supplies of the very drugs for which they were agitating completely passed them by – as it did Blade Nzimande, general-secretary of the South African Communist Party: ‘Nkosi’s life, struggle and contribution remind all of us that the majority of the four million people living with HIV/AIDS in our country have little or no access to information about prevention, good public health services, and affordable treatment.’

Word that he was ailing in January 2001 sparked an orgy of self-congratulatory commiserations. Everyone wanted a piece of the action, to be anointed with a bit of the dying boy’s blood, like Jesse Jackson daubing his shirt with Martin Luther King’s gore after his assassination in order to book himself a spot in the historical picture record. Everybody was very publicly there, physically at his bedside, in spirit pouring out their hearts in letters from all over the world, or wailing in the media. The Internet news forum AF-AIDS announced, ‘Nkosi Johnson, the brave 11-year old, who stood up at the opening plenary of the Durban 2000 conference to disclose his status and to speak to the international crowd, is currently very ill. The [forum moderators] would like to extend their support to the family of Nkosi, and to recognize the inspiration that Nkosi is to many activists.’

In fact he didn’t ‘disclose his status’ there at all; his story was already three years old, having hit the headlines in 1997 when he was battling to get into a school that had rejected him because he was HIV-positive. (The gay-lib agenda, to whose service the HIV-AIDS construct was pressed early on – disastrously, in the result – is given away by this endless cliché stream: disclosing his HIV status, breaking the silence, fighting the stigma. As in coming out.) But we still get the strangest primeval kick out of watching someone being separated for a ritual decease, hence the frisson folk get enunciating the expression ‘HIV status’. Signalling bravery at the stake. With the longer it taking the more gratifying it being. Just as the longer the ceremonial bull slaughter takes, and the louder the beast bellows in dismay, the more propitious the whole affair is read to be. As with the lynching of the Galilean. Even the ritualised expulsions in the Survivor, Big Brother and Weakest Link television shows faintly echo this old thrill. And how and why a child without any say over his own life should be an ‘inspiration’ to activists is beyond comprehension, except to excite their common mawkish sentimentality. After all, his only claim to fame was that the ‘AIDS experts’ had marked him for death, like a trussed goat on the roof of a bus headed home to take part in the wrong side of a traditional feast. Predicting that he wouldn’t last more than nine months, Xolani proved them wrong, to their disappointment, and kept them waiting a further decade. Think what a flop the show would have been had he made a perfect recovery and gone back to school.

On 9 January 2001 the Panafrican News Agency was pleased to report Messages of Support Pour in for Dying AIDS Activist. Activist? It told that ‘The HIV-virus he has carried since birth has now spread to his brain, causing permanent brain damage [and the loss of] his sight in both eyes.’ Two days earlier we’d heard from the Star that Youngest AIDS hero’s work drawing to a close in an article mentioning that a

tube is attached to his nose to feed him his diet of baby food, juice, and hot water … His medication is also taken this way, with tablets crushed into the juice. On Sunday, South Africa’s youngest Aids activist woke for half an hour. Mostly he has slept since he collapsed while being bathed last weekend, after which he was rushed to Coronation hospital in Johannesburg. Doctors have discovered that Nkosi, 11, who was struck by three severe seizures on Saturday and Sunday, has brain damage after they found a layer of damaged tissue. Gail Johnson of Melville, Nkosi’s foster mother, who adopted him when he was two, said: ‘The doctors said the damage was due to long-term degeneration, but they said it was not the seizures which caused the brain damage but just the progression of Aids.’

But that conclusion is insupportable in view of what his doctor, Ashraf Coovadia, told Susanna Loof of Associated Press, quoted in her piece, Child AIDS Activist Seriously Ill, on 6 January 2001: ‘Tests performed on Nkosi Johnson ruled out opportunistic infections, such as meningitis, as the cause for the worsening of his condition … The boy has lost a lot of weight and is being tube-fed because he can’t chew and swallow properly. His eyes are staring blankly and it is impossible to say whether he is aware of his surroundings.’

For the rest, Loof’s article was a rich serving of maudlin dross:

Johnson has been lauded for being open about his HIV-status in a country where people who are suspected of carrying the virus often are shunned by their families and chased away from their communities. … Nkosi Johnson became internationally known as an AIDS activist when he delivered a speech in August as part of the opening ceremony for the 13th International AIDS Conference, held in Durban. He called on the South African government to provide HIV-positive pregnant women with antiretroviral drugs to prevent transmission during childbirth.

Of course, the child hadn’t made any choice about ‘being open about his HIV-status’, nor was he any ‘activist’; this was all part of a sick but lucrative melodrama in which he’d been assigned the role of dead man walking – indeed he was carted around on display and made to shake a tin cup for his guardian: ‘Johnson and his foster mother last year travelled to the United States to raise AIDS awareness and money for Nkosi’s Haven, a Johannesburg shelter that provides care for HIV-positive mothers and their children.’

The PANA report mentioned that ‘a parade of friends, family and media’ had been to visit the child, including ‘friends such as Judge Edwin Cameron and Zackie Achmat [who stopped] by to lend support’. Friends? Puhleeze. About the only famous fairy not fluttering in was Michael Jackson. Praise be to the Almighty that the boy didn’t get a friendly visit from him too. As he lay there, paying the price for his father’s mortal sin. Loving his mother. Without a condom. They call it ‘unsafe sex’. Spreading germs. The sins of the father being visited on the son, in the best of biblical tradition. Being the unspoken take of the dew-eyed bedside AIDS gang pulling in to touch the Belsen bones of their fading relic. Visiting divines, smiling kindly, like priests at a burning. Murmuring sympathies, until doctor says that’s enough now.

The Mail&Guardian’s Belinda Beresford just revelled in it on 12 January in her piece, Half of nothing and still fighting:

They come to praise him. [Like the Magi.] And to mourn ... the skeletal 11-year-old child lying unmoving in his bed … But now the virus has attacked his brain, causing Aids-related dementia. [Like ‘tertiary’ syphilis. Except we know now it was actually the medicine: mercury arsenic and bismuth.] Although there is still hope [of tapping the tale for more copy], the politicians, media and friends flooding his house make it clear they are attending a deathwatch. Already the little boy ... has brain damage. When a caregiver lifts him up, his long, bony limbs trail uselessly across the bed [thanks to AZT-induced mitochondrial myopathy (muscle rot), discussed in Debating AZT]. He can communicate by squeezing his hands or moving his eyes and some of his facial muscles. A tube going down his nose is used to provide him with nutrients every two hours as he’s incapable of eating. He wears a baby’s nappy. … Aids physicians say that he’s almost certainly going to die, whether it be in a few hours or a few weeks. … last year an American woman offered to pay for the treatment, and Nkosi started undergoing triple therapy in June. He stopped the treatment a few weeks ago, saying that he didn’t feel better [of course], but was persuaded by his doctors to start again with just two of the drugs [they’re clever]. He continues to receive his anti-retroviral therapy, passed through the naso-gastric tube into his stomach. Since an essential part of his immune system is gone [his lymphocytes wiped out, as the literature on AZT predicts], such treatment is the only thing that provides hope of survival, by dampening down the virus and its attacks on Nkosi’s brain. … [The child’s doctor, Ashraf] Coovadia is adamant that Nkosi’s condition is not caused by anti-retroviral drugs: ‘I can say unreservedly that the condition he’s in now is in no way the result of anti-retroviral therapy.’ Dr Shaun Conway of the International Association of Physicians in Aids Care agrees: Nkosi’s dementia comes not from the drugs he has been taking but from a body that has run out of resources.

We couldn’t help noticing how the doctors rushed to tender not guilty pleas to murdering the boy even before the charge had been laid. As if they knew. But were helpless to desist from their grandly ordained crime. In a danse macabre. This is nothing new. Doctors have killed their patients with violent treatments (letting blood, drilling scalps, burning, purging, poisoning) for centuries – treatments that just a moment’s intellection ought to have revealed to be useless and deadly. As an advocate I’ve seen this kind of suspended judgment in terrible murder and robbery cases, with apparently good men drawn into plots to do evil things, as if the more wicked the suggestion, the greater its allure. Like giving a child AZT. Piped in even, when he can no longer swallow it.

Concerning Xolani’s ‘dementia’, Debating AZT canvassed several reports in the medical literature concerning the drug’s neurotoxicity. Some more pertinent data were published by Neuenburg et al. in the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology in October 2002 – foreshadowed in the title: HIV-Related Neuropathology, 1985 to 1999: Rising Prevalence of HIV Encephalopathy in the Era of Highly Active Antiretroviral Therapy. As Reuters Health reported it, ‘The prevalence of HIV encephalopathy increased over time ... to 59.5% in the 1996-1999 period. … In a multivariate model, HIV therapy was estimated to double the risk of HIV-related encephalopathy.’

The remainder of Beresford’s article was the literary equivalent of that ubiquitous little crying boy poster sold by OK Bazaars. In an editorial covering Beresford’s piece, Nkosi shows the way, Mail&Guardian editor Howard Barrell drooled: ‘The touch of a king was once believed to cure illness. It appears that many of our politicians believe the touch of a dying child might work similar miracles for them, to judge by their rush to be linked to Nkosi Johnson as he dies slowly of HIV/Aids. … The home in Johannesburg where he is dying is besieged by well-wishers. It also plays host to a herd of politicians and other hand-wringers.’ But Barrell then criticised Mbeki’s ‘snub’ of the boy’s alleged request for a meeting. Not wanting to be part of the ‘rush’. To join the ‘hand-wringers’. But who can blame him for not being interested in a lecture from the child along the lines of his coached Durban AIDS Conference speech:

I just wish the government can start giving AZT to pregnant HIV mothers to help stop the virus being passed on to their babies. Babies are dying very quickly and I know one little abandoned baby came to stay with us and his name was Micky. He couldn’t breathe, he couldn’t eat and he was so sick, and my mummy, Gail, had to phone welfare to have him admitted to a hospital and he died. But he was such a cute little baby and I think the government must start doing it because I don’t want babies to die.

Barrell proposed: ‘Perhaps this was what Mbeki could not bring himself to hear: his government gently lambasted by a child for its equivocation and delay in responding to a pandemic that affects mainly the poor and black population, a disproportionate number of them women.’ Barrell missed the fact that the boy was already moribund and couldn’t speak. And so couldn’t have requested a visit. Visiting, Barrell wrote, would be

a gesture Mbeki finds it difficult to make. For how could he make it with any sincerity without renouncing the nonsense he has been content to talk about HIV and Aids? His review of the year 2000 was equally inadequate. He could not bring himself, in his New Year address to the country, to acknowledge the massive crisis HIV/Aids is visiting upon us all. … The final report of the multimillion-rand presidential Aids advisory panel is still not out. Insiders say that the report is delayed by the difficulty in reconciling two opposing sets of views of factions of mainstream scientists and the dissidents. While we wait for this and our president to assume his full responsibilities, Aids dissidents spread additional confusion; as Nkosi’s health declines, so too does our view of the president; and more Nkosis are born and die. For how long will we tolerate this leaderless state of affairs?

Until journalists like you wake up and get a grip, Uncle.

In his explanation of the workings of political kitch in The Unbearable Lightness of Being (Harper and Row Publishers, Inc., 1984), Milan Kundera provides a better account of Mbeki’s aversion to joining the ‘rush’ to exploit the photo opportunity:

When the heart speaks, the mind finds it indecent to object. In the realm of kitsch, the dictatorship of the heart reigns supreme. The feeling induced by kitsch must be the kind the multitudes can share. … Kitsch causes two tears to flow in quick succession. The first tear says: How nice to see children running on the grass! The second tear says: How nice to be moved together with all mankind, by children running on the grass. It is the second tear that makes kitsch kitsch. The brotherhood of man will be possible only on a base of kitsch. And no one knows this better than politicians. Whenever a camera is in the offing, they immediately run to the nearest child, lift it in the air, kiss it on the cheek. Kitsch is the aesthetic ideal of all politicians and all political parties and movements. But whenever a single political movement corners power, we find ourselves in the realm of totalitarian kitsch. When I say ‘totalitarian’, what I mean is that everything that infringes on kitsch must be banished for life: every display of individualism (because a deviation from the collective is a spit in the eye of the smiling brotherhood); every doubt … In the realm of totalitarian kitsch, all answers are given in advance and preclude any questions. It follows then that the true opponent of totalitarian kitsch is the person who asks questions.

Is it really any surprise that Mbeki wanted nothing to do with this bleeding cabaret, and why the AIDS crowd harried him over it?

The Citizen managing editor Martin Williams took a dim view of the Nkosi Johnson affair for reasons quite distinct from Barrell’s in an editorial he wrote on 16 January entitled Exploiting little Nkosi:

Xolani Nkosi (that is his legally correct appellation) must be the most exploited child in South Africa. The parade of leeches trying to associate themselves with his plight, either by visiting him, or invoking his name in emotive statements about Aids, is truly nauseating. Some politicians had the gall to issue media notices in advance, advising when they would be at Nkosi Johnson’s side, obviously hoping to be photographed. Their motive was plain, to extract sympathetic publicity by linking their profiles to the suffering of an 11-year-old boy whose deteriorating condition had attracted headlines. There was also a cheap attempt to embarrass Thabo Mbeki by saying Nkosi’s fervent wish was to speak to the President, to ask why he walked out during the boy’s address at the Aids 2000 conference in Durban last year. Mbeki could, arguably, have played to the baying gallery of Aids activists and other critics, who are making capital out of Nkosi’s tragic situation. But it is doubtful whether even a quiet, pre-emptive visit would have silenced them. I have no insight into Mbeki’s views on Nkosi, although those in the know say the President is heartbroken. Dissidents in general have been respectfully restrained about what’s happening to the brave little chap but there is a view that he is being killed by drugs. He did not develop any opportunistic infections. People who saw him after the Aids conference said his orange-tinged hair suggested malnourishment; he was not eating well, and at one point was ingesting eight different types of medication. In a recent US television documentary Nkosi told Christine Maggiore that he had been ‘taking medicines’ for eight years. His caretaker, Gail Johnson, said he had been on a combination of AZT, 3TC and Nevirapine since December 1999. Before that he was apparently using Bactrim for about four years. AZT, as Citizen readers know by now, was designed specifically to kill cells. It is the subject of a book, Debating AZT, by Anthony Brink, which is currently on sale. Nevirapine, too, is not without detractors. Over the festive season the American Centers for Disease Control issued a warning after 22 health workers using the treatment developed serious side effects. If it’s dangerous for adults there is a reasonable assumption that children would also be at risk. Therefore, the notion that Nkosi’s condition is being made worse by drugs in not at all implausible. Which would mean he is being killed by misguided kindness and publicity.

The Democratic Alliance’s ‘deputy spokesperson on HIV/AIDS’, Sandy Kalyan, elbowing her way up the ladder of important political offices, reacted with outrage to Williams’s editorial in a letter:

I am shocked and alarmed that supposedly reputable journalists like Martin Williams can propagate the idea that Nkosi Johnson is being harmed by the medication he is taking for HIV rather than HIV itself. Any paediatrician in a state hospital would tell you, Mr Williams, that 10 years ago the death of a patient was exceptional – now, they see more children dying than surviving. And rest assured, Mr Williams, only the most exceptional state hospital patient even knows that antiretrovirals exist. On the other hand, HIV-positive children in the first world are living for longer and longer because there is more and more knowledge about how to use antiretrovirals most effectively. It is a pity you seem not to have heard Nkosi’s doctors attributing his collapse not to the drugs, but to the fact that he started on them too late. The general consensus among doctors all around the world is that antiretrovirals do cause some serious side effects, and need to be carefully monitored. But they are also now keeping alive, indefinitely, people who would previously have died within a year or eighteen months of infection. They are also preventing HIV-infected mothers like Nkosi’s mother from passing the virus on to their children. Every society needs its renegades those who refuse to follow the conventional line. But those who still argue that the world is flat, despite overwhelming evidence to the contrary, just look ridiculous. The evidence supporting the link between HIV and Aids is so strong that one cannot argue convincingly or honestly against it. I am not sure what your agenda is in propagating views that are plainly wrong Mr Williams, but please bear in mind the possible consequences of publishing opinions which may well lead to people’s deaths.

Mrs Pumpkin Pips MP would do well to a take a few deep breaths, light a joss-stick and have a nice cup of ginger tea while meditating on the reminder by early AZT clinical trials overseer Professor Anthony Pinching at the 12th International AIDS Conference in Geneva in 1998 that ‘The side effects of AZT can be indistinguishable from the symptoms of AIDS’, and calmly revisit the ugly case that Williams makes.

Debating AZT took us on a pretty thorough journey through the toxicity literature on AZT – how AZT kills nerve, muscle and all other cells, and it detailed how epidemiological investigations have found that the wasting, nerve and brain damage suffered by the child invariably occur among AZT-treated HIV-positives only, and not the untreated. A paper I omitted from Debating AZT by Poznansky et al. in the British Medical Journal in 1995, HIV positive patients first presenting with an AIDS defining illness: characteristics and survival, reported that ‘wasting syndrome [occurs] almost exclusively’ among AZT-treated patients, confirming what Coker et al. had reported in AIDS in 1991: ‘A clinically significant myopathy that precedes the development of zidovudine associated mitochondrial myopathy has been a rarity in our experience.’ And Dalakas et al. noted the year before that in the New England Journal of Medicine: ‘Before 1986, when zidovudine (formerly called azidothymidine) was introduced, the number of patients with HIV-associated myopathy was small, and myopathy was considered a rare complication of HIV infection.’

A report by Langston et al. in Paediatrics in February 2001, Human Immunodeficiency Virus-Related Mortality in Infants and Children […], documented the changing causes of death among HIV-positive children as they got older. The paper said nothing about the treatment that they were on, but we can guess in the light of what Poznansky, Coker, Dalakas and their colleagues noticed, and what Langston and associates found among the children in the study: ‘Children with HIV who survive longer are less likely to die of pulmonary disease or infection and more likely to die of cardiac causes or with wasting syndrome.’ That is, of cell poisoning, not infectious disease. The children would have been receiving the best of American medicine: antiretroviral therapy. Indeed, there’s little doubt that they were: Reporting the Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2C2 HIV study in the same journal in September 2002, Starc et al. found that ‘During 5 years of follow-up, cardiac dysfunction occurred in 18% to 39% of HIV-infected children and was associated with an increased risk of death.’ A covering editorial commented: ‘Further investigation of the best strategies to monitor and treat cardiac disease in HIV-infected children in the era of protease inhibitors now seems warranted.’ Protease Inhibitors are always used in combination with AZT-class drugs. Which so weaken cardiac muscle that the children’s hearts soon give in. In anywhere between eighteen and thirty-nine per cent of cases. Do you still tip your hat to ‘AIDS experts’? Unable to give up their pills.

In their paper The AIDS dilemma: drug diseases blamed on a passenger virus, published in Genetica in 1998, Duesberg and Rasnick made the riveting point that it was in 1987, the year that AZT was introduced to the market as an AIDS drug, that an epidemic of dementia and wasting among HIV-positives led the Centers for Disease Control to add those maladies to their list of ‘AIDS-defining’ illnesses. So doctors take us around another circle. Putting Xolani under – dolefully regretting that his neurotoxic and myopathic medicine sadly wasn’t able to prevent the onset of his AIDS brain damage, his AIDS blindness, his AIDS paralysis and his AIDS withering away to a skeleton.

Without drawing the obvious conclusion suggested by their data, a recent paper further evidences the damage that AZT and similar drugs do to optical nerves. Like Xolani’s. A Retinal nerve fiber layer evaluation in human immunodeficiency virus-positive patients by Plummer et al., published in February 2001 in the American Journal of Ophthalmology, found that ‘HIV-positive patients without CMV retinitis showed significant differences from HIV-negative normal controls in a number of measures of the retinal nerve fiber layer. This indicated a loss of retinal ganglion cells in HIV-positive patients without retinitis.’ They concluded: ‘Significant thinning of the retinal nerve fiber layer occurs in HIV-positive patients without infectious retinopathy.’ Which doesn’t tie in too well with the current model that HIV-positive people going blind in the care of their doctors do so because of cytomegalovirus infection. More like those expensive medicines. If Plummer and his colleagues had kept in mind the elementary principle that in nature the exception breaks the rule, that is, the anomaly destroys the hypothesis, they would have realised that their findings mark the end of the viral (cytomegalovirus) theory of blindness among AZT-treated AIDS patients. But for doctors, like goats driven to bitter grasses, to consider the prospect that the medicine itself is causing the malady is understandably entirely unappealing.

Steven Swindells’s report of the child’s death for Reuters on 1 June mentioned that before he died he had become completely incontinent and weighed less than 10kg. Swindells offered a plastic flowers eulogy: ‘He took his message of safe-sex and advocacy of anti-AIDS drugs across the country and abroad at a time when government policy towards the disease was thrown into disarray after Mandela’s successor, President Thabo Mbeki, questioned the link between HIV and AIDS and the safety of AIDS drugs.’ But the tiny waif hardly had any convictions of his own to sell. About safe sex and great pharmaceutical drugs. Under the absurd subheading, Nkosi Clashed With Mbeki, Swindells wrote: ‘Nkosi shot to world attention when he made an emotional appeal at the opening of the world’s biggest AIDS conference in Durban last year. Sharing the same platform as Mbeki, Nkosi won hearts with his appeal for compassion for AIDS victims, safe-sex and drugs such as AZT which can prevent the transmission of the virus from pregnant mothers to their babies.’ I watched. The boy was staged like a Dickensian circus freak. Hearing him reading the fake lines drawn by his handlers, calling for AZT for pregnant women, was revolting and distressing beyond words. It’s true. I lost it. That crazy guy pacing up and down the aisles with his hands in the air shouting at the sordid spectacle was me.

Ascribing a direct role to the media in Nkosi’s death, Fintan Dunne in Ireland had some pained words in White Medicine, Black Death for Nkosi, on his website. Implying that sentimentalism comes cheap and easy, he pointed to the gagging schlock turned out by journalists covering the boy’s demise in place of ‘healthy journalistic scepticism’. They might have raised their eyebrows at the fact that the boy was well when his white foster mother started feeding him ‘up to twenty five’ pills a day, including ‘toxic chemotherapy’, because he had been diagnosed HIV-positive, and assumed to be on his way to an AIDS death. Her relationship with him was, Dunne suggested,

a microcosm of the white relationship with Africa: well-intentioned but misinformed. … Nkosi was adopted by White culture. That was the beginning of the end … Had the orphaned Nkosi lived in a black community he might never have been medicated, or may have been treated with the traditional herbal medicine that in many Western eyes is the work of untutored savages. Our white culture has a different religion. White-coated doctors are our priesthood. Bodily immortality is the promise. Drugs are our sacred food from the holy of holies, even if side-effects and misdiagnosis are now killing millions in standard clinical practice – let alone in experimental areas like Aids. One of the many drugs administered to Nkosi was AZT. The bottle it comes in carries a skull and crossbones [when supplied to research laboratories]. The Physician’s Desk Reference has warned doctors that AZT can cause illness indistinguishable from Aids. … In truth, White Medicine has been killing Nkosi with misguided therapy, based on a bad diagnosis. Yet it is a profitable error. It sells lots of expensive drugs. Pretending all is well keeps doctors in social standing. In short, white medicine has sacrificed Nkosi. That’s entertainment. An Emergency Room drama. … Meanwhile, Western media describe Nkosi as dying from the Aids virus and castigate South African president Thabo Mbeki for daring to question the value of the magic White drugs.

Dunne described the popular emotionalism about Nkosi’s illness, particularly in the media, as a form of

sentimental fascism. … The dictator cries when the pretty girls hand him flowers. The fascist is always sentimental. The same tears flow for the fatherland. Tears flow as old rebel songs ring out to the clink of beer glasses. Their measure is the depth of personal denial and social schizophrenia. The killing goes hand in hand. The path to the graveyard is unimpeded by the tears and is well worn. Ask the Irish. Or ask Nkosi the Aids puppet. A pretty boy with a bunch of Aids flowers wheeled out for the great dictators at the 2000 Durban Aids conference. Satisfying the needs of our sentimental cult of gallant victimhood.

Gail Johnson’s notions about HIV and AIDS and the drugs were all informed by the media. A story Celia Farber has described as having been ‘botched virtually beyond repair’. But it’s a ‘profitable dereliction of duty’, Dunne noted, because ‘Sentiment sells newspapers and it does not hinder pharmaceutical advertising. In short, the white media is sacrificing Nkosi. That’s entertainment too. … History is written by Victors. They will write that they could not save Nkosi. Truth is authored by Time. It will write that they killed him. With sentimental fascism.’ Cameron was later to provide an example of it in his familiar muddled chat about Xolani’s death: ‘Ultimately through the grief and anger we must feel hope. It’s a challenge bigger than apartheid. … It’s a challenge to us all in South Africa – white, black, male, female, whatever you are.’ (Autistic, blind, spastic or gay.) A general observation made by Charles Darwin would have better fitted the occasion: ‘Wherever the European hath trod, death seems to follow the aboriginal.’

TIME took a swing at Mbeki in reporting Xolani’s death on 1 June: AIDS Orphan’s Preventable Death Challenges Those Left Behind: South Africa’s AIDS ‘celebrity’ Nkosi Johnson raised the profile of his country’s neglected sufferers. From the title alone, you get the picture. At a memorial service in St George’s Cathedral a week later, Achmat picked up the theme and warned from the pulpit: ‘To everyone in our government, we are saying please listen to us, because our anger will boil over. Our anger will boil over if this does not happen. We cannot let our people continue to die. We cannot let ourselves continue to die.’ Moreover we enjoy being angry, and we like talking about dying all the time; it makes us feel empowered. Why, everybody listens to us when we do. Just like they are listening to me now. The dean of St Georges, the Reverend Rowan Smith, said he wanted to weep when he heard Tshabalala-Msimang say in Parliament that she had no plans to make AIDS drugs available. Her remark that AZT didn’t cure AIDS came very close to the callousness of apartheid Minister of Justice Jimmy Kruger when he stated that Steve Biko’s death left him cold, he said. ‘To those thousands who have been using the drug that must have been a blow deep down in the stomach.’

Castro Hlongwane, Caravans, Cats, Geese, Foot and Mouth and Statistics: HIV/Aids and the struggle for the Humanisation of the African, a discussion document debated by the Tripartite Alliance in March 2002, which we’ll discuss later on in detail, charged bitterly that Xolani had been ‘forced to consume’ antiretroviral drugs and that they had killed him: ‘He was reborn as a creature of the imagination and the resources of white South Africa. The world decided to accord him the status of a hero, the new Hector Peterson murdered not by the apartheid regime, but by our country’s democratic government.’ On 23 March 2002 Die Burger reported Gail Johnson’s response (I translate from the Afrikaans report): ‘Nkosi [she can’t even get his name right, and uses the child’s surname – not the one given to him by his mother] was never forced to take antiretroviral drugs. A woman in America offered them. I took him to a paediatrician who told him how they worked and what the side effects are. [As if the child would have been able to comprehend, and make a choice of his own. Then she changes her story:] I told him and it was his choice to take them. [Not hers, as foster mother. She passes the buck to the child. For causing his death.] He only took the drugs for three months in 2000 [a month’s course of AZT and 3TC spread over two was enough to kill the adult James Hayman], when he was already too sick for them to have an effect. [So why give them then?] The drugs had absolutely nothing to do with his death.’ We’ll be the judge of that, madam. Especially in the light of how you laboured your account of how the toxicities of the drugs were explained to the child, before he died on them. And the fact that Alive and Well founder Christine Maggiore from Los Angeles recorded the boy on video telling her how you’d been drugging him from infancy. And that he particularly hated taking AZT, which you forced him to resume when he secretly tried to stop: ‘I’m taking AZT. I’m taking the cocktail. The bitter one I don’t like is AZT. There’re other pills. I don’t really know the names.’ Asked by Maggiore, ‘Do you ever not take the pills and not tell anyone?’, he replied, ‘I used to do that but my mom [Johnson] caught me.’

In an especially putrid instance of AIDS journalism-kitsch, In memory of Nkosi, published by Health-e on 28 November 2002, Anso Thom confirmed that before killing him off with AZT, Johnson and the doctors had been poisoning him with heaps of other drugs:

The scene played itself out three times a day. Nkosi would stand there, a glass of coke in one hand and a pile of pills and potions on the kitchen table in front of him. … that day Nkosi put on a brave face. ‘Tonight we’ll go and have those prawns,’ he announced once while trying to swallow the handful of tablets. He would stand there for about three minutes, glass in his slim hand, eyes shut tightly as he tried to coax his frail body into accepting the pills, some of them vitamins, some of them larger and too dry and bulky to swallow. … After he left we found an assortment of pills scattered under his bed. We realised then that he had not been taking all his medication and we knew that this was one of the many signs that he was ready to give up. He was tired.

He was being poly-medicated to death.

But Xolani did not avoid the drugs because he ‘was ready to give up’ as Thom put it in her koeksuster offering; he did so because he knew they were killing him. For her film, Maggiore also interviewed Winstone Zulu, a Zambian AIDS activist and orthodox member of the AIDS Panel: ‘I wasn’t compliant all the time because the drugs are difficult to take, you know, they make you sick. But in public I was compliant’ – not wanting to discourage others, he explained. ‘I wasn’t taking them all the time. Sometimes I skipped a whole week. … Every time I took the drugs I felt much closer to death than if I didn’t take them.’ Just as Xolani felt. Xolani died somewhat like a third-degree burn victim, only burned on the inside, and declining slowly, agonisingly, humiliatingly, horribly. All thanks to GlaxoSmithKline, whose drug has ‘extended and improved the quality of life of millions of people living with HIV/AIDS around the globe’. A lie exposed in March 2001: Reporting The use of highly active antiretroviral therapy (HAART) in patients with advanced HIV infection: Impact on medical, palliative care, and quality of life outcomes in the Journal of Pain Symptom Management, Bechtl et al. confirmed (per AIDS Weekly synopsis) that ‘HAART treatment does not appear to have significant benefits for the mental health of HIV patients; patients did not report a quality of life improvement after HAART; this was true even when the treatment regimen was clinically successful’. Not surprisingly, since ‘treatment failure, either intolerance or death, occurred in up to 40% of the patients studied’.

Thom dribbled on in her article: ‘Now, more than a year after his death we remember the little boy, wise beyond his years. A fighter, a survivor, a practical joker, a politician, a son, a friend and an awkward teenager. … Like Hector Peterson and Baby Tsepang, we can only hope, that like them, his suffering and bravery was not in vain. Lala Ngoxolo (rest in peace), Xolani Nkosi Johnson. Umzabalazo Usaqhubeka! (the struggle continues).’ Do you also write for Mills and Boon? In between ‘Talk To Your Maid’ Zulu classes over at the tech?

Had he been listening, Xolani wouldn’t have been able to understand Thom’s nauseatingly pretentious salutations – he couldn’t even speak his own language, thanks to Johnson’s removal of the child from his people. SABC Africa screened a television documentary about him in mid-2003, featuring a clip in which he referred to the country’s vernacular tongues as ‘those black languages’, and stated wretchedly: ‘I wish I was white, white people don’t die of AIDS.’ After a visit from his blood relatives had saddened him, Johnson stared deep into his eyes and asked: ‘Is it those people talking about your mommy who made you sad? Do you feel like they should all just go away?’ He wasn’t doing well, she said to the journalists: ‘He looks like someone on chemotherapy.’ Notwithstanding her observation that he was obviously being poisoned by the medicine she was feeding him, the film showed Johnson cajoling him to take it: ‘Life goes on. Medicine goes on.’ In fact she wanted him dead: she wished he had died earlier, she said, because ‘he was now beginning to understand about death’. Actually, his ‘understanding about death’ came from the fact that from the time Johnson took him, she’d been conducting a deathwatch, treating his arrival at the cemetery as long overdue. Because of a useless antibody test. And useless doctors. As a disgusted friend of mine voted after seeing the film: ‘That woman belongs in prison.’ Does anyone disagree?

In August 2000 Johnson had taken Xolani to see Professor Sam Mhlongo – a specialist in internal medicine, whose list of London medical qualifications and accreditations stretches longer than your arm. During their consultation at his home, Mhlongo strenuously warned her off AZT. But Johnson opted for the counsel of the white doctors. And Indians from the same academies. Who worship the same gods. And wage holy war against the same devils. Chemicals and germs. Because heedless of Mhlongo’s desperate advice given against all contemporary medical wisdom, she continued treating him with AZT and similar drugs.

For how long was Xolani poisoned before he died on 1 June 2001? The reports aren’t consistent. Gail Johnson claimed in Die Burger on 23 March 2002 that ‘He only took the drugs for three months in 2000.’ But it was much longer than that, according to Belinda Beresford writing in the Mail&Guardian on 12 January 2001, and after Xolani had become critically ill by this time the drugs the doctors continued piping the drugs in through his nose: ‘Nkosi started undergoing triple therapy in June. He stopped the treatment a few weeks ago, saying that he didn’t feel better, but was persuaded by his doctors to start again with just two of the drugs. He continues to receive his anti-retroviral therapy, passed through the naso-gastric tube into his stomach.’ No, it was before June 2000, according to Cameron in an interview by Tim Modise on SAfm radio on 18 July 2000: Johnson ‘told me last week in Durban that he had also started antiretroviral medication a few months ago and he’s on one of the protease inhibitors that I found uncomfortable. We spoke about possible [alternative] combinations for him. He’s in very loving hands and you can feel confident about that.’ It was even earlier than that according to Martin Williams, writing in the Citizen on 16 January 2001: ‘Gail Johnson … said he had been on a combination of AZT, 3TC and nevirapine since December 1999.’

April 2002 saw Xolani posthumously awarded the ‘Children’s Nobel Prize’ by a Swedish outfit, The Children’s World, funded by the Swedish International Development Cooperation Agency. Flying around peddling sentimental kitsch. And making people like Gail Johnson rich and famous. The award was presented by Queen Silvia. ‘I was overwhelmed,’ said Johnson. ‘Because of a little boy, I found myself in Sweden face to face with a queen. I had never imagined that.’ Of course it wasn’t ‘because of a little boy’. It was because she forced the medicine down when he tried giving it up. As determinedly as a breaking at the wheel by the Cape colonial authorities. Bone by bone. And killing him for real. Not like the cardboard effigies down at the indoor shooting range that Johnson blazes away at every week with her police reservist’s 9 mil Parabellum. Pretending, imagining it. Her jaw set with the satisfaction of it.

Jerry Coovadia, professor of ‘HIV-AIDS Research’ at the University of Natal and Chairman of the Durban AIDS conference, and Salim Abdool Karim, Deputy Vice-Chancellor of the same university, Scientific Programme Chair of the Durban conference and the MRC’s AIDS Research boss, wallowed in it like grunting hogs. Said Coovadia: ‘Nkosi is a worthy recipient of the Children’s Nobel Prize because of his magnificent contributions towards raising awareness of the terrible disaster of the HIV/AIDS pandemic. He lived through considerable difficulties as a child yet contributed more during his lifetime than many adults. Let us hope this award will rivet the world’s attention and help mobilize the action so long delayed that will prevent the birth of more Nkosis.’ Karim wasn’t going to be outdone in the manure: ‘This award is a great honour to Nkosi and everything he stood for. Nkosi was a beacon of hope. He gave all of us the inspiration to continue the struggle to address the global inequities that deprive the poor of life-saving HIV/AIDS treatments. The recognition that this prestigious award brings will ensure that his work continues.’

Neither Coovadia nor Karim, nor anyone else involved in killing Xolani Nkosi, or who enjoyed his death, journalists especially, seem to have known about the abortion of the AZT arm of a disastrous government-run study by Englwood et al. six years earlier. On 14 February 1995 the New York Times reported: AIDS drug AZT fails completely:

In a major surprise, the drug AZT – now the standard treatment for children infected by the AIDS virus – proved so ineffective in halting disease progression that federal officials have called off part of a large study involving it. AZT, or zidovudine, also had unexpectedly high rates of adverse side effects in children, like bleeding and biochemical abnormalities, officials said Monday. … Children receiving AZT alone had more rapid rates of disease progression, AIDS-related infections, impaired neurological development and death. The findings clearly caught health officials by surprise. AZT is widely considered the drug of choice in treating HIV-infected children and adults.

But the manufacturer paid no attention, continuing to market AZT for administration to children by advertising it in medical journals, highlighted by an image of three kids running hand in hand, a picture of happy vitality and financial prosperity: ‘Helping keep HIV disease at bay in children. Retrovir A world of antiretroviral experience. Generally well tolerated; Improved cognitive function; Survival rates similar to adults; Improvements in growth and well being.’ Under ‘Pediatrics’, persisted the company ‘Product Information’, ‘Retrovir is indicated for the HIV-infected children over 3 months of age who have HIV-related symptoms or who are asymptomatic with abnormal laboratory values indicating significant HIV-related immunosuppression. … The recommended dose in children 3 months to 12 years of age is 180 mg/m2 every 6 hours (720 mg/ m2 per day), not to exceed 200 mg every 6 hours [800 mg daily].’ GlaxoSmithKline currently suggests slightly differently: ‘Pediatrics: The recommended dose in pediatric patients 6 weeks to 12 years of age is 160 mg/m2 every 8 hours (480 mg/m2/day up to a maximum of 200 mg every 8 hours) in combination with other antiretroviral agents.’ Such as our AZT lookalike, 3TC.

CHAPTER

John le Carré’s best-selling novel, The Constant Gardener (Hodder and Staughton, 2001) presented a shocking fictionalised exposé of the pharmaceutical industry – but in an interview in the second December 2000 issue of the Spectator, he mentioned that during his research for the book, ‘As my journey through the pharmaceutical jungle progressed, by comparison with the reality, my novel was as tame as a holiday postcard. … The pharmas,’ he said, ‘are engaged in the systematic corruption of the medical profession.’ In his piece, The criminals of capitalism, published in the New York Nation on 9 April 2001, le Carré continued: ‘Big Pharma is engaged in the deliberate seduction of the medical profession, country by country, worldwide. It is spending a fortune on influencing, hiring and purchasing academic judgment to a point where, in a few years’ time, if Big Pharma continues unchecked on its present happy path, unbought medical opinion will be hard to find.’

Unbought literary opinion too. The feature film of The Constant Gardener released in 2005 featured what is known in the industry as a ‘product placement’, with Boehringer Ingelheim paying the producers millions to punt nevirapine as an AIDS drug, not once but twice in the script, some of which would have been recycled to Le Carré for the film rights.

Cara Jeppe, a research assistant in the department of surgery at Chris Hani-Baragwanath Hospital, made just this point about the corporate corruption of South African medical research in an essay, Save us from sophistry, published in the Mail&Guardian on 13 August 2002: ‘Sponsorship of many medical schools and research programmes by drug companies ensures few embarrassing exposés are published and unwelcome research remains unfunded. Thus much evidence refuting studies is embargoed, and the public is persuaded to support unscientific orthodoxies propagated by the pharmaceutical industry.’

An article Towards a philosophy of Science and Technology, published anonymously on an Internet site discussing the insights of science historian Thomas Kuhn, noted consonantly – with particular pertinence in the AIDS era: ‘Kuhn’s analysis allows for the possibility of the immense corruption and influence of science, ideologically, methodologically, politically.’

In the last half-century the vulnerability of the scientific endeavour to corruption, particularly in commercial bio-medicine, has been aggravated by the vast amounts of money available for research – provided that the grant applications serve the donors’ commercial or private interests, as in the case of pharmaceutical corporations, or the dominant paradigm, where parastatals like the Medical Research Council have substantial funds to dispense for research sponsorship. The result is that scientists naturally flock to the cash. And these days the cash is in HIV-AIDS research – no one gets grants to research non-viral multifactorial models to account for the incidence of ‘AIDS’. Jeppe explained the problem in her essay – quoting from Kuhn’s seminal The Structure of Scientific Revolutions (University of Chicago Press, 1970):

Another philosopher of science, Thomas Kuhn, argued: ‘No part of the aim of normal science is to call forth new sorts of phenomena; indeed those that will not fit the box are often not seen at all. Nor do scientists normally aim to invent new theories and they are often intolerant of those invented by others. Instead, normal scientific research is directed to the articulation of those phenomena and theories that the paradigm already supplies. … Given a paradigm, interpretation of data is central to the enterprise that explores it. But that interpretive enterprise ... .can only articulate a paradigm, not correct it.’ Having established the paradigm through repeated circular referencing to its articulators and through suppression of opposition, the ‘enterprise’ can provide lucrative avenues for industry.

In How Giant Drug Firm Funds the Aids Lobby in the London Sunday Times on 30 May 1993, Neville Hodgkinson described how the Wellcome Trust – GlaxoSmithKline’s arm’s-length charitable face – was systematically entrenching the viral/antiretroviral model by showering cash on gay AIDS activist organisations plugging this line, the Terrence Higgins Trust most lavishly – in the latter case by setting up a fund-raising operation to cover salaries and the rent for its expensive, leafy, inner-London digs. Also pay for its glossy booklets. Especially gladly for the AZT one, Positive Benefits. Extolling the drug’s virtues for nine pages. And claiming that ‘there are no life threatening side effects associated with zidovudine’. Of course not.

The Wellcome Trust was likewise funding the All-Party Parliamentary Group on AIDS, the London School of Hygiene and Tropical Medicine and the University College and Middlesex School of Medicine, and notably, the British Medical Association Foundation for AIDS, set up by the British Medical Association on the back of a Wellcome Trust bequest of £36 000 annually – in the very year that AZT was licensed in Britain. And the Wellcome Trust had recently set up the Wellcome Centre for Medical Science, which was lecturing teachers to get the gospel into schools. George Galloway MP saw what was going on: ‘The British health service rolled over on its back for Wellcome, spending millions of taxpayers’ money on this drug. In my opinion the health service has been well and truly shafted. The hegemony Wellcome have built up ... may turn out to be one of the greatest medical scandals of the century.’ You could be onto something there, George.

Martin Walker explained the game in his essay published online, HIV, AZT, big science & clinical failure. And a jolly clever game it was too. With £200 million at its disposal to scatter annually, by the late eighties the Wellcome Trust already had a long-established honey relationship with the British Medical Association. Just as it has with our own Medical Research Council, evidenced by sponsoring a conference it convened, The Second Wellcome Trust Workshop on HIV/AIDS and TB – contact the MRC to register for a week in scenic Cape Town, starting on 27 November 2001. Importantly, ‘... there will be sessions on how to write a grant application’ to the charity for ‘HIV-AIDS-TB’ research, and it ‘will also be an excellent opportunity to meet other researchers in the field. A number of prominent international and local speakers have been invited.’ To keep the party line straight. And stave off any questioning of the link – boiled down – between sex and TB among the poor, or the sense of giving potent cell-killing chemicals to people fallen ill through hopeless, chronic hunger. Among humans, the equivalent of Wellcome’s relationship with the British Medical Association and our MRC would be criminally punished as secret incest. In business, it was an arrangement to dodge a criminal charge of graft. Which it was, by any name.

With similar corrupt intent the Wellcome Trust funded a three-day ‘Scientific meeting on the empirical evidence for the demographic and socio-economic impact of AIDS’ in Durban over 26-28th March 2003, hosted by the University of KwaZulu-Natal’s flagship AIDS research institute, the Health Economics and HIV/AIDS Research Division (HEARD). Three days of buzzing chat around forty-four expert presentations produced a meaningless and tedious report in June, distilled perfectly in its last breath: ‘The point that we wish to end on, nonetheless, is that the meeting clearly encouraged methodological innovation. In other words, there is scope for experimentation, be it with linking and reconciling epidemiological and demographic data, comparing large workforce and ANC survey data, or conveying the significance of “the cost of a cuddle”.’

Taking a special interest in AIDS scaremongering by demographers, GlaxoSmithKline likewise underwrote the cost of a meeting of the Demographic Association at Potchefstroom in mid-October that year. Robert Shell, now associate professor in the Department of Statistics in the Western Cape, having earlier been kicked out of Rhodes, obliged the company by intoning: ‘We have reached a medical emergency in this country. We are looking at the destruction of our population at unparalleled levels. We are at a very profound moment in our history.’ After which everyone broke to natter over tea and cake.

As it brought AZT to market in Britain, Wellcome (now GlaxoSmithKline) didn’t want any dithering general practitioners making unpredictable treatment decisions off the AZT track. So with ‘specialists’ in its pocket, it had no trouble getting the BMA’s General Medical Council to cut GPs out of the action and make the treatment of AIDS patients a specialised business, with disciplinary sanctions in store for any GP not passing the work on. On to a club of ‘AIDS experts’. Whose doctrines sprung from a single font: the British Medical Association Foundation for AIDS. Set up by the British Medical Association. And paid for by the Wellcome Trust. To pump a single unquestionable creed: You are going to die because you had sex without a condom. Semen kills. It carries a deadly virus. AZT takes care of it.

Fixing the doctors was Wellcome’s first trick. Its next was to manoeuvre around the road boom between it and the laity, for unlike the case in America, it was illegal in Britain to advertise prescription drugs directly to the public. Expanding on Hodgkinson’s report, Walker explained that it did so by targeting the ‘plethora of self-help organisations which were springing up throughout the country’ and buying them all up –

all the self-help groups which had contact with gay men who tested ‘HIV antibody’ positive … Where they were unable to fund them directly, they gave grants for journals, papers and magazines or for specific projects. There were no overt strings attached to such money but recipients had to adhere to the medical model of AIDS [which prescribes AZT] and act as conduits by which off-the-street gay men concerned about their health could be funnelled into the charnel houses of chemotherapy. … By bombarding newly tested gay men with partial information about AZT and other so-called anti-viral drugs, Wellcome had found a way round the Medicines Act and the perfect way to construct a drugs market. Wellcome adopted a strategy which has been known within politics for hundreds of years. Wellcome didn’t need General Practitioners to sell AZT; they mounted their beachheads in the bourgeois sectors of the gay community and developed a colonial class which administered the medical model for them. … The fact that people were ill with greater frequency and died more quickly when they took AZT, did not affect the public perception that users of AZT got better, or lived longer lives of better quality than people who unfortunately did not have access to the drug.

GlaxoSmithKline and Bristol-Myers Squibb play at the same board. In 1999 BMS announced a grant of $100 million (later upped to $150 million) for the fight against AIDS in Southern Africa. That’s right, don’t adjust your set. The Washington Post told us all about it on 29 December 2000 in The Limits of $100 Million: ‘a five-year, $100 million charitable initiative to fight AIDS in Africa’. Which sounds like a lot. It is, in terms of controlling the field. Because a scientist who proposes, for example, looking into chronic malnourishment as a significant contributory cause of collapsing health in early adulthood among ostensibly well blacks has a fat chance of winning a research grant from any of the organisations promoting the HIV-AIDS model appointed by the company to hand out the bread. Much less a scientist who wants to research and report the cross-reactivity of ‘HIV antibody’ tests. Or go looking for ‘HIV’ in the blood of a person diagnosed HIV-positive, to establish whether HIV-positive really means HIV-infected as nearly all ‘AIDS experts’ say . But a hundred million is small change to Bristol-Myers Squibb, with ‘sales of $20.2 billion in more than 100 countries last year’, derived inter alia from its AZT-class drugs Videx (ddI) and Zerit (d4T), which sold $810 million worth in 1999.

And which, the company admits, are killing pregnant women. On 2 February 2001 the New York Times reported an alert issued by the European Medicines Evaluation Agency after

seven cases of lactic acidosis – three of them fatal [one South African] – had been reported worldwide in pregnant women taking the two drugs in combination. … Echoing last month’s warning by the US Food and Drug Administration, the EMEA pointed out that lactic acidosis is a known side effect of the class of HIV drugs called nucleoside reverse transcriptase inhibitors (NRTIs) [such as AZT]. The use of this class of drugs is not recommended during pregnancy unless the potential benefit clearly outweighs the potential risks.

Although the drugs’ labels already included strong warnings that lactic acidosis could occur in any patient, the FDA warned in a special advisory that ‘new evidence showed pregnant women have a greater chance of developing the condition’ (per Reuters). Bristol-Myers Squibb added this warning to its labels, and chased the change with an explanatory warning letter sent to 50 000 AIDS doctors. Like the EMEA, both the FDA and Bristol-Myers Squibb thoughtfully advised ‘pregnant women and their doctors to consider Zerit and Videx only when the benefits outweighed the risks’. But terrified pregnant women told they’ve got a killer virus, which could kill their babies too unless they take their medicine, are hardly placed to decide whether or not to take the antiretrovirals touted. The question is: when can we expect doctors to finally conclude that it never does – given all the nucleoside analogue drug foetal toxicity reports reviewed in Debating AZT, with more in Poisoning our Children.

In August 2002 Bristol-Myers Squibb sent out a blizzard of worried Important Drug Warning advisories to South African ‘healthcare professionals’. No longer just pregnant women in the firing line, everyone:

Bristol-Myers Squibb would like to remind health care providers caring for people with HIV of the potential for mitochondrial toxicity and lactic acidosis as a complication of therapy with nucleoside analogues, including Zerit (stavudine, d4T) [including] the risk of serious adverse reactions such as neuromuscular weakness, hepatoxicity and pancreatitis. … Bristol-Myers Squibb has received reports of rare occurrences of rapidly ascending neuromuscular weakness, mimicking the clinical presentation of Guillain-Barré Syndrome [general paralysis], including respiratory failure. Some of the reported cases were fatal. … Female gender, obesity, prolonged exposure may be risk factors.

Etc. In their chemical composition and pharmacological action, AZT and d4T are identical twins. Why the reports should be ‘rare’ is because, as was vividly illustrated in the Xolani Nkosi case, doctors under the HIV spell who see their HIV-patients gravely sickening after commencing their life-extending drugs blame the virus. They see the HIV-disease progressing.

CHAPTER

On 5 March 2001 a confederation of thirty-eight pharmaceutical companies commenced their action in the Pretoria High Court for an order knocking over provisions of the Medicines and Related Substances Control Amendment Act that allow for the importation of generic drugs. AIDS activists adopted the case as their own, a new front for their cause, the next thing to froth about, and the media were sucked right in. The following day Jon Jeter of the Washington Post reported the case as a ‘challenge of [sic] South Africa’s efforts to buy cheap, generic substitutes for patented AIDS medicines … life-prolonging treatments’. Instead of reporting the case, the rest of his report banged the AIDS drum, taking a swipe at Mbeki in the process for having ‘questioned the effectiveness of anti-retroviral medicines that are commonly used in the West to combat AIDS, and [his refusal] to authorize administration of relatively inexpensive treatments that have been shown to reduce transmission of HIV from pregnant women to their unborn children’.

The TAC provided huge fanfare for the launch of the case, bussing in hundreds of protestors clad in the purple and white company tee-shirt (‘HIV POSITIVE’) to march and toyi toyi with placards near the court and outside drug company headquarters, as well as in Durban and Cape Town. An appeal for donations on its website goes: ‘T-shirts and posters must be printed. Busses to bring affected people in from local townships need to be booked and paid for.’ Also picnic lunches. Achmat and his crypto-fascists had learned well from their antecessors – the propaganda value of organised street demonstrations having been recognised by the Nazis in the twenties and thirties. Supervised by another street-fighting femme: SA leader Ernst Roehm. As the Nazi newspaper the Völkischer Beobachter put it: ‘The very best thoughts are those inculcated by marching; in them reverberates the secret German spirit, the spirit of centuries.’

But as the drug companies’ attorneys correctly pointed out, ‘the case has virtually nothing to do with access to AIDS treatments, but centres instead on whether South Africa is obliged to follow international law regarding intellectual property rights and the country’s own international trade pacts’. The case quickly got chaotic. Judge Bernard Ngoepe wasn’t sure whether he could hear it. Because the act had not yet been promulgated, he mused in court over whether he could overturn it: ‘Courts cannot enforce those acts until they are in operation. It may very well be they are still in the kingdom of the legislature or executive.’ But that wasn’t the point at all. The applicants wanted it undone before it was enforced. A couple of days later he allowed the kids yelling outside the door to join the party, this high-powered spat, and the TAC was appointed a friend of the court, so that Achmat could helpfully tell it what it didn’t already know: that AIDS drugs are very expensive and that the poor can’t afford them. Oxfam characterised the case as an attempt by the pharmaceutical corporations to ‘engineer a gross violation of human rights’ in denying AIDS drugs to the needy; the ‘Vietnam of the drug industry’; a public relations disaster in a country with the highest number of AIDS sufferers in the world. They could have added ‘with a government under the greatest concerted massed pharmaceutical corporation pressure anywhere in the world ever’.

Even as he joined the party, pressing himself on the government like a suitor who doesn’t understand No, he was attacking it, claiming a week earlier that it had the blood of the country’s children on its hands, and ‘We face a greater tragedy than the acts or omissions of the drug companies, and that is the failure of government officials to act with courage, humility and urgency.’ Obediently, that is, to my sulky dictates.

The activists even got Madiba lined up behind them. On 15 April 2001 Mandela was interviewed on SABC television: ‘I think the pharmaceuticals are exploiting the situation that exists in countries like South Africa – in the developing world – because they charge exorbitant prices which are beyond the capacity of the ordinary HIV-AIDS person. That is completely wrong and must be condemned. The government is perfectly entitled, in facing that situation, to resort to generic drugs and it is a gross error for the companies, for the pharmaceuticals, to take the government to court.’ This got them sweating. The moral authority in the Nobel peace laureate’s rebuke for the drug companies became too much to bear. The Opium-laden frigate began breaking up on the rocks it had hit in its hostile harbour.

Bearing out the adage that the biggest bullies are usually the biggest cowards, GlaxoSmithKline and the other majors (with their combined market capitalisation of $1.3 trillion – said the Star on 16 April 2001 – ten times South Africa’s annual gross domestic product) were the first to break ranks with the rest. Four days after Mandela’s scolding they cracked and fled the court. A report in the London Guardian on the morning that it happened told that the ‘five big firms – including the world’s largest pharmaceutical company, Britain’s GlaxoSmithKline ... have lost all heart for the fight’. Which made the smaller players bitter after their three years of preparation, and the stakes involved in a determination of their complaint. The Guardian elaborated: ‘A split has developed between some of the larger drug companies and the Pharmaceutical Manufacturers Association of South Africa (PMA), which headed the legal action. At yesterday’s hearing, several drug firms sent in their own legal teams.’ The relative minors were not persuaded that the big conglomerates’ surrender had anything to do with the legal merits, as opposed to a buckling under organised public pressure, but, ‘Although some smaller firms could technically pursue the case, lawyers said it was highly unlikely that they will.’

Not with the kind of heat fixed by the activists: ‘Dear friend, URGENT DEADLINE: Médecins Sans Frontières (MSF) asks you to support South Africa’s efforts to make essential medicines more accessible to its people by signing the global ‘Drop the Case’ petition at by April 15.’ And a great success it was too; in a joint press release by MSF, Oxfam, and the TAC, Achmat said: ‘…we are especially grateful to the 260,000 concerned citizens and 140 organisations from 130 countries who signed the global ‘Drop the Case’ petition.’ The local AIDS Consortium mentioned some local organisations that signed up:

Finally the AIDS Consortium would like to thank all its members for their support. The voice of civil society has been strengthened by the strong alliance of organizations including the AIDS Law Project, the National Association of People Living with AIDS, the Congress of South African Trade Unions, MSF, Oxfam, and the Consumer Project on Technology including all the other organizations and community based structures that have been involved.

In a public relations disaster zone, the drug companies approached Kofi Annan to guide them out of it. Who phoned Mbeki in turn, and soon a settlement agreement had been hammered out by the lawyers, based on a concession by government that it would negotiate with the industry before issuing any compulsory licenses for the import and/or local manufacture of generic drugs..

The TAC was ecstatic: ‘Urgent Press Release 19 April 2001: Victory for Activists, People With HIV/AIDS and Poor People Everywhere! Pharmaceutical Companies Beaten! … The government must now fulfil its constitutional duties to protect the rights to life and health of all South Africans.’ To be achieved perfectly by providing those lifesavers, AZT and nevirapine.

GlaxoSmithKline’s Chief Executive Officer in Britain, Jean-Pierre Garnier, made a risible attempt to save face after his company’s rout. The company ‘unreservedly welcomed’ the settlement, he said. It ‘meets the objectives of both the South African government and the pharmaceutical industry, but it is my fervent hope that the real winners here will be patients’. Sure it is, you pompous arse. Gliding down your oak avenue. On the backseat of your Rolls. Twinkling in Nazi gold. If this drug deal has gone sour, you can always go off and sell some arms. Like Black Hawk helicopters. As a director of United Technologies. Your other job.

Significantly, in her detailed press statement on the day the case was settled, Tshabalala-Msimang mentioned nothing about antiretrovirals, the drugs that the TAC and the media imagined the case was all about. Nor did a joint statement issued by the principal parties to the litigation the next day. But she did make the government’s intentions plain in what the Wall Street Journal described as ‘a crowded conference room’ moments after the case was abandoned. It reported: ‘“We never said we want to use antiretrovirals,” she told the audience, which just moments prior had been singing and clapping. “People who want antiretrovirals can go to the private sector.”’ Quite so. The TAC would do whatever it took, Achmat responded, including taking government on to bring ‘real drugs to real people’. Since people like Mbeki and Tshabalala-Msimang were unreal. Unlike the exhaust pipe franchise, Speedy Exhausts: ‘Real people, real value, real Speedy’. And the furniture retailer chain: ‘Beares really cares about you’. As the drug companies do, delivering ‘healthcare’.

The TAC’s jubilation now began to fade rapidly. As the people got real. The guys with ice-cream on their cheeks now came to, and realised that for them the whole thing had been a huge waste of time and energy. Hadn’t they heard Tshabalala-Msimang’s repeated public rejection of AZT on the grounds of its toxicity and carcinogenicity? Don’t they wash their ears?

The US administration had brought heavy political pressure to bear on the South African government in support of the drug companies suing it, insisting that the AIDS drugs patents be respected, on pain of sanctions. Even if that put the proprietary medicines out of reach of the Third World poor – as the TAC was complaining. And that without the drugs, bodies, they said, would pile up in South Africa and beyond, great mountains high. The Bush administration’s thinking on this score seems to have been ‘Shucks, they’re only niggers and gooks.’ Because as anthrax hysteria exploded on home turf after the World Trade Centre attack on 11 September 2001, they weren’t so hassled about the goddam patents: the New York Times told in an editorial on 31 October 2001 that ‘When the federal government wanted to stockpile the antibiotic Cipro as a treatment for anthrax, Health and Human Services Secretary Tommy Thompson persuaded Bayer, the patent holder, to cut the price of the drug [from $4.67 per pill down to 95 cents, per Newsday] by threatening to buy generic versions. Yet the Bush administration is derailing efforts by poor countries ravaged by AIDS to facilitate their efforts to do the same’ by blocking a motion to be proposed on 9 November 2001 at a meeting of the World Trade Organisation ‘to make it easier for countries to manufacture or import low-cost drugs, especially the anti-AIDS cocktail … While current world trade rules allow countries to break patents under certain circumstances, among them public health emergencies, no country has done it for AIDS medicines, in part because of pressure from Washington.’ That’s because the numbers are too sweet. In every war effort against enemies real or imagined, from the Indochinese to cancer, someone always does great, and for the medical industrial complex, the war on AIDS has been the fattest of cash cows.

Five days after GlaxoSmithKline chickened out in the High Court and threw in its cards, it tried rescuing its threatened AZT and 3TC market by offering further price cuts. The New York Times reported on 24 April 2001 that it had ‘offered to cut its price for Combivir in Africa to $730 a year – about a tenth of its price in the United States and a price that it says is equal to its manufacturing cost. But $730 is close to three times Cipla’s offer.’ Revealing what big liars work for GlaxoSmithKline. The standard defence of the drug industry’s high prices is that it has to recover research and development costs. But in the case of AZT there weren’t any to speak of. The drug was designed by Richard Beltz in 1961 on a grant from the National Cancer Institute. The government paid. (See Inventing AZT in the appendices.)

GlaxoSmithKline’s tremendous concern for ‘AIDS sufferers’ reflected in their one-tenth fire-sale price, represented a small-change cost to the company anyway. The Times mentioned a report by industry analyst IMS Health that more than ninety per cent of the $3.8 billion spent worldwide on AIDS drugs was in just five First World countries: the US, France, Italy, Germany and Britain. Because people in the Third World can’t afford them. And in any event, of its total drug market, AIDS drugs make up only a small part; GlaxoSmithKline, the world’s biggest selling AIDS drug producer earned only about six per cent of its revenue from selling them.

Following the collapse of the generic drug case, the TAC’s allies in Oxfam kept the pressure up on GlaxoSmithKline for cheaper AZT for Africa, by lobbying shareholders attending the company’s annual general meeting in London on 22 May 2001. Dressed in white coats they dished out pillboxes to shareholders to make their point, and those whose consciences had been moved by the stunt gave CEO Jean-Pierre Garnier a grilling. But his company led the way in offering AZT and 3TC to Africans at a tenth of their ordinary cost, he protested. And it was committed to researching diseases of the developing world. Which impressed Oxfam policy analyst Sophia Tickell – sort of: ‘Glaxo has taken small steps in the right direction but must do more. If it does not address the issue of patents in developing countries, it runs the risk that its good intentions will be seen as so much window dressing.’ Oxfam liked GlaxoSmithKline’s show of ‘good intentions’. And we found the childishness of Oxfam’s moral assessment unbelievable

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CHAPTER

On 3 May 2001 Mbeki was interviewed by Jon Snow on the British television channel ITN. Snow asked him: ‘Do you regret the original stance you took questioning the link between HIV and AIDS?’ To which Mbeki replied:

But I didn’t, that was misreporting as you so often have happening. The point I was making, which I would make still, is this. It seems to me, from reading all the things that have been written about this, that in the collapse of people’s immune systems, a virus is part of that but there are other factors which cause the collapse of the immune system, as a result of which people suffer from AIDS. And therefore we need a comprehensive approach to the matter. Ask any doctor and they will say the matter of nutrition and therefore the struggle against poverty, the matter of clean water, these are critical to the protection of the immune system. So I was saying, we can’t just focus on one thing. This is a country that is very poor, and indeed that level of poverty will impact on the capacity of the immune system to survive. Let’s have a more comprehensive approach to this matter that is what I was saying.

Asked why he thought he might have been misunderstood – because perhaps he’d taken the drug companies on, who had deliberately misrepresented his position – he proposed:

I think the problem arose because there was a slogan that says ‘HIV causes AIDS’ and therefore you respond like this. When you say, let us look at the matter more broadly, more comprehensively, the response is that you are questioning orthodoxy. I think think for a long time people didn’t want to listen, but I think the atmosphere has changed. Certainly in this country people are saying, medical people, yes, we need a more comprehensive response to this challenge rather than just one narrowly focussed on a virus. It includes the virus, but we must include all these other elements wich relate to the question of what acquired immune deficiency means. There is an immune deficiency – how does it come about? How is it acquired, and what is the syndrom that results? If you ask these questions they are simple. You acquire that immune deficiency via a virus, via bad health conditions, which will destroy the immune system. So let’s deal with everything that leads to immune deficiency, which leads to the syndrome and all the various diseases. But when you say that, in a situation where people are accustomed to a particular formulation thay might very well have thought that this was sacrilege.

Two weeks later, on the 18th, taking some questions over the Internet from participants in the BBC Online forum, Mbeki elaborated. Asked why he denied ‘pregnant women the use of AZT in pregnancy when there is solid evidence it reduces the transmission of HIV from mother to child,’ he explained:

This is part of the discussion that is taking place. The latest circular from the World Health Organisation was specifically on AZT. It says when you dispense AZT, it must be done under close medical supervision, bearing in mind the contra-indications and potential toxicities. The idea the you can just give out this antiretroviral without the proper health infrastructure [is] wrong – because in many instances you’ve got to check this patient every day. You cannot do this in a rural hospital. This infrastructure does not exist. One of the issues that scientists are looking at is that of where you have to dispense these antiretrovirals to large numbers of poor people in a poor country, with a weak health delivery system. What the WHO is warning about is that if you don’t do it properly, you might kill the pregnant mother because of the toxicity of the drugs.

Challenged on his decision to convene his AIDS Panel for lending ‘credence to theories that the medical community long ago rejected’ and about the danger that people might not ‘take precautions against HIV infection when they hear you question the relationship between HIV and AIDS’, he endeavoured to set things straight once and for all:

There’s been a lot of misreporting about this. Let me tell you what they have been saying and doing. It seems to me that there are a number of scientific questions that need to be answered with regard to this, not so much to ensure that we’re better educated about science, but to ensure that we make a more effective intervention against AIDS. So we then appointed the scientists representing all the different points of view with regard to the scientific discussion, which, as you know, has been going on for a long time. I agree with you the majority of scientists are saying one thing. We need answers because we need to be very focussed and very effective in the fight against AIDS. One of the consequences is that the scientists themselves, the scientists on both sides, agreed that, yes indeed there are many angles of scientific questions. They further agreed that indeed they had not been discussing these questions for fifteen years because there had been mud-slinging, throwing mud at one another. They further agreed that they would then meet under the auspices of the US government’s Centers for Disease Control. All factions would meet under the auspices of the CDC to look at these unsettled scientific questions that exist.

‘But the question is whether HIV leads to AIDS?’ worried the caller. ‘That’s one of the questions that the scientists are discussing,’ Mbeki replied. ‘I’ve never made any judgment on that. It’s an issue they are debating. They’re debating it also, not because they’re interested in abstruse scientific conclusions, but for all these years we still haven’t found a vaccine for AIDS, and this is something that must be troubling to the scientists and the rest of us.’

Mbeki’s tactical approach to the strident demands of the orthodoxy that he give up his doubts about their devil was clear. Resisting the virus’s champions head-on was simply unfeasible, so better to include HIV among a portfolio of contributory causes, with poverty prioritised.

But head-on he ran into a bunch of AIDS activists at Glasgow Caledonian University on 13 June, when he arrived to open a health faculty building named after his father during a four-day trip to the UK. ‘AIDS is the new apartheid,’ shouted one excited protester, as his companions waved banners declaring ‘AZT saves babies’ lives’. But Mbeki paid the foolish demonstrators no attention, and in his speech at the opening made no reference to the AIDS controversy. Except perhaps to drily offer some oblique advice to the indignant activists: ‘It is clear that if we are to change South Africa for the better we are going to have to be more educated.’

On 14 June 2001 Mbeki and Prime Minister Tony Blair met at 10 Downing Street for the Fourth UK-South Africa Bilateral Forum, and on the lawn afterwards they stood together taking questions from journalists. Asked about AIDS and Zimbabwe, Mbeki responded:

Well, we have discussed the more … matters. We have to engage the matter for instance of AIDS as we are engaging it. There’s got to be very strong awareness campaigns, strong interventions to treat, to deal with opportunistic diseases, there’s got to be strong social programmes about home-based care, about care of orphans and so on. We’ve got to do that whole variety of things and we are doing that whole variety of things. And so we’ll continue with these programmes. As they say, we say well that’s what happening and people of course can check for themselves. But then to say that we then have to ask the question are there other things that we need to do to make ourselves more effective with regard to those interventions. And therefore that question needs to be answered. It’s rational, of course it’s rational.

Blair then invited two final questions, and the next journalist continued on the same theme, thinking she had Mbeki cornered:

Mr Mbeki your government introduced yesterday a programme for drugs which will stop the transmission of HIV from mothers to babies. How does that square with your earlier comments that there’s no link between HIV and the spread of AIDS.

‘When did I make that comment?’ Mbeki asked.

You made the comment, it’s well recorded that you made the comment and your government introduced this programme yesterday. How do you square up the two things.

Mbeki turned the tables:

I’ve never actually made the comment. If you say it’s well recorded I’d like to see the recording. I’ve never said it. See the thing…. What’s happened…. What you’re referring to is a particular drug which has just got licensed in South Africa, which it is said helps with this matter of mother-to-child transmission. When the medical authorities licensed it, that’s the Medicines Control Council, they said there’s a number of matters that remain unanswered integral to this question. One of them that’s not been resolved in regard to this particular drug [nevirapine], which is whether the mother who gets one dose and the child who gets one dose when the child gets born, whether the mother should breastfeed, because part of the evidence is now that if the mother breastfeeds when this child is two years old then they will become HIV-positive again. Now the problem with that what then do you do if you are going to say there shall be no breastfeeding. What do you do with the mother who’s poor, who comes from a rural area which has no clean water, has no electricity to boil water so that you can prepare these foods so that the child must eat because it’s not breastfeeding. So what was decided was that we will do two trial runs per province, urban and rural, to say if you make this drug generally available how do you cope with it. Because if science as it stands now says don’t breastfeed it means this mother who comes from the circumstances where they can’t produce formula feed because they are not breastfeeding, the government will then have to find the means to address that particular matter. So how do you do it? So what we are talking about is a trial we are running in all nine provinces, urban and rural sites so that we can see down the road how does the public health system cope with this. To try to respond also, then, to the matters raised by the Medicines Control Council, which said, as it licensed, there are a number of matters which have not been answered with regard to this. So it’s that kind of experiment. It’ll do all those things so we need some answers before you say this drug is generally available in the public health system. So that’s what’s happening.

On 26 June, right after his trip to see Blair, Mbeki paid a formal visit to the new US President, George W Bush. At a media photo-shoot in the Oval Office immediately after their meeting, one question was addressed to each President, and both concerned AIDS. Bush’s reply indicated that AIDS had been a hot topic of their discussions: ‘Mr President, neither of you have mentioned the AIDS scourge directly in your opening statements here. How high on the list of priorities for discussing the scourge is this on your agenda?’ Bush:

Well, it’s an incredibly important part of our dialogue. The AIDS pandemic in Africa is terrible. And our nation intends to do something about it. As a matter of fact, our nation is doing something about it. We provide more money than any nation in the world to fund a strategy to defeat AIDS [$200 million to the UN Global Fund for HIV/AIDS, TB and Malaria.] And we will continue to work with nations that can afford to put money into the trust to do so. I was so pleased to see not only to announce that our government put money into an international trust, but the Gates Foundation, a private foundation here in America, contributed $100 million. And yesterday, Tommy Thompson and Colin Powell went to the U.N. to discuss this important issue. And we will discuss it, and we’ll discuss it in depth, just like we did in Austin, Texas. The President is concerned, as am I. I discussed it in Europe. I talked to the Europeans. I said, we’ve made a down payment into the international trust to battle AIDS; they should contribute, I said. And I hope they do. [They did. The UK contributed $100 million, France $127 million, and the UN’s Kofi Annan paid $100 000 in from his own pocket.] I hope the European Union will follow suit. Part of our discussion that night in Sweden was the United States taking the lead in the AIDS pandemic, not only in the continent of Africa, but around the world. And this is a big issue, as far as we’re concerned. We’ve got to do something about it.

Bush then turned to Mbeki for his comment: ‘Mr President?’ Mbeki subtly moved the spotlight to the structural causes of disease in black Africa:

Yes, indeed. As the President says, we actually did discuss this matter, even then, last year in May, when we met in Texas. It clearly is an important matter. That’s why I mentioned the matter of diseases on the African continent. AIDS, indeed, is one of those. We have to respond in a comprehensive way. One of the matters we’ll discuss with the President is this African recovery program that we’re working on. And one of the major priority areas in that African recovery program is precisely this area. So we certainly will discuss this. And we have to do something, because in many instances, these are diseases which are not only caused by poverty, some of them, but also cause poverty. So if you’re talking about an African recovery, you cannot but discuss AIDS, and really confront it. Malaria, tuberculosis, all sorts of communicable diseases are a particular matter of what has to happen – we have to address them.

But the American journalist swung the focus back to drugs:

Mr President, President Mbeki, last week the New York Times published an editorial accusing your government of, in its words, dooming half a generation of young people to an early, protracted and expensive death because of its failure to distribute antiretrovirals. How do you explain the amount of criticism that you’re coming in for in the United States for what is a perception that you’re not doing enough on HIV?

Mbeki replied: ‘Well, as we’ve said – all I would say to that, really, is that people must look at what we’re doing in South Africa, not their perception of what they think we’re doing, but what we’re doing actually in the country. And I don’t think on the basis of facts an accusation like that can be sustained.’

Two days later, at a National Press Club lunch in Washington, Mbeki was asked whether he thought HIV was the primary cause of AIDS. He ducked: ‘... that’s what the scientists say. I don’t think my personal belief is relevant to a scientific fact. But it is in ordinary medical textbooks that the immune system can get compromised by a whole variety of things, not only a virus.’ Again he emphasized: ‘We’ve got to respond to a human body in a comprehensive manner and that includes this issue of HIV.’ He said the pharmaceutical manufacturer Merck, whose vaccine research facility he’d visited the day before, had expressed interest in working with the South African government to examine ‘these broader questions’. Criticized for skipping the UN AIDS Conference focussing on AIDS in Africa then underway in New York, he answered simply: ‘One can’t be at two places at the same time.’ He’d sent a large delegation including his Health and Foreign Affairs Ministers, he said. ‘What the Ministers said at the UN AIDS conference is no different from what I would have said.’

Being otherwise occupied spared him having to sit through the speech of a dimwit like US Secretary of State, General Colin Powell. Carrying on in the Security Council like one of his Joes on bad acid: ‘I was a soldier. But I know of no enemy in war more insidious or vicious than AIDS. An enemy that poses a clear and present danger to the world.’ Selling hallucinations so obviously at variance with the facts: ‘AIDS respects no man, woman or child. It knows no race, religion, class or creed. No community, country, or continent is immune from its ravages.’ Alluding to Mbeki, who saw things differently, he said: ‘Opinion leaders from all walks of life must deliver the message that AIDS is real.’ To justify the US getting stuck in everywhere:

President Bush has put the full force of his government, the full force of his cabinet, behind the US response to this crisis. He has named Secretary of Health and Human Services Tommy Thompson, who is here today, and me to co-chair a special task force to ensure that my government’s efforts are comprehensive and coordinated. Comprehensive and coordinated these efforts must be, for AIDS is not just a humanitarian or health issue. It not only kills. It also destroys communities. It decimates countries. It destabilizes regions. It can consume continents. No war on the face of the earth is more destructive than the AIDS pandemic. … In this global war against AIDS, everyone can and must be a leader. Everyone can and must be an ally. We are all vulnerable – big nations and small, the wealthy and the poor. We cannot let AIDS divide us. My country is ready to work with all nations to build a global coalition of action against this common foe.

And on he went, full of big American talk. Which he no doubt picked up from sitting listening every Sunday to the bulging homilies of his small-town Baptist pastor. Including lessons in not telling lies. About weapons of mass destruction and killer germs. With the Stars and Stripes waving proudly outside.

CHAPTER

A pillar of Achmat’s AIDS drug advocacy campaign throughout Mbeki’s first term as President, a stratagem applied with enormous success for making propaganda, and winning a huge bevy of admirers, was his publicly traded declaration that he would not take the drugs himself. As he explained to Time on 22 April 2001, ‘he refuses to take the drugs until they’re available to all South African AIDS patients through the public health system’. He repeated this two years later in the same mag, honouring him for his bravery under the laurel ‘Heroes*Activists’ on 20 April 2003: ‘When the program of treatment is established and irreversible, then, and only then, I might go into some serious treatment of my own.’ This meant that he was Dying To Get AIDS Drugs To All, according to the headline, because, Achmat explained, ‘The cost of treatment, if you could find any, was way out of the reach of poor people. To have AIDS was a death sentence.’ That is to say he would abstain from taking his life-saving medicine and thereby put his life on the line in the political tradition of Bobby Sands. This marvellous courage was calculated to attract plaudits from journalists and all sorts of players in high places, and place the government under unbearable pressure – at a propaganda level at any rate. The first it certainly did, but not the second, because, not so brave after all, he called his game off on 4 August 2003 after despairing of any prospect that the government might surrender to his demands. (Within a few months of his experimenting with drugs it would all end up in tears for Zackie Achmat, but we’re getting ahead of ourselves.)

Achmat volubly explained the motivation for his strike to his fans: ‘I don’t want to live in a world where people die every day simply because they are poor.’ In other words I want to die too. My refusal to take my medicine doesn’t make me a hero though: ‘I don’t think it’s noble, I think it’s dumb. But it’s a conscience issue. … The political scenario in South Africa has lost its moral content.’ And I’ve got to show them the way. How to be moral. Even though I’m dumb. ‘The poorest of the poor are dying, only the rich have access to treatment. My fight is essentially about this. If we don’t have morals in our politics, then South Africa is doomed.’ Unlike Mbeki, I’m the one with the morals around here, but on the other hand, ‘I don’t want to kill myself for Thabo. I want to make sure that people get medicines.’ I loudly claim I’m willing to die for this by not taking them. I pump up the volume by making a big show of refusing my treatment, even when Mandela comes begging, with the TV cameras in tow.

Achmat’s announcement that he was avoiding the drugs explained exactly why he was always looked fighting fit in his regular television appearances bashing Mbeki and Tshabalala-Msimang for their reluctance to buy them. Larry Fox of the Division of AIDS in the US NIH obliquely predicted that if Achmat would briefly taste the medicine that he advocated, he would undoubtedly spit it out: on 16 October 2000 at a symposium in Gaithersburg, Maryland, convened by the FDA, Fox remarked: ‘We have got a number of problems with [AIDS drugs]. So in South Africa, we experience people screaming, I want therapy, I want therapy, I want therapy. In the United States, we hear people saying, get me off this stuff, get me off this stuff, get me off this stuff.’

Martin Delaney, director of the AIDS drug promoting lobby Project Inform in the US, explained why. On 6 June 2001 he took part in a programme Plague: AIDS at 20 hosted by Ted Koppel on his ABC television show Nightline. The Judas goat of the gay American AIDS holocaust (himself hetero and HIV-negative), whose corrupted outfit has foisted the drug company line murderously on his frightened, motly gay constituency under the guise of an independent treatment advice and advocacy group, he volunteered some remarkable concessions:

Well, I think the dilemma here is we’ve got to learn from what has happened here in the last 18 years and try not to repeat it, as we move into Africa … I can’t overstate, I think, how severe the problems are with the current therapies. … People are dying from the effects of the therapies themselves in some cases. … People are suffering from severe life-threatening complications of drugs. … So as we talk about bringing therapy to Africa, even if we can solve the problem and cost and infrastructure and delivery, I have this pang in my heart of are we doing the right thing, you know, with these drugs? Or are we unleashing another kind of epidemic over there of drug side effects as well?

Is that a conscience we see beginning to nag there, Marty? If only for a moment: soon after the licensing of AZT in the US by the FDA in 1987, Delaney wrote in a newsletter put out by the AIDS Health Project, an AIDS service organization affiliated to the University of California:

The multi-center clinical trials of AZT are perhaps the sloppiest and most poorly controlled trials ever to serve as the basis for an FDA drug licensing approval. ... Because mortality was not an intended endpoint, causes of death were never verified. Despite this, and a frightening record of toxicity, the FDA approved AZT in record time, granting a treatment IND [investigational new drug] in less than five days and full pharmaceutical licensing in less than 6 months.

But when on 14 February 2003 Rasnick reminded him of this on the online letters page of the British Medical Journal, Delaney responded five days later:

If anyone cares, it is true that I made a critical statement about an early AZT trial some 16 years ago. That comment came at a time when I was just beginning my learning path about clinical research. Looking back, I would say that I was merely ‘mouthing off’ on a subject I knew little about. … And while my view of AZT did change over time, it was because of the proliferation of later studies which better defined the drug’s activities and limitations. … I never cease to amaze at the denialists’ continued obsession with that single early study of AZT, or with the drug itself. … I don’t know when the denialists will get it, but their era is over. They have no point and nothing to offer. They have no real data about anything. What they have is a grudge of some kind against the scientific community (for having left them behind?). Unfortunately, there will always be some new or uniformed people who will listen to them and suffer the consequences of their misinformation.

Under the BMJ’s ‘Competing interests’ question, there were ‘None declared’. In fact Project Inform is openly subsidised by the pharmaceutical industry. Had Delaney listed his organisation’s donors, readers might have been better able to comprehend his remarkable turnaround. I asked him whether he considered any of his statements in his original criticism of the Phase II AZT trial to have actually been wrong. He implicitly confirmed not: ‘The biggest mistake of the AZT trial was simply that they extrapolated some pretty grand claims from a very small, brief and limited trial. The conclusions went far beyond anything warranted by the data.’

The lowest dose recommended by GlaxoSmithKline is 500 mg daily. That’s 1021 molecules of AZT down Achmat’s hatch: a generous 10 million molecules for every single one of his cells, report Duesberg and Rasnick in The AIDS Dilemma. Bringing about ‘AIDS-defining’ conditions and other deadly ones within weeks in animal studies at human-equivalent doses: mitochondrial necrosis, weight loss, myelodysplasia, thymic atrophy, T-cell depletion, neutropenia, leukopenia, lymphopenia, thrombocyopenia, bone marrow depletion, anaemia. Not forgetting death. We mentioned Lenderking’s et al. report earlier on that 500 mg of AZT daily caused such ‘severe side effects’ among ‘asymptomatic patients’ that it was ‘life threatening in some cases’. And they were talking about AZT straight, without its virtually identical poisonous twin, 3TC, thrown in to almost double the total nucleoside analogue drug dose. Not only almost double it, but also synergistically exacerbate the toxicities of both drugs, the sum being much worse than the parts – the well-documented trouble with taking ‘antivirals’ of the same type together. And to add insult to injury, when the drugs are taken concomitantly, they increase the concentration of raw unphosphorylated AZT swilling around in your veins by thirty-nine per cent, according to the encyclopaedic American Hospital Formulary Service Drug Information 1998. All of which effectively treats the swallower to the kind of massive AZT dose abandoned years ago, the metal baseball bat that finished Freddie Mercury off in no time. But revived in the age of ‘combination therapy’ – although ‘Highly Active Antiretroviral Therapy’ looks to be a fashion as brief as oversized jackets, on its rapid way out, as we read above, with ‘AIDS experts’ surveying the battlefield after letting loose the new weapons and scratching their heads over why the dead and wounded are mostly their own.

A paper published in Lancet on 20 October 2001 formally reported what DAID’s Larry Fox was talking about. A novel investigation of the frequency of adverse reactions to single, double, and triple regimens of AIDS drugs by Fellay et al. found ‘a high prevalence of toxic effects’ in a cohort of 1160 patients. More than two thirds of patients on these drugs suffered side effects severe enough to affect treatment adherence – in other words prevent them taking the drugs as prescribed. Forty-seven per cent reported clinical problems like vomiting, diarrhoea, nausea, fat growth, mood swings, insomnia and fatigue. Blood tests revealed ‘potentially serious’ abnormalities among twenty-seven per cent. The researchers classed a ‘significant proportion’ of these adverse events as ‘serious or severe’. Kidney dysfunction and severe fatigue that were ‘probably or definitely’ due to their HIV treatment led to some patients winding up in hospital. The Fellay paper was preceded by one by Descamps et al. in the Journal of the American Medical Association on 12 January 2000, noting that ‘During the maintenance phase early and late virologic failures appeared to be related more to problems of adherence and antiretroviral treatment potency, respectively, than to selection of resistant mutant viruses.’ The mutation excuse heads for the bin, and doctors accept that their patients just can’t stomach the pills. At the same time suggesting they’re not strong enough. Because they’re doctors.

The November/December 2001 issue of TreatmentUpdate reviewed a study by Moreno et al. (described as Abstract 93) investigating the Toxicity profile of antiretroviral drugs in naive patients starting highly active antiretroviral therapy in routine clinical practice. Noting the remarkable fact that ‘in the real world reports of side effects are usually greater than those that are received during clinical trials’, Spanish researchers

reviewed data on 499 subjects with HIV/AIDS who started taking HAART between the years 1996 and 2000. Their aim was to find out about drug-related side effects. These doctors collected data from PHAs [people having AIDS] attending an HIV/AIDS clinic. … Overall, about 34% of subjects (172 subjects) developed drug-related side effects. In most of these cases (145 of 172 subjects, or 84%), subjects had to stop using the drug that caused the side effect.

But the March 2002 issue of TreatmentUpdate bore even wilder news. A study by Reisler et al. of the US NIH, Incidence of grade IV events, AIDS and mortality in a large multicenter cohort receiving HAART (Abstract 36), looked at data collected from 3227 HIV positive subjects who had been on several clinical trials between 1996 and 2001. They compared the incidence of what they called ‘AIDS-related events’ (typical infections) and serious or life-threatening drug side effects, which doctors call ‘grade IV events’, and found three hundred and sixteen ‘AIDS-related events’ (fourteen per cent of subjects) but double that number of grade IV events: six hundred and sixty three (twenty eight per cent). By about thirty months, ten per cent of subjects had died. The reviewer of the paper remarked insightfully: ‘This attests to the severity of such complications.’ What were described as ‘psychiatric’ problems – drug neurotoxicity – joined bone marrow damage, liver disease, pancreatitis, kidney and cardiovascular problems as the most life-threatening drug side effects noted. In short on AIDS drugs you have twice the chance of succumbing to their toxicities as you do to ‘AIDS’. But if we remember what Collazos et al. told us in AIDS in June 2002, discussed above: the strangest things often seems to happen when you go on the drugs. Like developing B cell lymphomas, and experiencing ‘paradoxical flares of diverse opportunistic conditions shortly after the onset of HAART’ – so six cited studies reported.

Consistent with these findings, O’Brien et al. had just reported Patterns and correlates of discontinuation of the initial HAART regimen in an urban outpatient cohort in the Journal of Acquired Immune Deficiency Syndromes on 1 December 2003: ‘After a median follow-up of 8.1 months, 61% of patients changed or discontinued their initial HAART regimen. … The events most commonly cited as the cause for discontinuation were nausea, vomiting, and diarrhea. … Gastrointestinal adverse events of HAART are the most frequently cited reason for discontinuation of HAART.’

Back home, an article in City Press on 30 March 2003 reported that prominent playwright Gibson Kente, who announced the year before that he was HIV-positive, has ‘stopped using AIDS drugs and is now sticking to herbs. … He says he won’t take antiretroviral drugs as they have too many side-effects on him. Although he has been to the Chris Hani-Baragwanath Hospital for check-ups, he says he isn’t using any of the medications supplied by the hospital. “I am my own doctor. I’m going to stick to herbal medicines. I don’t want medical drugs any more.”’

As Mbeki was being disparaged and reviled for questioning the viral/chemotherapy AIDS paradigm, Achmat and his TAC were winning rich prizes one after another for promoting it. In 1999 the organisation was honoured for its fighting spirit by the South African National NGO Coalition. Its judicial patron cosied up in the happy moment: the TAC, Cameron said, had ‘given a life-enhancing focus to the PWA movement’ – before bestowing financial favour on the TAC himself: entitled under the rules of the Nelson Mandela Award for Health and Human Rights, which he won in December 2000, to designate a worthy organisation to receive an amount equivalent to his prize – $10 000 – Cameron picked the TAC. The pop music channel MTV Europe gave the lobby its annual Free your Mind Award on 8 November 2001. In December 2003 the TAC got the prize money again, this time directly chosen to receive the Nelson Mandela Award for Health and Human Rights.

As noted earlier, Achmat himself won a ‘Spirit of Hope Award’ from the SA NGO Coalition in September 2000. It was followed by a personal honour from Time magazine on 22 April 2001. He hadn’t hired a professional publicist to lobby behind the scenes, as Aaron Diamond AIDS Research Centre Director David Ho had to secure him Time’s Man of the Year award in 1996. So they gave him a Noddy badge instead, making him ‘Person of the Week’ for his role in organising the international pressure that caused the pharmaceutical corporations to cave in their case against the government. This was followed by a cash purse of $25 000 when winning the first ‘Desmond Tutu Footprints of Legends Leadership Award’ in 2001, for his ‘selfless services to humanity’. Achmat explained why he thought he deserved it: ‘The central value underpinning my leadership efforts is justice: to see that the right thing is done.’

Another AIDS prize-winner in 2001 was Deputy President Zuma, who won an honorary PhD on 26 May 2001 from Mhlongo’s university, MEDUNSA, for his ‘contribution to the liberation struggle as well as his outstanding effort in the fight against HIV/AIDS’. So praised Professor Ramaranka Mogotlane, Vice-Chancellor and Principal. As Zuma commenced his acceptance speech and began plugging the usual AIDS clichés, Mhlongo made punishingly plain what he thought. Unable to stomach it as he sat on stage among his academic colleagues in front of all the new graduates and well-wishers in the hall, he gathered his hat and robes and walked out.

Achmat got an honorary degree the following year too. With some reservations in the academic ranks it seems. On 21 June 2002 the University of Cape Town awarded him not the usual doctorate handed out at such self-serving dos, but a half-assed honorary masters degree in social science. But on 5 April 2003 he got that PhD – an honorary doctorate from the Law Faculty of the University of Natal. Time nominated him a ‘World Hero’ three weeks later: ‘I am proud because many of the people on the list are opposed to poverty, inequality and war. Also, Africa is often very underestimated in its contribution because of the bad reputation our continent has for poor governance, corruption, etcetera. I believe there is much more talent than anyone gives Africa credit for.’ Kind of off-topic, one might say. But sweet. The next month Doctors of the World, the Association Francois-Xavier Bagnoud and the Global Health Council awarded Achmat their jointly administered Jonathan Mann Award for Global Health and Human Rights for bravely not taking AZT. Nils Daulaire, president of the organisation, explained: ‘When Mahatma Gandhi went on his hunger strikes, a lot of people thought he was killing himself for no good reason. But he [Achmat] has made a moral judgment that by taking this position he can have greater impact. That is what I call moral courage.’ The New York Times agreed on 10 May, running a tribute to the great martyr under the tear-jerking title: In Grip of AIDS, South African Cries for Equity. Achmat was formally awarded the prize at a presentation on the 29th – worth R160 000, half of which he announced he’d be keeping, and the rest ploughing into his TAC. Which got even more cash on 6 October 2003 on winning the Nelson Mandela Award for Health and Human Rights.

On 20 November 2001 Health-e reported that Achmat had thrown a press conference in Cape Town at which he urged delegates at the two-day National Health Summit, which had commenced the day before, to ‘address the issue of access to anti-retroviral medicines for people with HIV/AIDS’ on the basis that the ‘benefits of anti-retroviral therapy far outweighed the risks’. Achmat identified getting AZT and such drugs into the bellies of the poor as our country’s number one health policy priority: ‘We feel the [National Health Summit] will fail, completely fail, if it does not address the most critical issue facing health in South Africa, the use of anti-retroviral drugs in the public sector itself.’ How about the use of food? The report said that the ‘TAC trumpeted the findings of a conference it had hosted in late October, which had brought together leading scientists working in the field of HIV/AIDS along with a range of participants including churches, trade unions and business organisations’ which had ‘acknowledged that HIV/AIDS was a major health problem in South Africa and that providing anti-retroviral drugs was a necessary way of dealing with the problem that must be facilitated by the government and the private sector’. According to the report, ‘Achmat said the conference had agreed that the benefits of taking the drugs outweighed the risks of side effects and toxicities. … “Extending access to these life-saving medications has become a moral, political, social and economic imperative.” He said more programmes to educate people about the drugs were needed so that “treatment literacy” among all South Africans could be improved.’ More programmes to give guys like him plush jobs flying around and selling AIDS drugs on behalf of the drug industry. And presumably by education for ‘treatment literacy’, he didn’t have in mind bringing to the attention of his arrogated ward any of the papers reviewed in Debating AZT.

A treatment literate bunch some Members of Parliament have become. On 14 November 2001, in MPs want antiretrovirals in public health system, SAPA reported that that the Joint Monitoring Committee on the Improvement of the Quality of Life and the Status of Women held public hearings in October and November on what to do about the impact of HIV and AIDS on women and girls. One can put money down that the TAC was there to make a pitch for AZT and/or nevirapine, because the committee’s report concluded that for ‘mother-to-child-transmission ... the benefits outweigh the risk and it is affordable’. The report advocated drugs for rape victims too. Would it be a reliable guess that the Honourable Members weren’t told about any of the foetal toxicity reports that had rained in at the turn of the decade?

On 10 February 2002 Achmat was interviewed in Rapport. A most revealing read it was. But it comes out in full colour offset against the foil of matters still to be discussed. So we’ll come back to the interview later.

The bathos of Achmat’s hypocrisy – fat and healthy, and making a fine living as an AIDS activist while studiously avoiding the deadly cell-poisoning chemicals he campaigns for – was paralleled in the story of another prominent AIDS activist and journalist, Lucky Mazibuko. Towards the end of August 2002 Mazibuko was interviewed by BBC HARDtalk host, Tim Sebastian. He’d ‘lived with HIV’ for ten years, he said; a girlfriend gave it to him – deliberately! But of course. She’s black – and your chances of picking up HIV from loving a black woman are just short of fifty-fifty. Particularly in KwaZulu-Natal. Since the HIV-infection rate reaches nearly 40 per cent in some parts, say ‘AIDS experts’ like Jerry Coovadia and his colleagues at the University of Natal’s Nelson Mandela Medical School. Except they were being perfectly serious when saying so in Lancet in September 2002, in a report of their study, led by Rollins: Prevalence, incidence, and mother-to-child transmission of HIV-1 in rural South Africa. Claiming also that rural black women are truckers’ whores. OK, not out loud, but unmistakeably implied: the infection rate ranged between 34 and 40 per cent in women aged between 21 and 25, they said – the lower prevalence among women living further from a major north-south highway. Lancet published this tripe without pause. Are you also beginning to despise the medical mind? Minds like Coovadia’s. Who never does his little blood tests on the abundant Natal Indian poor. Sharing his ancestry. Or on anyone else. Since it’s the blacks who shag around. For money. And who are all dirty and diseased.

Not only are these blacks promiscuous and dirty and spread horrible diseases, but when they pertinaciously deny it, it’s proof that they’re mentally disturbed into the bargain. Insolent it makes them too: they even demand better wages. RW Johnson wrote in the London Times on 29 August 2000: ‘Twice I’ve had to deal with employees who suddenly became petulant and incomprehensibly demanding. Both died of Aids soon after and I realised we’d been dealing with the special dementia that often afflicts Aids victims: there is no knowing the hidden psychological torments such unfortunates suffer.’

A correspondent of mine, who watched the Mazibuko interview, told me he appeared a picture of good health. After banging Mbeki about on AIDS policy for much of the first twenty minutes, Sebastian incidentally enquired: ‘You don’t take the anti-retroviral drugs yourself, do you?’ Mazibuko replied, ‘No, I don’t take them. This is to highlight the fact that others cannot easily get hold of them.’ Just like Achmat. But then he hastened to say that his health was ‘taking a battering’. Borne out by the fact, he said, that ‘I usually go to the doctor maybe once a year’. Evidently appreciating just how ridiculous that sounded, he added, ‘In the last year I’ve been eight to ten times.’ He didn’t say why, but he did let out that he wasn’t sure if it was on account of his ten-year-old HIV or ‘stress’. Following this pathetic Achmat-style performance, Sebastian didn’t close in for the kill. Not much HARDtalk from Tim Sebastian when interviewing AIDS wimps.

Achmat would abandon his moral stand and start taking his drugs in the second half of 2003, with disastrous consequences. How it all ended up in in tears is for later.

CHAPTER

Mbeki was challenged to what he rejected as an ‘irrelevant … publicity stunt’ on on 24 April 2001. The first question Debra Patta asked him was whether he’d ‘take an HIV-AIDS test?’ He declined for the reason just mentioned, even if ‘It might be dramatic, and make newspaper headlines’, and because it would be merely ‘setting an example within a particular paradigm’. What he meant was that it would be like submitting to an examination for the Devil’s hidden marks during the European and American witchery epoch. One recalls that rows of encyclopaedic tomes on that subject lined library shelves, penned by eminent demonologists, some being professional inquisitors, who imparted their knowledge of devilry at the University of Cambridge and such places, and whose learning was cited deferentially by judges condemning folks to hang and burn. In the same sport as those Spanish priests who had been allowed to develop the runaway power to anathematise, isolate, and immolate. Rather like medical practitioners today. Not with fire anymore, but with chemicals, causing massive oxidative damage to cells just the same, on the inside rather than out. And all with the same noble sense of higher purpose. Killing to cure. And killing to maintain their power, and public belief in it. The racket works like this. The doctor tell a person he has cancer and that he’ll certainly die of it without medical intervention. A harsh one, to be true, he says. The gulled and frightened patient accepts the proferred cure. It kills him, along with the high percentage of others who do likewise. Death all around from ‘cancer’ reinforces the demand for medical goods and services.

Mbeki illustrated his point about the shifting sands of HIV-AIDS science in the interview by referring to the new guidelines issued by the ‘US government ... about the use of antiretrovirals radically different from what had been the practice before, and they themselves – the US government and all the scientists who did this – say we are issuing these new guidelines based on our experience and because there are many unanswered questions. So they change the guidelines? Which is fine. But what they are raising fundamentally is that science does not have enough answers to deal with this question.’ He explained that this was why he’d convened his AIDS Panel: to bring scientists with different views together in a bid to resolve their differences. To advance knowledge. By way of open debate. The way scientists were supposed to do it. But not in the AIDS age – until Mbeki’s extraordinary initiative. He then reverted to the drug problem, and in forthright terms: ‘I would think it would be a criminal dereliction of duty if our government didn’t say: “How do we cope with issues of the toxicity of these drugs raised very sharply by these US government guidelines on the fifth of February?” They say the levels of toxicity of these drugs are such that we’ve got to introduce these drugs later in the incidence of the disease because you have these toxicities, and they even say that there are even other unknown toxicities … So, do I go down the street dispensing these pills knowing from the best science there is that there are these consequences about which science itself says we don’t know enough. No. So I think no stunts.’ Patta interrupted: ‘So antiretroviral….’ Mbeki pressed home: ‘Please, no stunts. Let’s stop politicising this question. Lets deal with the science of it. The panel said one of the things we have got to do is to determine when you do an HIV test what is the test testing. And those were the scientists: ‘What is it measuring?” So I go and do a test; I’m confirming a particular paradigm. It doesn’t help in addressing this health need. Our focus must be how do we improve the health of our people, and that is what we are focused on.’ Patta: ‘Well, what is the next step then?’ Mbeki: ‘I am very keen that this panel should do these scientific experiments itself, that on its own it decided it must do, to empower us to respond better to this crisis.’

One of those experiments, mooted and adopted as I sat and watched in awe in the hottest committee side-room of the whole event, involves trying to isolate HIV from the blood of HIV-positive people. We’ll talk about this later. It was the sweetest fruit of the entire meeting. Making it all worthwhile. The rest was a pointless cacophony. (Opposed to the experiment, Duesberg upped and left. Why, we’ll see shortly.) Mbeki referred to this crucial experiment in Parliament during question time on 26 March 2001: ‘I have said that the AIDS panel is doing its work and in the past few days scientists from both sides of the divide have met, further to work on the experiment that they decided should be carried out. They will continue with that work, and that work will also inform what the government does. We are not engaging in this matter as a academic exercise but in order that as government we respond in a targeted and effective way to these matters that cause ill health among our people, that cause death among our people. So yes indeed, honourable member, whatever comes out of those particular processes will inform government policy.’

On 2 December 2001, the Sunday Independent reproved Mbeki for declining the same proposal to be tested for ‘HIV antibodies’, made again at a briefing of foreign correspondents earlier in the week, commenting that his dismissal of what he called a ‘meaningless game’ ‘missed the point’. ‘An act of leadership’ it would be ‘to create an environment in which people feel more comfortable to come forward for testing’. And then veering off the point itself, the paper continued: ‘What message does the government send to the 4.7 million HIV-positive South Africans when it refuses to roll out anti-retrovirals, scientifically proven to be safe and effective?’ Just as the company says. Backed by a top judge. The former President. And all the clergy:

Archbishop Desmond Tutu has made common cause with his successor, current Anglican Church head Archbishop Njongonkulu Ndungane, in pleading for the provision of AZT and similar drugs by the government. On 7 October 2001, on the SABC television programme Newsmaker, the bishop, a kind friend to my late father Robin Brink during their time serving on the Truth and Reconciliation Commission together, criticised the government for ‘dithering’ while people died of AIDS – ‘the new apartheid, the new enemy’. He said he was glad that religious and union leaders had agreed: ‘... let’s stop fiddling while our robe [Rome?] is burning. … People are dying, people whose lives could be extended by getting the right drugs. Discussing whether this or that is the cause is a luxury we cannot afford. … Let’s stop playing marbles and roll up our sleeves and invoke the spirit that fought apartheid. We did it with apartheid, we can repeat it with AIDS.’

Invoking the horrors of apartheid to whip along the AIDS drug campaign is a trick that the National Youth Commission also used on its national public holiday in 2000, appropriating that heartbreaking snap of Hector Peterson being carried away lifeless, the first victim of the 1976 Soweto revolt, for a poster announcing its AIDS message in a dripping-blood designer font from a late show slasher movie.

Full of AIDS ire, Tutu was in a foul mood when he arrived at the University of Pretoria on 6 September 2002 for the award of an honorary theology doctorate. The Daily Dispatch reported the next day that in his acceptance speech he made ‘a scathing attack on government … [calling] on people to ask questions about the government’s controversial Aids policy … Tutu said toeing the government line was a threat to democracy.’ We should safeguard democracy by toeing the TAC line instead. AZT, nevirapine and everything. For women especially. Mostly black. Raped and/or pregnant.

CHAPTER

On 7 October 2001, in Glaxo gives up rights to AIDS drugs in South Africa, Reuters reported that the company had granted a voluntary patent licence and had waived rights to royalties on sales of AZT, 3TC and Combivir (the drugs combined) to South African generic drug maker, Aspen Pharmacare. In terms of the deal the locally made drugs are to be ‘distributed to the government, NGOs and charities, with GSK continuing to supply other markets.’ This keeps GlaxoSmithKline’s receipts securely pocketed from AZT sales in the private market, a market it has completely sewn up: Ask absolutely any media-exposed woman anywhere in South Africa what drug she’d take if raped, any white person here what precautionary medicine he’d swallow after coming into contact with the blood of a black. This is no ugly exaggeration. Jittery about reports from ‘AIDS experts’ headlined on the front page of the Natal Witness on 14 April 1999 as KZN HIV rate now one-third, it emerged that the Natal Blood Transfusion Service was ditching blood given by black donors into the street. Like sewerage in old London. Being dirty and diseased. Being black. To blacks responding to appeals to donate blood, thanks, but no thanks. After a ponderous liberal deliberation, an editorial on 13 September, with the title, Red lining, supported what it regretted appeared to be a ‘crude form of racial selection’ as a ‘difficult, pragmatic decision’, hastening to emphasize that the decision had nothing to with the ‘racial myths peddled by fanatics of the Nazi or Verwoerdian kinds’. But pedalling them just the same. Subscribed to by guys like French fascist Jean-Marie le Penn, leader of the National Front, who the Sunday Times reported on 28 April 2002 asking: ‘What do I have to do to prove I’m not a racist? Marry a black woman? With AIDS if possible?’

The same racist paranoia reigns at blood banks in the US: The sister of a white South African friend of mine, who lives in Massachusetts with her American husband, wanted to donate blood after the September 11 attack. Her offer was declined for the reason that she originated from Africa. One of the screening questions put to her husband was whether he’d had sexual relations with anyone from Africa in the past year. Which blew him out too.

The private market for antivirals may not be big, as Business Day pointed out on 8 October 2001, but it’s certainly ‘lucrative’ – including as it does, ‘medical aid schemes and larger buyers, like mining or manufacturing companies like Ford or DaimlerChrysler’. The newspaper reported the following day though that because of their cost only senior staff on medical insurance score. And even then the drugs are restricted to pregnant women and children; HIV-positive brass don’t get it for long-term treatment. But in August 2002, Anglo American, De Beers, Transnet and BP announced that they would be supplying the drugs to all comers on the payroll. Everyone was pleased. Old Mutual followed in September. With Deputy Managing Director Peter Moyo, duly advised by consultant ‘AIDS experts’, enthusing that ‘infected people can live for up to twenty years with the right management strategy and treatment’. Anglo changed its mind in October; the Financial Times quoted medical director Brian Brink explaining that ‘the company’s 14 000 senior staff would receive anti-retroviral treatment as part of their medical insurance, but that the provision of drug treatment for [its 146 000] lower income employees was too expensive’.

A further cleverly creative term of the deal is that Aspen has to pay 30 per cent of its take on sales to ‘non-governmental organisations fighting HIV-AIDS in South Africa’ – meaning lobbying for the purchase of AIDS drugs.

One really must stand up and clap hands for the marketing strategists who cooked up this smart scheme. GlaxoSmithKline come off smelling of roses – selfless Samaritans rather than rapacious merchants who have lost the bidding, having offered, to no avail, ‘the cheapest prices [for AZT and 3TC] anywhere in the world’ – so claimed GlaxoSmithKline’s South African boss, John Kearney. Having also dropped its demand that in return for a price discount, the government had to bind itself to guaranteeing the company a monopoly in the supply of AZT for three years after its patent expired – according to an online post on AF-AIDS on 3 March 1999: ‘That was not in the papers but it makes [then Health Minister Dlamini-] Zuma’s action [in rejecting the drug] more understandable.’

Getting more desperate by the minute, like a hooker with tired feet, Reuters reported on 30 November 2001 that GlaxoSmithKline had cut its price on 3TC and Combivir by a further twenty per cent ‘to mark World AIDS Day’. ‘We sincerely believe that our HIV-AIDS medicines will be more accessible to a greater number of people,’ Kearney said plaintively. We sincerely hope to boost sales by persuading those medical schemes not to be so tight-fisted: ‘GSK’s offer is ... limited to the country’s private sector and is aimed at those who could benefit from lower prices under existing medical schemes.’

The Aspen deal was cut just as the upper ranks in the medical clergy were slowly coming to their senses about what they have been doing to people with AIDS drugs, and they lose their lustre. Not to mention the collapse of GlaxoSmithKline’s case against the government to block generic imports, leaving Indian generic manufacturers Cipla, Zydus Cadila, Aurobindo Pharma, Ranbaxy, Hetero Drugs and Kopran circling hungrily above the new opportunities opened up.

At the point that Aspen won the deal, Cipla had been closest to the prize, having been the first to penetrate the African market. It had recently clinched a deal for the supply of AIDS drugs to Nigeria, and was manoeuvring to repeat its success in Zimbabwe, Cameroon, Ivory Coast and Algeria. It had even hooked the interest of South African multinational Anglo American. Much better to pay $350 to $500 for a year’s supply of an AIDS drug cocktail per patient on its medical aid scheme than the $10 000 to $15 000 coined by the proprietary drug manufacturers for exactly the same stuff. Cipla had taken everyone’s breath away earlier in the year by making good on its promise to supply a triple cocktail of AIDS drugs to Médecines sans Frontières for $350 per patient per year, the first lot of which had already been delivered to Cambodia. And in the first week of March 2001 it had applied to the South African Registrar of Patents for a compulsory licence to import AZT and other AIDS drugs on the basis that GlaxoSmithKline was abusing its copyright.

Pharmaceutical industry writer Ben Hirschler, who penned the Aspen story for Reuters, deduced that it was ‘an attempt to defuse a continuing row over access to treatment’. More to the point, to deflect the heat. Laying that tatty old guilt-trip on the government again, he wrote under the subheading, Government Holds Key: ‘But the success of the scheme will hinge on the response of the government – in particular, whether or not the health ministry decides to offer up a state tender for Aspen’s generic product.’ Noting reproachfully that ‘South Africa’s government – faced with the largest number of HIV-AIDS cases of any country in the world – has pursued a controversial policy on the disease’, he then made his ignorant opinions plain by writing, ‘President Thabo Mbeki touched off a storm of protest by questioning ... the efficacy of antiretrovirals such as AZT. His ministers have resisted the use of antiretroviral drugs in the state health sector on cost and safety grounds, despite the country having close to five million people living with the deadly virus.’

‘Close to five million living with the deadly virus’? We recall the Mail&Guardian’s unforgettable Just Say Yes, Mr President front-page headline plea on 15 September 2000 (that HIV causes AIDS, not let Jesus into your life). Renounce your heresy and accept the true faith. A headline as foolish as the exhortation, Aids Exists: Let’s Fight It Together, in the same paper on 11 February that year. Like we’re a jamboree of boy scouts. And that the obvious needs affirming. Just in case it’s not obvious. The sub-headline of Just Say Yes went: South Africa is gripped by a catastrophe that is killing millions of our people. Already in their boxes. But according to Hirschler, alive and kicking. By ‘our people’ the M&G meant the servants. In South Africa, when liberal whites say ‘our communities’ and ‘our people’, they always mean blacks. At risk of catching AIDS. From sex. Because black men are congenital philanderers. On 12 August 1999 the KwaZulu-Natal provincial health department ran a full-page ad in Echo, the Natal Witness supplement for blacks: ‘A Woman Has The Right To Say No To Aids – No to sex … No to unsafe practices. Women have the right to insist on the use of a condom.’ Apart from a token Natal Indian thrown in, the four other women with imploring eyes in the accompanying picture were all black. Apparently white women don’t have these problems.

Defeated in its plan to hawk AZT to the South African government and keep the dough to itself, GlaxoSmithKline delegated the battle to local mercenaries to open up a new front. Fresh in the trenches, Aspen immediately fired off a fresh salvo of marketing hooks to government. Chief executive officer Stephen Saad was reported saying, ‘Our price for Combivir will be about $1 to $1.50 per patient per day, compared to about $2 [for the original by GlaxoSmithKline]. This gives hope to South Africans. By far the majority needing the drugs, those not covered by medical aid and government, are in the public sector.’ He said he hoped to meet with officials from the Department of Health ‘to look at total health care savings. The government is already paying to treat secondary infections and for hospitalisation of people with HIV-AIDS, which is very expensive.’ As to cost, Hirschler pointed out that Aspen’s prices would still be about twice those that Indian generic manufacturer Cipla has long touted. But the government wasn’t impressed much by Saad’s pitch. On 30 November 2001 Reuters reported that ‘the move has so far failed to take off with no sign of a deal between generic producer Aspen and the health department’.

With the sound of jingling coins in the air, Heywood, speaking on the TAC’s behalf, said it welcomed the Aspen deal. In April 2000 Lancet had addressed a warning to scientists and politicians, but the hat fits these do-good lobbyists too: ‘All policymakers must be vigilant to the possibility of research data being manipulated by corporate bodies and of scientific colleagues being seduced by the material charms of industry. Trust is no defence against an aggressively deceptive corporate sector.’ Having consistently demonstrated the political sophistication of children, the odds look mighty low that South Africa’s AIDS treatment activists are about to exhibit much of the vigilance that Lancet was urging. It’s been like watching a performance of marionettes here, because, as Michael Ellner has pointed out in reference to the hullabaloo in March and April 2000 over the drug companies’ efforts to interdict the government from importing generics, ‘These staged battles over the prices of AIDS drugs are the best advertisement for these failed drugs possible.’ He’s right, because the most potent strategic propaganda always entails the fomenting of impassioned public controversy around a minor issue such that the major issue is neglected, with the result that the desired perception is taken for granted and consolidated.

CHAPTER

On 12 October 2001 Mbeki delivered the inaugural ZK Mathews Memorial Lecture at the University of Fort Hare, entitled He Wakened To His Responsibilities, an imperative Mbeki himself knew all about – demonstrated by his unpopular order, two years earlier, that the safety of AZT be investigated. In the course of his address, he made Frantz Fanon’s point (discussed below) about some medical models being essentially racist. Ashen-faced with shock, Drew Forrest reported in the Mail&Guardian on 26 October 2001, Mbeki in bizarre Aids outburst. What the white boy found ‘bizarre’ was Mbeki’s pained allusion to the basic racism of the African AIDS construct – an insight first flashed in his address at the Third African Renaissance Festival in Durban earlier in the year on 31 March, during which he mentioned the Eurocentric ‘image of our Continent’ that ‘history has created’, ‘one that is naturally prone to ... an AIDS pandemic caused, it is said, by rampant sexual promiscuity and endemic amorality’.

But now in his Fort Hare lecture he got stuck in. As Fanon had done, Mbeki referred in to medical schools where black people were ‘reminded of their role as germ carriers’, and said, ‘Thus does it happen that others who consider themselves to be our leaders take to the streets carrying their placards, to demand that because we are germ carriers, and human beings of a lower order that cannot subject its passions to reason, we must perforce adopt strange opinions, to save a depraved and diseased people from perishing from self-inflicted disease. … 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.’ Tony Leon’s sort of ideas – as revealed in a seamy swipe during his exchange with Mbeki over AZT in July the previous year: ‘I am not interested in whether my [mostly white] supporters or yours [overwhelmingly black] suffer more from STDs [sexually transmitted diseases].’

Rachel Swarns noted the talk in an article in the New York Times on 25 November 2001: ‘In October [at the Z K Mathews Memorial Lecture at the University of Fort Hare], Mr Mbeki suggested that whites, and unwitting black allies, were deliberately overplaying the AIDS epidemic to undermine a black continent on the rise and to perpetuate stereotypes of Africans as “promiscuous carriers of germs”.’

An old stereotype: in his Letter from the President in ANC Today on 13 February 2004, entitled District Six reminds us never to turn back, Mbeki recalled the mass eviction of black Africans from Cape Town in February 1901 during the bubonic plague scare: ‘This provided an excuse for the white authorities of the day forcibly to relocate the Africans living in central Cape Town to a state farm called Uitvlugt. This new settlement was called Ndabeni and was located near Maitland. The false and insulting reason given for this forced removal was that because they were generally diseased, the Africans in central Cape Town, many of whom worked at the docks, contributed to the propagation of the disease. … such was the strength of the racist stereotype of the Africans that the white authorities of the day, with the full support of the white community, punished the Africans for the outbreak of a disease that had nothing to do with them, by banishing them to Ndabeni. Within a month, 5,000 Africans had been moved to the new location. … Interestingly, and as part of the history of the formation of our urban areas, the next major health scare to hit Cape Town occurred in 1918. This time there was an outbreak of a flu epidemic. Again white Cape Town identified Africans as a health risk. Ndabeni was now viewed as being too close to “white” Cape Town. People were therefore moved to Langa, separated from the rest of the city by railway lines and a highway.’

Heywood was quick to get the broad if not the finer point of Mbeki’s Fort Hare talk: He ‘appears to describe those who believe AIDS is a virologically caused, mostly sexually transmitted disease that can be medically contained, as stigmatising and demeaning black people’. His address was ‘evidence [that] tragically but inexorably suggests that the President is an unreconstructed AIDS dissident’. Inexorably? Like the Italian guy who asked me after losing his car-crash case and I ordered him to pay the costs: ‘But what if they are exuberant?’ And ‘unreconstructed’? As in Nazi? A couple of months later, just such an indictment was served by the Mail&Guardian. On 7 December an article, Has Mbeki heard of Nuremberg? written by a couple of kids at Wits University’s law school, pleaded the TAC’s averments repeatedly, and foamed about the genocidal violated human rights of it all. OK, not quite as bad as the Nazi Holocaust, but same department, it argued lugubriously, and ever so earnestly: ‘... the South African government’s policy may well result in the deaths of millions of South Africans from Aids, and it thus seems plausible to call this policy a crime against humanity.’ An F for the childish essay, especially for breaching the rule against hearsay and confusing daydreams for facts, but an A for their grass, for sure.

Commenting further on Mbeki’s Fort Hare address Heywood said: ‘The dissident view rests on three pillars: that HIV is a harmless organism that causes no illness; that AIDS, if it exists at all, is caused by factors unrelated to HIV; and that drugs supposed to treat AIDS do more harm than good. Despite evasion and obfuscation, all these positions emerge from the President’s statements over the past two years. … Mbeki’s stand on AIDS is a tragedy of momentous proportions. The onus is on him to dispel the view that he is a dissident, which is widely held in South Africa and internationally.’ Mbeki met the criticism in Parliament a few days later. He’d asked Tshabalala-Msimang to evaluate the latest statistics on causes of death in South Africa, he said, and no reallocation of health budget funds would be made until she’d done so. ‘We want to have a proper profile of the incidence of the disease. The government is not an NGO ... focused on one particular disease. We are not a TB NGO or an AIDS NGO or a pneumonia NGO. We are concerned about the health of our people. I am concerned about the incidence of disease and the incidence of mortality comprehensively. We need to have a look at that so that we can see whether our programmes are correct. Health programmes do not consist only of drugs and medicine. They include improving the general health conditions of our people, and this includes nutrition, clean water. ... It includes the question of the violence in this society. We have to look at all of those questions ... to make sure our spending not only in health but generally throughout government responds to that particular health profile.’

Later in the same month Heywood, with his honours degree in English from Balliol College, Oxford, responded to Mbeki’s dismissal of the Medical Research Council’s fantastic AIDS numbers (to justify gilded funding demands) and his preference for those of Statistics South Africa, the professionals in number crunching: Mbeki was using Statistics SA as a ‘bulldog to savage’ the MRC findings, he said. ‘Damaging discussion has been set up and fuelled by a government which instead of giving inclusive political leadership is acting in a way that is alienating and damaging.’ Are these really the kinds of minds they turn out at Oxford? Apparently – some of the biggest jerks in this tale hale from there: Heywood, Makgoba, and RW Johnson. Howard Barrell – an expert in the history of the ANC, he considers himself – has a DPhil from the place too. No great shakes though, after you’ve read Rosa Ehrenreich’s revelatory embarrassment, A Garden of Paper Flowers: An American at Oxford.

The MRC’s next numbers racket was played on 3 September 2002. Its Debbie Bradshaw told the parliamentary Arts, Culture, Science and Technology Committee that ‘the number of people infected with HIV was projected to increase from the current six million to around seven million to eight million by 2006’. Six million? Just three months earlier, on 11 June 2002, the Department of Health announced 4.7 million infected in South Africa on the basis of figures supplied by the University of Cape Town’s Actuarial Science Centre. Where they keep computers to do the sums with special computer programmes, in order to come up with the numbers. Because there are no real data to be found anywhere. They don’t exist. It’s all thumb-suck presented as scientific fact. But anyway, building its house on this swamp, the MCC carried on: by 2010 five million South Africans would be dead from AIDS. Weren’t the apocalyptics in American medicine faffing just this way in the 80s? Ridiculously. Led by their Surgeon General, Everett Koop. Like Jehovah’s Witnesses predicting the end of the world, date and all, in their magazines.

Heywood won’t care for the University of California at Berkeley’s mission statement: ‘Under present scientific protocol, theories can only be recognized as true after withstanding extensive scientific review: publication in scientific journals, followed by experimental verification of the proposed theory. The process of scientific review, however, can only be effective as long as the competing theories are each given due consideration. Without diversity of thought provided by different viewpoints, science becomes locked into potentially inaccurate paradigms. ... In light of the recent controversy over racial diversity here at University of California at Berkeley, we, as students and scientists, carry the responsibility of maintaining diversity in science. Without minority views, majority views cannot be validated. The truth, in some cases, may even side with the few.’ But just hint to paid professional activists like Achmat and Heywood that they might be off-centre, and draw their attention to unsettling facts, and instead of pausing to consider them (and risk their jobs), they run off shrieking, covering their ears like charismatics fleeing from a church in which someone accidentally mentioned Beelzebub during the holy babbling.

Heywood was a guest at a meeting of the South African Association of Professionals in Health Care on 7 February 2002, at which Mhlongo presented a PowerPoint slide-show, A Critical Analysis Of The Evidence Considered Proof That Nevirapine Prevents Mother-To-Child Transmission Of HIV, in which the Perth Group detailed the radical flaws of the Ugandan nevirapine study founding the TAC’s case in the High Court for the mandatory supply of the drug by the state to pregnant women. The Oxford alumnus’s thoughtful response to Mhlongo when it was over? ‘The time for science is gone; people are dying.’ And during a debate with Mhlongo concerning AIDS and nutrition on on 24 January a year later, Heywood told him that the TAC would be applying for the revocation of his medical licence because he was a ‘danger to health’. And, as we’re still to read, he meant it.

Published alongside his ‘Mbeki’s bizarre outburst’ article, was another offering by Forrest, slating Mbeki’s speech at Fort Hare as ‘pompous’ and ‘tortured’. Behind the Smokescreen: The record reveals President Thabo Mbeki’s true stance on Aids went on to indict him for heresy, a la Galileo, assembling a long charge sheet, a ‘catalogue’ of recalled utterances upon which to convict him. Pronouncing him ‘obsessional’, Forrest cited as evidence Mbeki’s ‘focus on the toxicity of Aids drugs, absent, for example, in regard to equally toxic cancer medication’. (Hey, one thing at a time. If you don’t mind, sailor. But we appreciate the ‘equally toxic’ bit.) Unable to credit that there may be some substance to Mbeki’s concerns, Forrest stated: ‘In no other country would the Cabinet intervene so persistently on the technical issues of drug toxicity and effectiveness’, attributing this to ‘Mbeki’s own all-consuming interest in the disease, which drives his repeated interventions’. Well, he does have a handle not just on toxicity but also on the radical triphosphorylation problem. The isolation problem too, we’re about to discover. Stuff the hack at the M&G hadn’t bothered to check out himself.

Apart from how Mbeki had condemned himself in his own words, Forrest levelled further complaints: Mbeki had not declared his faith, as required by the crusaders in this 20-year-old cult of sex and death: ‘... just as revealing is what he has not said. He has never unequivocally conceded that viral infection is a necessary condition for the disease. He has never clearly stated that drugs can improve the life expectancy and quality of life of infected people.’ No he hasn’t. Should anyone, with even a passing acquaintance with the literature? Forrest mocked: ‘It is repeatedly suggested that pharmaceutical companies are promoting the virological view to swell their profits.’ Silly Mbeki for thinking that the Glaxo Wellcome AIDS Helpline, and the multimillion rand AIDS Research Centre in Matubatuba, KwaZulu-Natal that it is building for the University of Natal’s medical school, among other projects (like BristolMyers Squibb’s $100 million for the war on AIDS) were all about promoting and entrenching the HIV-AIDS model. You know, to keep its drugs moving. And for mistaking GlaxoSmithKline for a trading corporation rather than an international philanthropic organisation.

Why, the proof of it – that GlaxoSmithKline is actually a public charity – came in on 21 May 2001, when its local public relations firm, Meropa Communications, told us so in a press statement, GlaxoSmithKline’s 3rd annual winter charity drive to benefit HIV orphans gets under way: ‘From GSK. Supporting doctors in South Africa will once again be able to assist GlaxoSmithKline (GSK) with its Winter Charity Drive, which runs until September 30. The Drive aims to raise over R306 000 from the sale of ZINNAT(r), the proceeds of which will be donated to six organisations caring for abused children and terminally ill patients. ZINNAT(r) is a broad-spectrum oral antibiotic successfully used to treat a variety of respiratory tract infections, including bronchitis, sinusitis, otitis media and tonsillopharyngitis. “This is the third year that GSK has embarked on this project,” says Dominique Bielovich, GSK Product Manager. “We have been tremendously impressed by the results of the Drive to date and are confident that this year will be even better than the previous two years. The trend has shown that support is growing: in 2000, we raised R306 000 for the six charities, R104 000 more than in 1999!” The six charities chosen by GSK this year are the: Jakaranda Kinderhuis in Pretoria, Hospice East Rand, St. Nicholas’ Children’s Hospice in the Free State, PE Childline and Family Centre, Durban Children’s Home and St. Luke’s Hospice in Cape Town. Marion Snape, representing the Hospice East Rand, says: “The plight of orphaned, abused and HIV-positive children is great in this country and finances are not readily available to us. We welcome every endeavour of the private sector to assist us and I am confident that all the charities that benefit from ZINNAT(r) Winter Charity Drive 2001, join me in thanking not only GSK, but all the doctors supporting the Drive.” Steve Lancaster of the PE Childline and Family Centre agrees: “When doctors prescribe this product, they will not only help the selected charities financially, but they will also help to enhance the quality of life of all the recipients.”’

Real sweethearts, these drug executives. Concerned about those little kids. For as long as you don’t fuck with their profits: On 1 December 2000 the Wall Street Journal reported that the company had fired off a threatening letter to generic manufacturer Cipla and a distributor for ‘violating company patents’, as a result of which Cipla had ‘stopped selling its low cost version ... of expensive HIV drugs ... in Ghana’.

In his Mail&Guardian piece Forrest added a further charge against Mbeki: ‘Orthodox scientific opinion, here and abroad, is questioned from a non-specialist position.’ This of course is intolerable. Such affairs must be left to the new clergy, undisturbed. Professionals like Makgoba, Karim, Folb, Rees, Eagles and the rest of them. On whose diligence we can rely. But Forrest finds nothing remiss in non-experts conspicuously paying homage to the popular priests propounding the fashionable new doctrines, and publicly reviling accused heretics. Provided the laymen cheering are PC and important. Thus he approvingly quoted Cameron’s reckless insinuation that Mbeki and anyone sharing his doubts and concerns about AIDS medicine are dishonest in engendering ‘the crisis of truth-telling’ in relation to AIDS issues in South Africa.

CHAPTER

By the end of 2001, infected by the enthusiasm at last, Mandela was in a tizz over the AIDS drug controversy and could no longer keep himself from getting involved. He began trying to reach Mbeki by telephone to tell him what he thought he should do about getting drugs to the people, but the latter’s office blocked his calls. On 17 November Mandela made a speech at an HIV/AIDS clinic in Khayelitsha in which he criticised Mbeki, obliquely but unmistakeably: ‘We have wasted time but the more vigorous and focussed we are in what we do, the greater the chance we have of moving forward.’ Mbeki was annoyed by Mandela’s backseat driving, and had his one of his aides call him to tell him to back off.

To the reported joy of the TAC, Mandela added his stentorian voice to its call for AIDS drugs on World AIDS Day on 1 December 2001 at several stops around Cape Town. His first call was at Beautiful Gate Children’s Home at Crossroads informal settlement, where he announced how he thought Mbeki should be conducting himself in office – his wife too:

One of the most important things ... is that the head of state and the first lady must be in the forefront of the campaign to fight this disease. Like President Yoweri Museveni of Uganda and President Abdoulaye Wade of Senegal, and the president of Botswana. These presidents themselves are leading the campaign about AIDS. Every day they make certain that every minister who delivers a speech must spend five minutes talking about AIDS. They pick up children with AIDS, together with their first ladies.

Like the late Lady Diana too, he said, warming hearts by cuddling a few HIV-positive babies himself as he spoke. Showing how much he cared. Moving next to a community hall in Nyanga packed with schoolchildren, Mandela repeatedly stressed the need for AIDS drugs in his answers to their questions: ‘For those who are HIV-positive, we must ensure that they get the proper treatment and drugs which are going to help them resist the pandemic. ... We must combine various strategies, firstly giving people the necessary drugs to try and prevent the disease taking the upper hand.’ His final stop was the Victoria and Albert Waterfront to open the Nelson Mandela Gateway to Robben Island, a museum and ferry port for the tourists, where he sermonized some more: ‘Nothing threatens us more today than HIV/AIDS ... AIDS is a scourge threatening to undo all the gains we made in our generations of struggle.’ So the government should work with drug companies to get drug prices down, he said, and parents should discuss sex with their children, because their failure to talk sex and clear up the myths about AIDS were big problems. Then it got awkward. When a journalist questioned him about his open rift with Mbeki over AIDS, he responded by blaming ‘sections of the press’ for trying to divide them. He volunteered that he’d been ‘shocked’ when he’d been taxed over his criticism of Mbeki in a telephone call from the latter’s office, and repeated his justification – stubbornly and clumsily, and ticking Mbeki off even further:

I said the countries which have succeeded in bringing down the level of AIDS are those where the president of the country takes the lead. I said our President and Deputy President are doing the same thing, but the difficulty with the President is that he is busy with Africa and countries beyond. … As a result he cannot concentrate on the problems of the country because he has to attend to these duties as well, which are absolutely necessary.

He’s not giving AIDS his proper attention. He’s not doing his job properly. I was better.

Tutu accompanied Mandela to the children’s home to underscore his solidarity with the latter’s mission – putting the squeeze on government over AIDS drugs. During an interview on that night, Tutu said he agreed with Mandela: ‘Yes, our government ought to be providing the drugs that extend people’s lives.’ The TAC was mighty appreciative of Mandela’s drug drive: ‘There is a lot of internal pressure building up within the ANC, including from Mr Mandela, for Mr Mbeki to acknowledge the realities,’ said Mark Heywood. Mandela’s ‘comment would not have been made without realising it is in contrast with what Mr Mbeki has been saying’. Therefore it was ‘a subtle message to Mbeki’.

As Mandela was cuddling babies, selling drugs to schoolchildren, and justifying his political misconduct, Mbeki was busy discussing party business at a meeting on the same day of the ANC NEC. But on World AIDS Day, he had not a word about AIDS. As he waited patiently for the South Sea bubble to pop; the Tulip craze to wilt; and like Louis IV in France, wishing the witchcraft mania would pass (and frustrating the Church by determinedly commuting death sentences on condemned witches).

A couple of days later, Mandela phoned Cameron and asked him over to his house; it was urgent, he said. What lay heavy on Mandela’s mind was AIDS, he announced at their meeting the following evening – specifically, how Cameron thought Mandela might take a leading role in securing antiretroviral drug treatment to save the lives of those dying of AIDS in South Africa, in the face of Mbeki’s reluctance to do the right thing. As they concluded their little conspiracy, Mandela asked Cameron for a testimonial, a statement of the facts of AIDS according to Cameron, and a personal statement of how his life had been affected by the terrible disease. Mandela also requested that he phone Makgoba to ask him to pay a visit too. He did so immediately after the meeting. In Cape Town when he got the call, Makgoba flew up to Johannesburg to see Mandela the following day, first popping in to see Cameron for a discussion along the way.

Two months later, on 7 February, the day before Mbeki’s 2002 State of the Nation speech, Mandela made a big symbolic strike by crowning AIDS drug researchers James McIntyre and Glenda Gray of Chris Hani-Baragwanath Hospital’s Paediatric AIDS Unit winners of his Nelson Mandela Prize for Health and Human Rights, granted for their heroic work in giving pregnant African mothers AZT. In his speech at the event, at the Mount Nelson Hotel in Cape Town, Mandela delivered a personal parable about a dispute between several urologists, who had expressed different views about how his prostate cancer should be treated. Some dissenters urged that radio therapy was a bad idea for someone of his age. But he ignored them, and thanks to that decision his cancer was gone. Mandela’s moral for Mbeki being: Stick to the old thinking in medicine, it works.

Mandela then criticised him directly: debate over

some fundamental issues unfortunately continues to rage in manners that detract attention from what needs to be our core concern. However, I have reason to believe that insofar as this debate affects our country, it’s likely very soon we will solve the problem [that Mbeki is asking questions], and many people, especially in government, are thinking very seriously about the observations that have been made in regard to the policy of the government.

Writing in City Press on 10 March, under the title Leave Mbeki to Rule!, Thami Mazwai reflected the irritation amongst thoughtful Mbeki supporters over Mandela’s white-anting of the former’s thoroughly researched, thoroughly considered policy position:

Former President Nelson Mandela’s intervention in the HIV/AIDS issue and in fact in several other issues concerning the government is not diplomatic. Sir Ketumile Masire of Botswana left government and does not spend his time tutoring his successor, Festus Mogae, on how to run the country. If he does, it is within the confines of his office and that is not publicized. Likewise in the United States, Bill Clinton has left the White House and little is heard of him on issues of state.

As it’s prone to do the controversy highlighted the polar difference between the two men on the world stage – the one an adorable populist, easily symbolising the hopes and early achievements of the Rainbow Nation, and now finding a new role in glibly and ignorantly advocating the TAC agenda, the other, an intellectual and visionary grappling with hard problems after the honeymoon. (‘The time has now come that we go back to work,’ said Mbeki on the eve of his succession after the 1999 elections.) Hard problems like pointless toxic drugs being pressed on his government and people – not only by the drug companies, their agents in the TAC, the medical profession, academia, the courts, the unions, the clergy, the Communist Party, the liberal media, and foreign governments and foundations, but by his own immensely popular predecessor too.

Such is the power of the machine that even Tata and Tutu have bought the whole bill of goods, the useless poisonous drugs, everything, sold by the media. And by the ‘AIDS experts’ and activists who mythologize and obfuscate the desperate plight of the African destitute, by blaming their ill health on their sexual behaviour.

Even the Steve Biko Foundation has been recruited to the antiretroviral cause; its president Xolela Mangcu has added its moral weight to calls on the government to dish the drugs out in hospitals. I personally handed him a draft of The trouble with nevirapine in May 2002. He hasn’t responded. Mhlongo noted in a circularised email on 13 September that year: ‘Today is the 25th anniversary of Steve Biko’s death in chains in prison at the hands of the South African apartheid police, aided by white doctors. Only one white doctor (Wendy 0rr) protested – the rest of the South African medical establishment remained silent – but today with AIDS and the dreaded black penis, whites are out in the streets and trenches to save the black man from himself.’ With the support of the Steve Biko Foundation, sorry to say: its ‘Public health ... programme focuses’ not on the pragmatics of poverty alleviation but on ‘fighting the scourge of Aids’. Mhlongo added: ‘... shortly after the July 2000 Sheraton debate, I wrote in The Star that HIV/AIDS is dominated by white activists and white doctors in South Africa – marked similarities with the Christian Missionary epoch of some 100 years ago. Where were these hordes of whites when we were fighting apartheid?’

CHAPTER

On 4 November 2001, on its television show Carte Blanche, MNet screened an interesting collage of interviews with Cameron conducted by his varsity friend Ruda Landman in May 1996, in February and November 1997, and finally, shortly before the broadcast. When the interviews began Cameron had convinced himself that he was on his way to the arms of Jesus: ‘It feels almost like writing my will because I’m going to do things and say things with a view really to my death. We’re all going to die, but it’s my death that we’re talking about.’ Thanks to the virus that was going to take him: ‘Look at my hands, the virus is there. It’s a metre away from you. … if you pricked my finger, you’d have the virus. It’s got HIV in it and it’s everywhere.’ He was awfully scared: ‘I’m fearful this afternoon of going through that dreadfully debilitating, painful process that a death from AIDS means.’ By November 1997 he feared the tokens were upon him:

I’ve had my first symptoms, my first presentation of symptomatic AIDS. I looked in my mouth and I saw I had thrush all over, and that was the most scary night in ten or eleven years. … It’s terrifying. I was so horrified. It’s a terrible feeling to feel death in your lungs and you have to come to the momentous acceptance that you’ve now got AIDS and not just HIV, which is very traumatic. … I’ve got to look at you ... and say I’ve got AIDS.

Luckily he had this real bright spark for a doctor, Dave Johnson: ‘My approach is I believe in these drugs. I believe they work … My job is to get Edwin, or anybody else, information that says “I think these drugs are going to work. I think you should go on them.”’ Cameron believed in these drugs too, and made friends with them: ‘I talk to them. I say, “You’re my allies. I want you to enter my virological system [wot’s that?] and I want you to fight with me against this alien invader” and then I swallow them and it feels better. Isn’t it bizarre?’ Asked about this bizarre behaviour, he explained: ‘Because I’m so terrified, Ruda. If my body is intolerant to the triple therapy, I may be dead within thirty to thirty-six months.’ That’s why I talk to my medicines. I’m a sophisticated intellectual. I’m also a senior judge, deciding important cases. I have exceptionally fine judgment.

But in November 2001 he was still around, to be interviewed about the miracle of his salvation: ‘It seemed important to tell a story. So we, I think, were actually going to tell a story about my death – and what we’re telling now is the story about my life.’ Landman’s very first question went to drugs, and off he charged, telling of his ‘Lazarus experience’, and pumping his conviction that, but for the medicines, he would have been ‘lying in bed or hospital dying for the last three-and-a-half years’. Even as every epidemiological study of ‘long term survivors’ reports that the thing that all these guys have in common is that they avoided the drugs. But Cameron enthused that his staunch medicines fortified him. Rather like the former Indian Prime Minister who told Time several years ago that a glass of his own urine every morning did the same for him. Made him feel invigorated, he said. Put the fire back in his belly. Cameron didn’t see the connection between his Lazarus rebirth and ending eighteen months of protease inhibitor treatment, which had caused ‘terrible side effects’, making him ‘nauseous’ and giving him ‘terrible diarrhoea twice a day. … I felt an almost immediate surge in energy … I didn’t have to go to bed early, I could resume all my activities fully. So it was a wonderful sense – it was almost like a second birth.’ It was also a break from being poisoned. Is it any wonder he felt so much better? His instincts seemed to be telling him something his beholden mind could not: asked how easy it was taking the drugs, he answered all mixed up: ‘So it’s easy, but it’s also important to remember that it’s not so easy.’ Nor did he see any significance in the fact that ‘in 1994 I hadn’t started on the treatments yet, and I hadn’t fallen ill’. It’s important to note here that when Cameron noticed his thrush – medically unremarkable until it became one of the signs and wonders of the AIDS age – he wasn’t ill. It was after ‘I started anti-retroviral therapy in November 1997’ that his lung disease set in, along with fungal infestations of the mucous membranes of his throat and mouth in ‘December 1998’. Just as the toxicity literature predicted.

What was apparent from Cameron’s description of his new pill regimen was that his dose was low, confirming what he had said before, and accounting for why an upset gut seemed to be his only trouble. Not the grave broad-spectrum toxicity manifestations following conventional dosing that had given the US health authorities a serious case of cold feet about the drugs at the start of the year.

Having previously attacked the government vigorously at every public opportunity, to encouraging applause always, he now toned it down, regretting instead the government’s reluctance to give pregnant women the drugs he’s on, especially nevirapine, ‘which is a very good drug’, he said. ‘It’s been offered free to our government to give to mothers who are about to have babies and our government has not yet taken up that offer, which is a tragedy I think.’ He was referring to Boehringer Ingelheim’s offer to just give it away, having failed to close a sale deal with our government – so eager is the company to establish a beachhead in the developing world market. Cameron didn’t think as far as Michael Ellner in New York, who more wisely observed to me that ‘when the cheese is free it’s usually a trap’.

The precise appeals judge, ever scrupulous with the facts, informed us that three hundred thousand people had died of AIDS in South Africa in 2000 – a swollen puff, worthy of any prosperity gospel evangelist. ‘We have an epidemic of people who are dying,’ he said – right after Statistics South Africa’s rebuke of Makgoba for making the same idle claim last year, noting that there is ‘no new mortality profile’ here.

On 19 April 2002 Minister of Trade and Industry Alec Irwin confirmed on the morning radio show AM Live: ‘There is no definite concrete evidence’ that AIDS is having any impact on industry at all. Commenting on statistics just released predicting a massive reduction in the workforce, Irwin pointed out, quite correctly, that the numbers were just ‘projections based on models’. Asked after the weekend on the same show for his response, Congress of South African Trade Unions (Cosatu) General Secretary Zwelinzima Vavi, was full of talk about the ‘epidemic’ and the spectre of everyone dropping down dead as the ‘AIDS experts’ were predicting, but had to agree: ‘There is no indication that there is a large number of workers dying.’ Just reports of the odd worker ‘disappearing off the face of the earth’. Like sucked up into spaceships. The communists don’t go for Jesus – opium of the people and all that. They go for substitute tall tales. They call it the AIDS epidemic. So we have National Union of Mineworkers spokesman Moferefe Lekorotsoane disagreeing with Irwin and Vavi, and treating us to a lesson in logic: ‘In the mining sector we see workers leaving and not coming back and then we hear they are dead and that is proof enough for us that the disease has an impact on the industry.’ The professionals who make a living peddling the AIDS myth voiced similar thoughts. Steve Kraimer, head of Metropolitan Life’s AIDS research Unit, said 20 per cent of workers are infected, ‘significantly affecting production’. Contradicting Irwin. (Not that any of them have been tested for anything. The figure loosely derives from the extrapolation of single ELISA antibody test results among poor black women at antenatal clinics.) Wayne Myslik of industrial relations firm NMG-Levy rued that ‘most companies still have their heads in the sand’. In other words, aren’t hiring NMG-Levy. But Truworths human resources director Phil McInnes explained why he found claims about the terrible AIDS epidemic hard to buy: his company had not been affected. ‘But I can’t tell if there’s a bubble coming at me.’ There surely is, Phil. And it’s got more hot gas in it than Branson’s balloon.

Cameron urged in the interview: ‘The government should roll out a treatment plan immediately because the drugs have come down in price, the drug companies are offering to negotiate with African governments even cheaper prices.’ This is their famous compassion, demonstrated to impress again. A hit with progressive judges evidently. ‘We don’t need to suffer all these losses of our fellow countrymen and women. We don’t need to suffer because the treatments are available to stop many, if not most, of those deaths. … many, many tens and hundreds of thousands and even millions of people can be saved from a dreadful illness and death by a treatment plan on the part of the government now.’ What a galloping imagination! A multiplying enthusiasm! Whizzing up like Tulip prices in the 1600s. He went on: ‘... anti-retroviral treatment has broken the equation between Aids and death.’ Just like our Lord and saviour. ‘Because here I’m sitting – I should be dead by now, after three-and-a-half years after falling ill with Aids.’ Cameron seems to have his eschatology all wrong. Isn’t it meant to be about ten to blast-off, according to the ‘AIDS experts’? Although in the beginning they didn’t say so:

Ben Gardiner, an elderly gay man living in the Castro district of San Francisco, who witnessed the rise of CDC-fanned AIDS panic in the early eighties, told me during a visit in 1997 that the first deaths he saw, some among men he nursed, were relatively quick – drug intoxication diseases usually. With the introduction of HIV antibody tests, HIV diagnoses began. Even among people in good health. So the latency period/slow virus theory arose. Getting longer and longer to meet the need. Of doctors whose patients weren’t getting sick. And who needed an excuse. It started off as six months between infection and illness, then two years, then five, eight, ten twelve, fifteen. It’s now fashionable to talk only of ‘shortened life expectancy’. Whatever that’s supposed to mean.

With only the holy book missing from his raised hand, Cameron continued:

In my own life, it’s given me a second chance to live. And it’s a wonderful thing. It’s so mundane, it’s so corny in a way to be alive and yet it’s the most wondrous gift that one can have. And I feel deeply grateful for that, and I think it’s a gift that should be put in the position, in the hands of so many more people. … For most of the people very ill with AIDS, for most of the people dying from AIDS now, treatment offers a realistic, a pragmatic intervention to save them from death. That’s the fact – this isn’t a position that I take. The truth is, if those treatments can be made available to them, they need not die of Aids. It’s as simple and as dramatic as that.

Of course, Brother Ed. Pills are all we need. For happiness, and eternal life. Rich with daily meaning. Even with a chronically empty ballooning belly in a rural ghetto. Where kwashiorkor is king, but the girls are eager, and the guys really know how to party on down.

Mbeki’s persistent refrain that the disease burden of the poor comes of hunger, cold and despair – to the irritation of AIDS activists and journalists who say it’s all about endless rubberless sex – hasn’t been rejected everywhere. On 3 March 2000 Mbeki appeared at a press conference in Berlin with Bill Clinton and German Chancellor Gerhard Schroeder following an economic summit. Speaking to Mbeki’s insistence that poverty, tuberculosis and malaria lie at the heart of what presents as the ‘African AIDS epidemic’, Clinton noted: ‘We agreed that those of us who are members of the G8 will emphasize these issues, particularly the impact of TB and malaria in relation to AIDS.’ Tshabalala-Msimang agreed too in Parliament on 7 June 2000: ‘We believe that there are many confounding factors such as poverty and malnutrition ... which have an important impact on the pathogenesis of Aids in developing countries.’ She also mentioned tuberculosis and malaria: ‘A better understanding of these relationships is crucial for an appropriate and comprehensive response.’ Then she trod on the drug industry’s toes: ‘We strongly believe that a successful response to HIV has to be developmental in character and extend well beyond the narrow biomedical model.’ That’s what we like to hear, Mama. She made a similar point in her address to the United Nations General Assembly Special Session of HIV/AIDS (UNGASS) in New York on 26 June 2001:

Antiretroviral drugs were not the only form of treatment for HIV/AIDS. Those who propagate this thinking serve only to create unnecessary animosity between the people in the developing world and their governments. … Many developing countries, including South Africa, did not have the capacity and sufficient resources to procure and administer these drugs. These countries have opted for other effective treatment options. It is a known fact that vigorous treatment of opportunistic infections, coupled with good and healthy nutrition can make people with HIV/AIDS live long and healthy lives.

But in his address, UNAIDS chief, Peter Piot, had different ideas for the country, and said he wasn’t going to be obstructed by uncommitted local politicians like Mbeki and her: ‘This path ... must be one of commitment to stop this epidemic. To never give up. To never allow the obstacles along the way to defeat us. … To go on until antiretroviral therapy is essential care for anyone living with HIV.’ The rest of the delegates saw it his way, not hers, resolving in the UNGASS Declaration, ‘By 2003, [to] ensure that national strategies, supported by regional and international strategies, are developed ... to strengthen health-care systems and address factors affecting the provision of HIV-related drugs, including antiretroviral drugs, inter alia, affordability and pricing, including differential pricing, and technical and health-care system capacity.’

On 24 December 1998 the Chicago Tribune mentioned a survey just published in the New England Journal of Medicine by Bozzette et al. looking at nearly two hundred and fifty thousand adults in the US, who had been treated for HIV. Guess what they turned up: ‘The authors found that adult HIV patients are strikingly different from the general population. They are disproportionately male, black, unemployed, poor and without private health insurance.’ Just as McQuillan et al. reported in November 1994 in their paper, The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991, in the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology: ‘Black participants were four times more likely to be HIV positive than white/other individuals.’ An article in the New York Times on 11 January 2001, The Quiet Scourge, claimed, ‘The AIDS virus is surging like a prairie fire through black communities in the United States ... concentrated in inner-city neighbourhoods.’ Odd how similar the epidemiological pattern to South Africa’s. Stressed health among the poor.

The class origins of the original white gay AIDS patients treated at the San Francisco General Hospital were meticulously researched and plotted by Michelle Cochrane for her PhD thesis, The social construction of knowledge on HIV and AIDS: With a case study of the history and practices of AIDS surveillance activities in San Francisco, awarded by the University of California at Berkeley in 1997 (the basis of a book, When AIDS Began: San Francisco and the Making of an Epidemic (Routledge, 2003)). Nearly all were unemployed or menially employed down-and-outs. The sort of blokes, one imagines, fleeing the bigotry of their small towns for the Castro district. The gay Mecca. Only to fall on difficult times. Cochrane’s findings debunked Randy Shilts’s myth-igniting proposal in his early history, And the band played on (Penguin Books, 1988) (reinforced in the Tom Hanks movie Philadelphia) that

AIDS first emerged among moderately wealthy ‘Guppies’ who ... lived the high and fast night-life in New York and San Francisco. … In Shilts’s estimation, it was only as the epidemic evolved out of this core group of moderately affluent gay men, that AIDS then began to appear in the ‘corridors of poverty’ associated with marginalized populations in urban centres on the East Coast. To the contrary, I am suggesting [following a painstaking analysis of the data] that the epidemic began, and to a large extent remains to this day, overwhelmingly (though not exclusively) concentrated among impoverished or disenfranchised inner-city populations; a population which does not ipso facto exclude homosexual/bisexual men.

Since empty pockets was what those gay AIDS cases had in common with their black hetero brothers and sisters in the US and in South Africa, the open-minded might want to ponder the possibility that the unpopular skin colour and the unpopular sexual preference have nothing to do with the burden of disease (or the health stresses possibly indicated by positive HIV antibody tests) among these folk. And that it might be their quality of life in a depressed environment instead.

But the Cameron interview wasn’t as entirely banal as he thought it was. Deconstructed, it offers a rich seam to mine for many of the social meanings of AIDS, and it lays bare the straw bricks and short-measured mortar that have made up this towering medical monolith in the popular consciousness over the last twenty years.

From the time of the ancients, folk at large have disliked lawyers. It’s in the literature all over, most recently in John le Carré’s tale about the murder of a troublesome barrister by a pharmaceutical corporation, The Constant Gardener: ‘Tessa was that rarest thing. A lawyer who cared about justice.’ Apart from their notorious greed, and their pretensions to serve the public interest rather than strictly their own, it’s mainly because lawyers are perceived to be too clever by half, the locus, as a class, of society’s coolest rationality, even chilly cunning.

Although Cameron’s language has become increasingly intemperate, as his bully’s confidence in his personal joust with Mbeki has grown in tandem with the latter’s intellectual and political isolation on AIDS, his demeanour is regal, pensive. ‘The tall, imposing Cameron had the gravitas of a judge some time before he was elevated to the Bench,’ licked fellow gay Shaun de Waal in a panegyric in the Mail&Guardian on 23 April 1999. His ‘academic trajectory was meteoric. A Rhodes scholar sent to Oxford, he got two degrees there with first-class honours (and a Vinerian scholarship) to add to his bachelor of arts from Stellenbosch and his LlB from Unisa – both cum laude.’ ‘One of the leading lawyers of his generation, possibly the leading lawyer. His record is one of great balance and judiciousness,’ praised David Unterhalter, a silk, now a professor and Director of the Mandela Institute at Wits Law School. His colleague Professor Martin Brassey seconded that: ‘A man of remarkable ability [distinguished by] the lucidity of his mind.’ A ‘man of the highest intellect’, opined the Mail&Guardian on 19 April 2002 in an op-ed piece knocking Mbeki: ‘The Triumph of Unreason’. So Carte Blanche is not to be faulted for introducing Cameron as an ‘intellectual’. Everyone reckons so.

Indeed, in an interview by Gavin Evans, HIV+ judge wants Aids justice, published by the Daily Dispatch on 13 November 2001, Cameron fancied he’s one himself: ‘I have no doubt that I have natural intellectual gifts.’ Unlike the rest of us. Unfortunately you have to look beyond his early legal articles on the human rights of AIDS sufferers for any evidence of them. You honestly do. Such as in Public Health and Human Rights in the South African Journal on Human Rights in 1992. Writing in the honeymoon of his diagnosis. Highfalutin shit like:

The premises on which the debate starts are unchallengeable. [He must have dozed off in philosophy. When his tutor was discussing Karl Popper’s observation that all knowledge is provisional. And that science is indissociable from myth.] The disease is incurable, it is fatal, and it will soon be rampant. Its spread, now at epidemic dimensions, is insidious. It occurs mostly in moments of intimacy between two people who do not know that one of their healthy bodies harbours eventual death for both.

Cameron had taken his confirmation instruction well. Especially its gist. That the flesh pulls us down into the flames of Hell. He could have been mistaken for one of those American businessmen who get their kicks spreading the word around hotels in the weekend. To save souls. (Especially those of the girls in the bar.) Because the introduction to the Gideon Bible sounds the same: ‘The Bible contains the mind of God, the state of man, the way of salvation, the doom of sinners, and the happiness of believers. Its doctrines are holy, its precepts are binding, its histories are true, and its decisions are immutable.’ May we be excused for not swallowing a guffaw over the judge’s lapsed faith in the incurable, fatal bit? After confessing it to Sister Ruda: ‘... for most of the people dying from AIDS now, treatment offers a realistic, a pragmatic intervention to save them from death.’ Challenging the unchallengeable. And sounding like Calvin changing his mind. But at least coming round to Nobel-winning physicist Richard Feynman’s point: ‘We absolutely must leave room for doubt or there is no progress and there is no learning.’

Strikingly similar too sounded the Reverend Samuel Parris’s menacing prattle in Salem in February 1692 at the start of the witchhunt there:

It is altogether undeniable that our great and blessed God, for wise and holy ends, hath suffered many persons in several families of this little village, to be grievously vexed, and tortured in body, to be deeply tempted, to the enduring destruction of their souls; and by all these came amazing feats (well known to many of us) to be done by witchcraft and diabolical operations.

The Evans interview plugged some gaps left in the Carte Blanche one, by providing more personal history and fleshing out the episteme within which Cameron’s silly mind ranges. Evans’s leading questions disclosed his own too. It’s Cameron’s claimed sophisticated rationality that makes him a particularly intriguing case study in hysterical suggestibility in what we like to think to be our cool, intelligent, modern, enlightened, secular, industrial society. On which Orwell threw some light in 1984: ‘Doublethink means the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them. … In general, the greater the understanding, the greater the delusion: the more intelligent, the less sane. One clear illustration of this is the fact that war hysteria increases in intensity as one rises in the social scale.’ Hence the top judge’s enthusiasm for the war on AIDS. Made possible by a thinking trick:

Crimestop [a Newspeak term for ‘acquired internal discipline’ to avoid crimethink] means the faculty of stopping short, as though by instinct, at the threshold of any dangerous thought. It includes the power of not grasping analogies, of failing to perceive logical errors, of misunderstanding the simplest arguments if they are inimical to Ingsoc [‘English Socialism’], and of being bored or repelled by any train of thought which is capable of leading in a heretical direction. Crimestop, in short, means protective stupidity.

Cameron’s Carte Blanche spiel would have been right at home in a fellowship circle of Jesus freaks witnessing fervently about their salvation from perdition. Caused by possession by demons. Miniature ones. That’s how it sounded. And was meant to:

Ruda, you know, we’ve been friends for 29 years now since we’ve been revealing secrets. We were first years together at Stellenbosch in 1972, and you were one of my first friends that I told about this. It was a very emotional time for both of us, and I expected to die. I believed that I would die before I was 45 or 50. I’m now 48 and I’m in better health than I’ve been almost at any time since I’ve been an adult. But at the time, it seemed important to tell a story. You and I discussed it and I think from your producer’s and filmmaker’s and anchor’s perspective, you thought that this might be a story worth telling and worth showing to your viewers. I think we were actually going to tell the story of my death, and what we’re telling now is the story of my life, and I’m more involved with more things [I’m into drugs now], with more public-interest projects, with more organisations, more involved with my work and with my life than I’ve ever been.

I’m more and more in touch with my inner being.

In her study, Hystories: Hysterical Epidemics and Modern Culture (Picador, 1997), Showalter sums up the type, these hysterical ‘career patients ... addicted to their symptoms’ for whom ‘the patient career may be a permanent way of life, with a self-supporting network of friends, activities, doctors, and treatments’. She describes how they typically ‘learn about diseases from the media, unconsciously develop the symptoms, and then attract media attention in an endless cycle. Culture forces people to deny the psychological and emotional sources of their symptoms, and to insist that they must be biological and beyond their control, for them to view themselves as legitimately ill.’

Showalter quotes Norman Cohn in The Pursuit of the Millennium (Secker and Warburg, 1957), writing about the currents churning around the turn of the first millennium – but human psychology has a dreary consistency, as Cameron and Achmat’s hysterical agitation over AIDS bears out:

Those who are first attracted will mostly be people who seek a sanction for the emotional needs generated by their own unconscious conflicts. It is as though units of paranoia hitherto diffused through the population suddenly coalesce to form a new entity: a collective paranoiac fanaticism. But these first followers, precisely because they are true believers, can endow their new movement with such confidence, energy and ruthlessness that it will attract into its wake vast multitudes of people who are not at all paranoid but simply harassed, hungry or frightened.

And, Cohn noted, when ‘a paranoiac mass movement captures political power’, disaster follows.

As gay men, Cameron and Achmat’s sick roles are very much a throwback to Victorian ideals of femininity. Constitutional delicacy was considered refined and attractive. Crippling corsets tied tightly for hourglass figures caused extreme discomfort (there were even reports of wombs forced down unmentionable passages) with the result that ladies were reduced to mincing around helplessly like their Chinese sisters with bound feet. Fainting spells were all the rage. A sick pallor was prized, and women took drops of arsenic and silver nitrate to keep up the look. I suspect that rouge applied to cheeks, favoured by prostitutes and common women, was a bid to imitate the upper class complexion – flushed red by mercurial intoxication, thanks to the diligent attendances of Victorian doctors. Keeping them permanently sick. And attractive to their men. Cameron and Achmat seem to think we find their daintiness in health sexy too. Journalists certainly do.

I mention en passant that in their essay, Overview of Mass Psychogenic Illness: Hysteria Revisited? introducing their collection, Mass Psychogenic Illness: A Social Psychological Analysis (Lawrence Erlbaum Associates, Publishers, 1982), Michael Colligan et al. remind us of Hippocrates’s fascinating suspicion, all those years ago, that hysteria (which he diagnosed for the first time in an unmarried woman) was the result of ‘an unnatural state’ of ‘sexual abstinence’. (The word ‘fascinating’, my Latin professor explained, has a fascinating root in male tumescence. Whoops!) Sigmund Freud, I might add, contended that hysterical men tend to be sexually passive; Wilhelm Reich that they typically display a ‘feminine facial expression and feminine behaviour’. About Cameron and Achmat in this regard, not another word.

Cameron’s AIDS Law Committee (he’s proud chairman) of the South African Law Commission was quite happy to note in its Fifth Interim Report on Aspects of the Law Relating to AIDS that the Criminal Law Amendment Act 105 of 1997 prescribes a mandatory sentence of life imprisonment for rape by a man knowing he’s ‘HIV-positive’ or ‘has AIDS’. Not because the sexual assault is thereby transformed into assault with a deadly weapon of sorts, mind you, but because, the report explains to us, this aggravating fact could make the victim feel extra distressed – suffer ‘psychological harm’ as the original language in the preceding bill had it. And so our criminal law is fouled with AIDS hysteria just as the Nazis, with their own mystical notions of defiled blood, once corrupted theirs. Our labour law too. (The several ponderous reports produced by Cameron and his fabulously paid committee of ‘AIDS consultants’, are enough to make a man hold his head in hands and cry. With pity. Especially where they get ‘scientific’.)

Could the new rape law be all about keeping them in their place? The modern way? Caged forever. Where they belong. Those guys whose faces blend into the night. Jumping over white picket fences. Or grey concrete walls with voortrekker wheels. Spreading disease. (One in three in HIV-positive in KwaZulu-Natal say the ‘AIDS experts’. Where Zulus live – those militant threatening people with warrior traditions.) Sick from all that sneaking around with the maids. Even if they feel perfectly vigorous, and appear so in court. But on the other hand if leprous, tubercular, syphilitic, pocked, or plagued by boiling buboes, the law has no business. Reckons the South African Law Commission. With Cameron’s concurrence. The guy with the ‘natural intellectual gifts’. The new rape law is redolent of Charlemagne’s edicts prescribing death for tormenting one’s fellows with sores and diseases. Also afflicting them with barrenness, troubling the atmosphere, exciting tempests, summoning down lightening, drying up the milk of cows and blasting fruits and crops. Stand by for the Law Commission to propose life in C-Max for Muslims attempting murder by spreading anthrax. In jokers’ envelopes containing talcum powder. Or sprinkled on your long end before you go.

The judge’s hysterical lunacy has even infected such otherwise sober dudes as international war crimes prosecutor Richard Goldstone, Chancellor of the University of the Witwatersrand and, until his resignation on 1 October 2003, justice of the Constitutional Court. On 7 March 2001 Goldstone presided over a special rally held there, a rare General Assembly of the University, to whip up highbrow fervour against the threatened new menace – since the black democratic government didn’t seem to be as alarmed by it as the white liberals were. Chief Justice Arthur Chaskalson, Cameron JA, various High Court judges, and Gauteng’s health and education MECs, duly taking their parts in Cameron’s grand folly, all listened in rapt attention, gathered along with staff and thousands of students to hear Goldstone make a special statement about AIDS, and to learn about the launch of the University’s new HIV-AIDS policy. A remarkable affair when one considers that all eight other general assemblies had been called to protest the distinctly palpable evils of apartheid. Individuals, families, communities, societies banished to remote wastes to starve. By the million. Just to begin with. Something worth protesting about.

‘While apartheid was an attack by a white minority on a black majority, AIDS poses a threat to the whole society,’ Goldstone remarked by way of an introduction, not having noticed apparently that the employed had by and large been left untouched by the diseases suffered by the black poor, which the ‘experts’ had taken to calling AIDS. But you can always count on judges to be careful with the facts. Especially as they step out of their sequestered, socially aloof little worlds into the big wide one. And get all fired up at Jimmy Swaggart style conventions.

Even if we uncritically accept the ‘everyone’s dying’ alarmism of AIDS activists and the newspapers, only the blind can miss just who. Not Mbeki – in the course of whose exchange with DA leader Tony Leon over the appropriateness of AZT for rape victims (discussed below) he noted: ‘Contrary to what you say [(‘death and disease know no race’)], even a child, from among the black communities, knows that our own burden of disease coincides with the racial divisions in our country.’ But the Cape Times got hot and bothered in a typical white liberal end-is-nigh article on 16 April 2001: Death rate trebles as AIDS crisis hits Cape. Like Mbeki, one couldn’t help noticing that there were no white, Indian or ‘coloured’ deaths mentioned, and that they were reportedly occurring in the wretched black townships of Khayelitsha, Langa and Guguletu. Not Constantia, Houghton, or Durban’s Berea.

Undertakers say business ... is ‘like a factory’ at weekends, with up to 20 burials at once. … In Johannesburg and rural KwaZulu-Natal, death rates have rocketed because of AIDS. Jack Bloom of the Democratic Alliance said that, in Johannesburg alone, the number of funerals had doubled in the past five years from 15 000 to 30 000 a year and figures were expected to double again by 2005. ‘At the Avalon cemetery in Soweto, between 100 and 150 people are buried every Saturday,’ he said.

The puzzling thing about these sorts of neurotic reports is that a couple of months later renowned journalist and author Rian Malan did a thorough survey of his own, looking into how brisk business is for funeral parlours – supposedly experiencing boom times thanks to the ‘AIDS epidemic’ – and found quite the opposite. Commissioned to research the subject by Rolling Stone, with a view to exposing Mbeki’s irresponsible ‘AIDS denialism’, he expected to find ample evidence, but found himself soon disabused of all his preconceptions, his confidence in the medical and scientific establishment forever wrecked. As he put it to me in my kitchen in October 2000: ‘I began looking into AIDS with a view to bashing Mbeki, but I found the facts reluctant to cooperate.’ His demystification of the African AIDS holocaust fancy, subscribed to and promoted by Cameron and his brother judges, appeared in the October 2001 issue of Rolling Stone as AIDS in Africa: In Search of the Truth. We recall that ‘AIDS experts’ in the Department of Health were reported in the Natal Witness on 24 October 1997 predicting that ‘Between 3,5 and 4,8 million South African children younger than 15 years will have lost their mothers to Aids by 2000.’ So where’s this gaggle of orphans – the ‘feral’ black orphans everywhere in the streets, as RW Johnson envisioned. Like where?

Unnoticed was the bleak irony of the 9th General Assembly of the University of the Witwatersrand celebrating and formally embracing a new medical ideology that black African intellectuals like Mbeki had recognised to be profoundly racist, inhumane, alienating, hopeless, callous, mechanically reductionistic, simplistic, aggressive, fearful, mercantile, and politically antagonistic to the poor – by casting them as personally responsible for their lot when their health fails. In short, intrinsically American. But then after apartheid, something had to fill the vacuum – some new schema within which white liberals could relate to blacks. Providing new furniture for racist ideology, AIDS came tailor-made with its inarticulate burden that blacks are the harbingers of disease, spread by their uncontainable sexual proclivities, an evergreen fascination and horror among the European-descended. For white folk rushing to help their swarthier countrymen (always code for control), AIDS as an ideology arrived as perfect a vehicle as the Beatles were as a vent for the social pressures of the sixties.

And there’s an intriguing precedent for racist sentiment swelling along with plague hysteria. In his study, The Black Death (The History Bookclub, 1969), Philip Ziegler devotes a gory chapter to Germany: the Flagellants and the Jews in which he details the especially severe and widespread persecution of Jews in German villages in mid-1300, accused of spreading plague by poisoning wells – themselves or via hired lepers. Jewish leaders and rabbis were arrested and naturally confessed on the rack. Zurich began by voting to exclude Jews from its precincts; the Jews of Basle were penned up in wooden buildings and burned alive, and those of Hansa walled up in their homes to suffocate and starve. Instigated by Christian zealots, the genocide fanned over the country and enveloped dozens of villages, spreading even to Spain: in Barcelona, the Jewish ghetto was sacked; there were anti-Jewish riots in other Spanish cities, and in Tarrogona three hundred Jews were killed. ‘Anno domini 1349 sloeg men de Joden dood’, went a chronicle of the time, summing up the fact but not the scale. Ziegler tells that the attacks ‘virtually wiped out the Jewish communities in large areas of Europe. In all, sixty large and one hundred and fifty smaller communities are believed to have been exterminated and three hundred and fifty massacres of various dimensions took place. It led to permanent shifts in population, such as the concentration of Jews in Poland and Lithuania, which have survived almost to the present day.’

Guess who the Wits General Assembly’s keynote speaker was? Gee, none other than Chair of Council, Judge of Appeal Edwin Cameron. He reiterated that same hysterical point: ‘... every one of us is vulnerable.’ In the teeth of all the epidemiological data. And then shared with us again his odd idea that just as long as you have the cash, expensive poisons keep you well: ‘... wealth can buy you life and health. … This drug battle shows that HIV-AIDS is not about hopelessness.’ Urging students to join the fray in the campaign for cheaper AIDS drugs, he said: ‘We can change the conditions in which South Africans live with and die of the disease. By our own efforts and actions we can give hope. Wits will continue to make positive choices to act upon, build for and defeat this pandemic.’ With pills. Not rural development, food and water. Very expensive pills. To take forever, keeping the till tinkling: as Carr pointed out in Lancet in July 2002: ‘Near perfect and life-long adherence to treatment is not required for any other chronic infectious disease.’ Even antibiotics are generally capped at a week’s course. Being cell poisons too. Bacteria being unicellular organisms. And when chemotherapeutic drugs are given to cancer patients, there’s always a similar tight limit to the duration of the treatment. Because it’s killing you along with your unwanted cells. But with chemotherapeutic AZT, the most poisonous chemical ever licensed for indefinite use, you take it until you die. Which you will. Sooner rather than later. Just how long it takes depends. On your luck.

Wits Vice-Chancellor Professor Colin Bundy then launched the university’s HIV-AIDS policy, adopted by Council in December. We half braced for an announcement that the university would be expelling its Jews and revising all its syllabi, but we were spared the former. He announced that the new policy would have five components: The rights and responsibilities of staff and students affected by and living with HIV-AIDS were to be codified (red stars for their coats?); HIV-AIDS was to be integrated into teaching – reminiscent of Nazi physics, Nazi mathematics, Nazi history, Nazi music and Nazi art; all faculties would be pressed into doing performing AIDS research and ‘service activities’ – just as those German faculties were required to serve volkische aims; stations would be set up on campus manned by commissars to provide political education in the new ideology that intimacy can kill you (the closer you get, the more dangerous it is) and to dish out rubbers to stunt sexual connection, by reducing the flash and staunching the spirit (also jamming some amazing female biochemical receptors to about two dozen prostaglandins and other merrymaking ingredients of seminal plasma); implementation of the new policy would be constantly monitored to expose recalcitrant holdouts; and it would be regularly reviewed to further its goals. Yep, you got it baby, right out of Ripley’s Believe it or Not.

The President of Convocation, John Shochot, announced that the assembly was ‘sadly not much different to the previous ones against apartheid’ that he’d attended. Then after he’d mopped his eyes he really got going: ‘This crisis will divide South Africa in ways that apartheid never did,’ he said, both right on and right off the mark, in ways the earnest fellow would never understand. Like a child throwing his gorged cookies, the self-flagellating penitent, sick with all the propaganda he’d downed, said he was ashamed that South Africa has more HIV-positive people than any other country in the world and what our country was doing about it. He meant not buying GlaxoSmithKline’s medicines, since we spend no end of public money on ‘AIDS prevention’ – confirmed in a Lancet editorial on 5 April 2003: ‘The Government of South Africa has been severely criticised for moving too slowly, yet there are more AIDS programmes and initiatives on the ground in that country than anywhere else on the continent.’

But all this was just a curtain-raiser for SRC president Muhammad Cajee’s delirious show: ‘Twelve per cent of students and staff are living with HIV-AIDS,’ he said, ‘meaning that every tenth student you see here will not live long enough to complete their studies.’ A Roman decimation! For rebellion against the Moral Majority! Punishing our defiantly irreligious, permissive modern society! On the ten years countdown to AIDS theory, they sure must be taking their time to get through their degrees, these dim Wits students. To make sure he and his fellow SRC members weren’t left out of this Passion Play, he said they would all be off for HIV tests within a day or two and invited other students to join them. Checking up to make sure there’s no bad blood in those veins. Like Germans checking their family trees. But half-hoping that there is, so that they can become cult-heroes like Edwin Cameron and Zackie Achmat.

Presumably, Judges Chaskalson, Goldstone, and their other judicial brethren present at the Wits General Assembly concurred in the proceedings by nodding in accord. Because none of their Lordships were observed to clutch their sides and fall about laughing, or at least cough or clear their throats in awkward embarrassment, much less get up and walk out of the final act of this unimaginable farce.

We interpose here that at neighbouring Rand Afrikaans University the results of a blood-testing survey performed, released in mid-January 2002, were just 1.1 per cent HIV-positive. Whatever conclusions you want to draw from the comparison. Probably not too many after you’re done reading what’s coming up.

Cajee’s and Cameron’s subscription to the odd idea in the AIDS age that you can be sick without knowing it is actually as old as the hills in Western culture – rooted, I suspect, in the Christian concept of original sin. Daniel Defoe reported such notions exactly in his romance invention, Journal of the Plague Year, published in 1722, romanticizing the ‘last great visitation’ of the plague in London in 1665 so titillatingly that the rich and lurid legends he propounded for his novel have entered the popular consciousness as real history – no small thanks to his ‘peculiar talent’, like Cameron’s, ‘for telling fiction in the guise of truth’, according to Defoe’s modern editor, Kenneth Hopkins.

Compare Cameron: ‘The disease is ... spread ... mostly in moments of intimacy between two people who do not know that one of their healthy bodies harbours eventual death for both.’ And Mandela, speaking at the Barcelona AIDS Conference in July 2002: ‘The great tragedy of HIV infection is that most people, surely more than ninety per cent, do not know that they are infected with the virus. They continue, unwittingly, to spread the infection.’ With Defoe:

This infecting and being infected without so much being known to either person is evident from two sorts of cases which frequently happened at that time … 1. Fathers and mothers have gone about as if they had been well, and have believed themselves to be so, till they have insensibly infected and been the destruction of their whole families … 2. The other particular is that many people having been well to the best of their own judgment, or by the best observation which they could make of themselves for several days, and only finding a decay of appetite, or a light sickness upon their stomachs; nay, some whose appetite has been strong, and even craving, and only a light pain in their heads, have sent for physicians to know what ailed them, and have been found, to their great surprise, at the brink of death, the tokens upon them, or the plague grown up to an incurable height. It was very sad to reflect how such a person as this last mentioned above had been a walking destroyer perhaps for a week or fortnight before that; how he had ruined those that he would have hazarded his life to save, and had been breathing death upon them, even perhaps in his tender kissing and embracings of his own children. … This frequently puzzled our physicians, and especially the apothecaries and surgeons, who knew not how to discover the sick from the sound; they all allowed that it was really so, that many people had the plague in their very blood, and preying upon their spirits, and were in themselves walking putrefied carcases, whose breath was infectious and their sweat poison, yet were as well to look on as other people, and even knew it not themselves. … Sometimes a man or woman dropped down dead in the very markets, for many people that had the plague upon them knew nothing of it till the inward gangrene had affected their vitals, and they died in a few moments.

Sure they did. Like Jesus ascended into the heavens. Passing through the clouds like a rocket in slow motion.

‘AIDS experts’ such as Makgoba and lay preachers such as Cameron like to excite themselves (we’ll later read) with allusions to ‘the Black Death’, packing plague imagery onto their attacks on Mbeki and the government for not doing enough in the war on AIDS. Yet there’s surprisingly little in the many myths that abound about it – the first being in the name itself. Rather like the fallacies inherent in the acronym ‘AIDS’ that we’ll be getting onto soon: that it’s acquired; that people diagnosed with AIDS necessarily have ‘compromised immune systems’; and that the diseases renamed AIDS if the patient is HIV-positive are part of a coherent syndrome in any meaningful sense – from invasive cervical cancer to dementia to TB, among an American list of about thirty completely disparate illnesses. Balding to foot fungus, just about.

In The Black Death, Ziegler reveals that the name derives from the ‘traditional belief that it was so called because the putrefying flesh of the victims blackened in the final hours before death supervened. The trouble about this ... plausible theory is that no such phenomenon occurred.’ There is every reason, I think, to suspect that the rest of our conventional wisdom about the Black Death is as solid as the Virgin Birth. Although most of us have a pretty fixed idea of what it was from our history lessons, opinions and orthodoxies about the causes of widespread collapsing health in the mid-14th century, both contemporaneous and later on, have varied as widely and radically as constructions of the putative disease itself. And when one considers the fantastic claims of the ‘AIDS experts’ in the modern era concerning the devastation allegedly wreaked by the ‘AIDS epidemic’, the generally accepted belief that the Black Death took a third to half the population of Europe starts looking less like history and more like the story of the Easter bunny.

It’s currently widely believed by modern doctors that fleas leaping off rats spread the bubonic plague, their bites inoculating folk with a bacterium residing in their stomachs, Pasteurella Pestis. (Which is a joke for another book.) In fact there is nothing in the chronicles to support the rat and flea theory at all. On the other hand, Ziegler notes, ‘almost every fourteenth century savant or doctor took it for granted that the corruption of the atmosphere was a prime cause of the Black Death’. This was the ancient and long-lived miasma theory, which held that noxious vapours carried disease. Nor was the Black Death exclusively what doctors call bubonic plague manifesting in the glands of your groin or armpits swelling up into hideous, suppurating buboes, according to some accounts. But not others – some doctors claimed that it was precisely because the swellings were hard and didn’t leak that they were deadly. (Curious that the boils and lumps should allegedly occur in the groin – next the genitals. But then this was Christian Europe: the first book of Samuel (5:6-12) speaks of a plague of ‘tumours in the groin’ as a special divine punishment for the thieves of the Ark of the Covenant.) Or instead of boils or lumps, such sufferers might develop blotchy skin, even go mad. According to medieval accounts ‘In Provence a man climbed onto the roof of his house and threw down tiles into the street. Another executed a mad, grotesque dance on the roof.’ Doesn’t this sound all too familiar – archetypal plague horrors resurfacing in the AIDS age? Swollen glands, skin blotches, lunacy?

To this diagnostic hodgepodge, second and third elements were thrown in – the sinister appearances growing dizzily like the US CDC’s ever-expanding list of AIDS-defining diseases. Pneumonic plague was joined – meaning about any ailment of the lungs. Along with septacaemic plague, doctors’ handy catch-all explanation for folk in fine health who didn’t get up in the morning or who suddenly fell unwell and were shortly dead, but who didn’t exhibit any symptoms. Today called a heart attack. Or a stroke. As with their talk about AIDS today, doctors and their believers during the plague years liked to emphasize morbid inevitability following the appearance of the signs upon the victim. ‘For example,’ wrote Defoe,

many persons in the time of this visitation never perceived that they were infected till they found, to their unspeakable surprise, the tokens come out upon them; after which they seldom lived six hours. … when the disease was come up to that length nothing but certain death could follow, and yet as I said, they knew nothing of their being infected, nor found themselves so much as out of order, till those mortal marks were upon them.

And similarly, Ziegler cites Boccacio, telling us that the bubo was an ‘infallible token of approaching death’. But, as Ziegler also points out, ‘Other contemporary records as well as observation of subsequent epidemics’ noted plenty of full recoveries.

It was widely believed that not only did the plague pass by breath, but also by looks, and quickly too: Ziegler quotes a contemporary doctor: ‘Instantaneous death occurs when the aerial spirit escaping from the eyes of the sick man strikes the eyes of a healthy person standing near and looking at the sick, especially when the latter are in agony; for often the poisonous nature of that member passes from one to the other, killing the other.’ Also by touch or breath: Ziegler quotes Simon of Corvino telling of priests who ‘were seized by the plague whilst administering spiritual aid; and, often by a single touch, or a single breath of the plague stricken, perished even before the sick person they had come to assist’. The fabulous credulousness of doctors remains unchanged through the ages: today they’re telling us equally wonderfully that making love with a new mate (unmarried or of the same sex) can kill you – ten years afterwards.

But unlike contemporary AIDS enthusiasts, even a dreamer like Defoe recognised that the widely disparate diseases lumped together as ‘the plague’ largely took the struggling broke, not the well to do: ‘It must be confessed ... that the plague was chiefly among the poor.’ Ziegler mentioned a consonant epigram of the day: ‘No lady ever got the plague.’ Just as white ladies rarely develop AIDS – those treated with AZT aside. Ziegler cites the 19th century French historian Michon making the same point, implicitly debunking, on the way, the myth that during the great plague of the mid-thirteen-hundreds something qualitatively exceptional was about: ‘The plague of the fourteenth century was no different to those which preceded or which followed it. It killed more people, not because of its nature, but because of the conditions of suffering and servitude in which it surprised its victims.’ A discussion of the ruptured social, political and economic conditions prevailing in Europe at the time is, as they say, beyond the scope. But Ziegler captured it: ‘... general malnutrition was a contributory reason for the high death rate of the plague years.’ In relation to the London plague three centuries later, Defoe alludes to overcrowding in London in mentioning ‘the exceeding populousness of the city at the time of the infection’. Christopher Hill wrote similarly in Liberty against the Law (Penguin Books, 1997): ‘In the 1660s the victims of plague, Clarendon tells us [in Life published in 1759], were mostly the poor (and sectaries [i.e. dissenters from the Church of England], almost all from the lower classes). … Plague, when it came, hit the poorest classes hardest, especially in the overcrowded and insanitary towns. … Some said the plague was a blessing since it killed off “the baser and poorer sort, such whose lives were burdensome, whose deaths were beneficial” to their society [as Robert Harris commented (with a full belly) in 1626].’ This is just how many whites see the blessing of AIDS in South Africa and Africa generally. I hear it all the time.

The Nazi revisionist historian David Irving recorded such thinking in his diary in 1987 during a trip to South Africa to hang out with Clive and Gay Derby-Lewis and other such charming hosts: concerning ‘the AIDS epidemic in Black Africa’ a white doctor practising in Swaziland told him that

he thinks that the Black population in all Africa will die out within a very short space of time. He attributes the incredibly high AIDS incidence among Blacks to their sexual activity, few Blacks apparently engaging in less than five sexual acts per night. He says the astonishing sexual activity among Black men accounts for why a large number of white female intellectuals and students like having Black boyfriends, which now, of course, they will regret. God works in mysterious ways, but here, He appears to be working remorselessly towards a Final Solution, which may cruelly wipe out not only the Blacks and homosexuals but a large part of the drug addicts and sexually promiscuous and indiscriminate heterosexual population as well. He says the virus is clearly the same as one known for a long time to have affected the monkey population. ‘The only weapon against AIDS,’ I suggest, ‘is an aspirin: clenched firmly between the knees at all times.’

Medieval doctors, like their modern counterparts, were apparently too hung up on their poisonous mists and scientific theories to notice their patients’ dire living conditions. But to those of us less fired up than Ziegler by thrilling thoughts of deadly aggressive germs (‘this sudden and horrifying holocaust’), widespread hunger was more than a contributory reason; it was a sufficient reason – if one factors in the profound psychological deterioration that springs from hopeless destitution, and the ready contagiousness of ideas and fears. And one keeps in mind the medical care: the stock treatment of the sick was bleeding, as always. Ziegler quotes one top doc: should the patient faint, splash cold water on him and carry on as before. To ensure his speedy passage to the next world. All manner of aggressive chemicals too were administered too; Defoe notes:

Nay, there was another thing which made the mere catching of the distemper frightful, and that was the terrible burning of the caustics which the surgeons laid on the swellings to bring them to break and run. … On the other hand it is scarce to be imagined how the posts of houses and corners of streets were plastered over with doctors’ bills and papers of ignorant fellows, quacking and tampering in physic [medicine].

After cataloguing a whole page full of crooked examples, Defoe records: ‘Tis sufficient from these to apprise any one of the humour of those times, and how a set of thieves and pickpockets not only robbed and cheated the poor of their money, but poisoned their bodies with odious and fatal preparations: some with mercury, and some with other things as bad, perfectly remote from the thing pretended to, and rather hurtful than serviceable to the body in case an infection followed.’ In their ‘foolish humour’ folk went ‘running after quacks and mountebanks ... blindly, and without consideration, [taking] poison for physic and death instead of life.’ Sort of like Edwin Cameron.

Making the poor to blame when they got sick – just as ‘AIDS experts’ currently do, especially when facing defiant rejection of their new doctrines by plebeian folk – Defoe complained:

But it was impossible to beat anything into the heads of the poor. They went on with the usual impetuosity of their tempers, full of outcries and lamentations when taken, but madly careless of themselves, foolhardy and obstinate, while they were well. … This adventurous conduct of the poor was that which brought the plague among them in a most furious manner, and this, joined to the distress of their circumstances when taken, was the reason they died so by heaps.

But he acknowledged frankly that ‘when they came to be taken sick they were immediately in the utmost distress, as well for want as for sickness, as well for lack of food as lack of health’.

Finerman and Bennet described the modern tendency in industrialised societies to shift responsibility from the environment to the individual, consummated in the AIDS era, in a brief but powerful analysis published in the journal, Social Science and Medicine, in 1995: Guilt Blame and Shame: Responsibility in Sickness and Health. They reported ‘a sudden and dramatic proliferation in what Foucault termed medical policing [in his The Birth of the Clinic: An Archaeology of Medical Perception (Vintage Books, 1994)], as social institutions and their agents increasingly monitor, regulate and subdue individuals in the name of health’. Among a host of instances cited,

Visa applicants face probes on their sexual behaviour and those with HIV-positive status can be barred from entering the United States. … Such policies reflect a shift in medical worldview. They signal the emergence of new explanatory models, particularly prevalent in Western and industrialized populations, which are responsibility and blame focussed; that is, disease, onset and outcome are directly ascribed to the afflicted themselves. These responsible parties are then subject to censure for personal failures which ‘caused’ their condition. … In essence, such blame-oriented models are more accusation than they are explanation. In many respects, accusation in explanatory models speaks louder about our own culture and values than it does about the health seeking behaviour and medical systems of other populations. … Kirmayer indicates that blaming patients for illness results in status loss, social moralising and medical paternalism, noting that, ‘Sickness makes the patient’s stewardship of the body suspect. The physician then appropriates the body and performs caretaking functions for the patient who has failed to protect the body and lacks the expert knowledge necessary to understand what is wrong.’

Nowadays ‘AIDS experts’ force feed AZT to babies with the backing of the courts, as the horrific experiences of David and Kathleen Tyson, Pamela Anderson and Valerie Emerson in the US, Sophie Brassard in Canada, and Toni Watson and the late Molly Radcliffe in England, among countless others, have told. The tendency described by Finerman and Bennet to blame the victim may be more prevalent nowadays than before, but it’s not recent. In her meditation, AIDS and its Metaphors (Allen Lane, 1988), Susan Sontag – bright to its meanings, but dull to its core vacancy as a socially supported scientific construct – noted that ‘Plagues are invariably regarded as judgments on society … This is a traditional use of sexually transmitted diseases: to be described as punishments not just of individuals but of a group.’ Other widespread diseases too have been interpreted

as a sign of moral laxity. … Responses to illnesses associated with sinners and the poor invariably [recommend] the adoption of middle-class values: the regular habits, productivity, and emotional self-control to which drunkenness was thought to be the chief impediment. Health itself was eventually identified with these values, which were religious as well as mercantile, health being evidence of virtue as disease was of depravity.

Senator Walter Bennett has the idea. At a rally at Manzini, Swaziland in December 2002 the senior advisor to Swazi King Mswati III proposed that the government should not provide medical care to ‘HIV/AIDS’ patients because they ‘contract the disease out of their evil habits and out of choice’. So has Sunday Times columnist, David Bullard, playing with his penile cigar in a snapshot next to his by-line, and writing Life’s more fun when you know you’re going to die on 9 March 2003:

In most cases [HIV infection] is a ‘voluntary’ condition, transmitted sexually. … AIDS is not a particularly strong deterrent to people who know their lives will never amount to much. … some people actually embrace their own mortality. … Almost a year ago I wrote a column suggesting that the government was unwilling to pump public money into providing AIDS drugs because it would involve keeping an economically unviable portion of the population alive. The chances of many of these people becoming active contributors to the South African economy after a course of free drugs is, sadly, remote. I was expecting howls of protest but I heard nothing, so I must assume that I was spot-on.

Yes, David, you were, in articulating how your average white South African reader thinks, sitting alone in his car in the morning traffic jam.

A month after the Wits General Assembly on AIDS, the university set to work, hosting a four-day conference under the moniker, ‘AIDS in Context’. Cameron, needless to say, was there to open it on 4 April, sermonising interminably, as ever, in that feebly emotive, over-ripe fruity pitch of his – funny grammar, peculiar adjectives – that makes him the darling of AIDS career types all over. With his oratory billowing grandly without conceptual content to match. Saying so much yet so little other than, basically, how terrific the drugs are and why everyone should get them. But two tidbits caught the ear: ‘... this epidemic has from the outset involved as much a battle of ideas as a battle about bodies and organisms and cells.’ Indeed – because the AIDS controversy has been a stage on which a profound clash of thinking systems, value systems and political styles has been played out: pragmatic, open-ended African versus dogmatic, intolerant European. In a way, AIDS has afforded liberal ideology its last gasp in Africa, with Mbeki’s scornful lapse posing a dire and infuriating challenge to it. And whereas Cameron’s brother Goldstone J had just declared, ‘AIDS poses a threat to the whole society,’ Cameron now corrected him: ‘... the disease overwhelmingly, now, affects poor heterosexuals in the developing world. What these groups have in common in their vulnerability to AIDS is that HIV remains overwhelmingly a disease of the dispossessed, the marginalised and the stigmatized.’ Or to put it more simply, it’s the poor, as Mbeki points out: ‘... even a child, from among the black communities, knows that our own burden of disease coincides with the racial divisions in our country.’

A front-page headline report in the Sunday Times on 28 July 2002, Dread diseases hit SA’s starving kids: Three quarters of all South Africans do not have enough food, sketched a desperate scene ordinarily beneath the view of the newspaper-reading, television-watching, AIDS-fascinated public in South Africa – an entirely novel subject in the liberal media, and remarkable for a main story, particularly since it’s been politically incorrect to talk about chronic hunger as a cause of disease and early death after the fuss Mbeki caused by linking them in his opening address at the Durban AIDS conference in July 2000.

Mhlongo endorsed the Sunday Times article in a letter published the following week: Poverty and destitution explains the poor health status of black South Africans, picking up where it left off:

When President Mbeki and I repeatedly focus on issues of grinding poverty and destitution as the main reasons for the extremely poor health status of Africans, we are pilloried by all the media in South Africa. The media’s unbalanced preoccupation with HIV=AIDS=DEATH prevents any meaningful attempts to examine crucial health indices such as the deprivation index for South Africa. … Infant mortality, chronic malnutrition, marasmus, kwashiorkor and hypoproteinaemia as listed in the report can all be explained in terms of grinding poverty, squalor and deprivation. It is futile to focus on political correctness around issues of assumed heterosexual AIDS at the expense of the real issue of poverty. … Antiretroviral drugs are no substitute for food in Africa. Infant mortality, stunted growth and the link with poverty have been well documented in South Africa by Professors Reid and Moosa at the Durban Medical School in the sixties, i.e. long before the advent of HIV. These two professors noted then that 50% of black children in Natal were dead before reaching the age of five. (Archives of Race Relations in South Africa, Braamfontein). What we are seeing today as The Sunday Times article shows is nothing new. What is new is that those of our citizens from the former apartheid homelands are free to travel, seek hospital care, seek work and live in any part of South Africa.

Mhlongo’s final observation usefully explains why post-apartheid, formerly white urban hospitals have filled up with unwell blacks, a phenomenon chalked up by most whites to rampant AIDS.

Talking about poverty is frowned upon but not sex anymore, provided it’s coupled to the groovy American medical wisdom that it can kill you. When it’s ‘unsafe’. So we have Mandela, Tutu, and other celebs urging us endlessly in the newspapers and on radio and television to ‘Love them enough to talk about sex.’ Reinforcing the medical and social construction of diseases of poverty as a behavioural problem. Not a raw political one.

Public health programmes in the fight against AIDS, whether government or private sector originated, all have one thing in common: a didactic tone that casts their market constituency in the role of children in need of grown-up advice. Imparting wise information as a launch pad for behavioural directives. And some of the kids tutored play junior in turn. As we’ve seen from the pathetic tone of the TAC’s public statements. In his essay, The AIDS Cult and its Seroconverts, included in The AIDS Cult, Young notes incidentally that even the name, ACT UP, the AIDS activist organisation lobbying for AIDS drugs with branches all over the US and elsewhere, comes from what children do to win attention. Like Achmat and his refusal to take his medicine, playing up, mouth clamped shut.

CHAPTER

Much of USAID’s annual $54m grant to South Africa goes ‘into Aids programmes, including initiatives that deal with aspects of mother-to-child transmission’ – so US Senator Jim Kolbe told journalists in early April 2002, and slated to go up to $62m in 2003. Add a zero to work out the South African rand equivalent, and you begin to understand why there’s a chokehold on the free flow of ideas about AIDS in this country. Because thinking about AIDS is bad for business. And business in AIDS in South Africa is very good. Kolbe could have learned his lines from Cameron:

It is tragic that we have such a lack of leadership on the part of central government to deal with this problem, but we are getting services to where it is needed … So we are in South Africa simply working around the lack of leadership at the central government level to make sure that we’re dealing with the Aids problem. The money is getting there [‘to private health foundations, NGOs, clinics, hospitals and provincial governments’], the programs are there. … It is very sad and I’m very discouraged to see that the government has decided to appeal the decision of the [High Court] here to allow the distribution of nevirapine. They have not been able to demonstrate one bit of evidence that shows it is not a safe drug. [But see The trouble with nevirapine.] And when you’re looking at the alternative, which is certain death, it strikes me as common sense to make this drug available: it’s being used widely everywhere else. It is a tragedy of unspeakable magnitude.

He said he didn’t understand Mbeki’s position on HIV/AIDS; Mbeki was seen as a ‘conflicted’ back home. Whatever that’s supposed to mean. But basically unwell on top, since to a guy with Kolbe’s imagination Mbeki’s independent standpoint on AIDS can only signal mental disturbance. Imagine a senior South African politician visiting the US and publicly commending Michael Moore’s book about the Bush administration, Stupid White Men – ‘providing fascinating details on just how stupid Bush is’, as the back-cover blurb puts it. Or quoting gaffes from Mark Crispin Miller’s hilarious but chilling collection, The Bush Dyslexicon (Bantam Books, 2001), such as, ‘More and more of our imports come from overseas.’ Or pointing out that even one of Canadian Prime Minister (at the time) Jean Chretien’s aides openly called Bush a ‘moron’ in late November 2002. Followed by Mandela in late January, describing him as ‘a president who cannot think properly’. Kolbe went on: ‘There is no doubt he is a brilliant individual, probably one of the most intellectually brilliant people that has ever been a leader in Africa. He is a person that should know better that to say the kind of things he has said about HIV/Aids. That’s why it is puzzling to us.’ Not to Arthur Schopenhauer though, who once explained: ‘Intelligence is always invisible to the man who has none.’

It’s not only the Americans pitching in to save South Africa from AIDS, but the Europeans too. On 8 February 2002 the EU’s European Commission announced that it had allocated 50 million euros (about R400m) in aid, to be spent over 6 years to fight HIV/AIDS in South Africa and to strengthen primary health care.

To top up the coffers, as if we we’re running short, Health-e reported on 26 April that the Global Fund to Fight HIV/AIDS, TB and Malaria had just added R1.8 billion. Explaining why the United Nations was funnelling much of the cash – about R800 million – directly into AIDS organisations in KwaZulu-Natal province, rather than to national structures, a spokesman for the fund, Dr Christopher Benn, said that it would make these direct injections in countries that ‘suppress or have not established partnerships with NGOs’.

Both Mbeki and Tshabalala-Msimang were justifiably irked by the UN’s move to bypass national government and defy national policy. The Financial Mail reported on 14 June that when the minister demanded that the grant to the province be forwarded on to national government, Professor Umesh Laloo, dean of the University of Natal’s medical school and leader of team that had made the direct bid for funding, blew her off with the retort that his bid had been accepted already and it was too late for her to interfere. The next thing was that Laloo, along with the provincial premier and health MEC, found himself up on a red carpet before Mbeki and Tshabalala-Msimang ‘to explain the province’s breach of bid protocol’. But that was just a red herring, claimed Heywood in the Mail&Guardian on 26 July; the real reason for their opposition was because ‘When the grant goes ahead it will be the beginning of the provision of antiretroviral drugs to poor people in the worst-affected areas.’ The TAC’s national manager Nathan Geffen added: ‘What lies at the root of what is going on is the agenda of the AIDS denialists.’

Archbishop Ndungane’s reaction to Tshabalala-Msimang’s persistence in her objection was to demand that she resign, adding, ‘We must eliminate the fear fuelled by misinformation and stop dithering about response and responsibility [which is to buy AIDS drugs with the UN money]. We must unite in a stand for hope.’ The TAC’s response was to threaten to sue her. On 11 July, flushed with victory against the government in the High and Constitutional Courts over nevirapine, Heywood announced that another interdict application was on the cards: ‘The Ministry of Health, and the Minister of Health in particular, in trying to block that grant. It is extremely urgent that this situation be resolved quickly. It is not beyond the rules [sic] of possibility that we take this to court. This situation is about saving lives.’ UNAIDS director Peter Piot chipped in that ‘governments blocking funding of care and treatment’ might be bypassed in future, with the money being sent to ‘civil society’ instead, ‘as happened under apartheid’.

On 19 June, claiming that two thousand babies get AIDS [sic] from their mothers every day, Bush announced that he had proposed the allocation of a further $500 million to ‘prevent mother to child transmission’ in eight African countries and the Caribbean – in other words to buy to buy AZT and nevirapine for pregnant black women, to ‘save children from disease and death’ – on account of being born to ‘AIDS-infected’ mothers. As the New York Times put it: ‘Included on the target list in Bush’s proposal is South Africa, which has the highest rate of HIV infection in the world. The government there had until recently been widely criticized for government policies that did not do enough to provide access to lifesaving treatment.’ AZT and nevirapine. ‘Lifesaving’ like Nestlé formula milk.

On 23 July the German government announced that it had committed R550 million to South Africa for various vaguely defined, feel-good projects, with HIV-AIDS prevention on the top of the list. And that it had made a grant of a further R9 million for constructing and manning centres for HIV testing and advice. A statement from the German embassy went: ‘The devastating HIV/Aids pandemic remains a central cross-cutting issue in the development cooperation with South Africa.’ Cutting across the most basic common sense and empirical facts.

The US NIH’s NIAID bought itself some political shares with the Bush administration on 26 July by announcing through the US embassy here a grant of R110 million for AIDS research made to ‘a new, collaborative Center for the AIDS Program of Research in South Africa (CAPRISA), led by the University of Natal in Durban’. The idea seems to have been to deliver an implicit insult for Mbeki. The embassy commented that ‘the grant is one of the largest NIH grants made directly to international investigators. It demonstrated that South Africans can be among the world leaders in HIV/AIDS research and that the U.S. is prepared to be a committed partner in South Africa’s fight to prevent and treat HIV/AIDS to save human lives.’ Stuff Mbeki wasn’t doing and was frustrating. With all this pointless talk of his about poverty and things. If you won’t do your job looking after your people, we will.

Joining the fashion for pouring cash into the country to wage war on AIDS, the Danish government pledged R110 million of its own for the fight on 19 August.

There can be no gainsaying that, like apartheid and Nazism, AIDS, with the massive infusion of cash it has drawn from abroad, has been a fantastic boon for job creation, and a huge boost for the economy – tapped here largely by the lighter castes. For consultants, advisers, researchers, counsellors, non-governmental organisations, journalists, university academics, project managers, auditors, advertisers, printers and hoteliers, AIDS has been a bonanza bigger than Christmas. And for the fight against AIDS there’s a king’s ransom swilling around the country right now, and particularly in KwaZulu-Natal. The terror and hopelessness inflicted upon the mostly poor by its beneficiaries is a matter of no account. The trouble with this kind of massive infusion of money is that, as Indian AIDS dissident activist Anju Singh in Delhi has noted, it ‘sidelines our democratic institutions to the dictates of alien agendas’. And it practically buys opinion, chokes off critical voices, and effectively bars scientific inquiry and policy formulation off the beaten path. It’s why the Wellcome Trust have so generously endowed a chair at the University of Cape Town’s medical school, for instance. Followed by two research fellowships worth ten million rand over five years announced in June 2003. To keep things on track. Theirs.

And it’s not just an incidental effect of pouring tons of foreign cash into our country that our democratic institutions are sidelined – it’s become a deliberate policy of the UN. Using big business as a conduit. On 30 August Business Day reported:

The United Nations (UN) has abandoned its policy of relying on governments to tackle the HIV/AIDS crisis in developing countries, saying it will now help fund corporate initiatives to provide antiretroviral drugs to sufferers. It may also presage a situation in which the SA government, which is reluctant to concede to most prevailing orthodoxies about the pandemic, is simply bypassed by international agencies wishing to assist affected populations. … Peter Piot, [head of UNAIDS said] that the $2bn UN Global Fund ... would consider supporting corporate programmes that offered antiretroviral treatment to employees and their dependants

– in line with his plans to bypass ‘governments blocking funding of care and treatment’, as he said in July, the money being sent to directly to ‘civil society’ instead, ‘as happened under apartheid’.

Excited by talk of such lolly, the South African Medical Association made a pitch, announcing in the Cape Times on 3 September that it intended establishing two stations in each province, one urban, the other rural, through which people ‘with HIV/AIDS’ would be funnelled ‘to doctors in the private sector ... paid a lower rate than usual, but ... assured of a large number of patients’. SAMA had trained eighteen hundred of them, it said, many of them members of its HIV/AIDS Clinicians Society. Its president Des Martin said the drug-dispensing programme would be the biggest in the world, dwarfing those in other countries. All it needed was R80 million. To pay for the drugs, it said. And, of course, the all-important doctors’ consulting fees.

After three visits to persuade him to act as patron of this clever business scheme, SAMA president Kgosi Letlape reported that he’d got Mandela ‘very keen to get involved’. So announced the Mail&Guardian on 20 September with expected fanfare in a front-page headline: Mandela leads charge on Aids. The caption to a photo inside seemed to have confused him with Jesus: ‘Nelson Mandela has toured the country calling for a treatment programme and for the sick to come forward.’ And for just one light moment we thought the editorial, Roll out the drugs, meant reefer – until we read:

This week the admirable South African Medical Association boss Kgosi Letlape announced a plan, backed by former president Nelson Mandela, to give free anti-retroviral treatment to those who cannot afford the drugs. … Manto Tshabalala-Msimang has complained she is being forced to “poison my people” by providing anti-retrovirals. … One can assume she would not act and speak in this way if her principal, President Thabo Mbeki, disapproved. … And to show that they are no longer prey to dissident fantasies, the health minister and her Cabinet colleagues should consider submitting to Aids tests and publicising the results.

Classic Howard Barrell, getting in his last word on the South African AIDS epidemic before quitting to emigrate to mother England.

Any Cabinet member lighting up the ‘antibody’ test can get ‘monitoring tests’ done cheap: on 20 August the South African HIV-AIDS Clinicians Society announced that anyone consulting one of its members could get a half-price discount for an HIV test, viral load and CD4 cell count combo from Toga Laboratories. Penny Penhall, a ‘spokeswoman for the society’ said: ‘The society views this as an important development which could ultimately lead to an increasing number of people living with HIV/Aids being able to access antiretroviral therapies. …Toga has also notified the Treatment Action Campaign about the offer and we urge other laboratory service providers to join in this initiative.’ It would have been a bit awkward also telling us that Toga Laboratories’s Des Martin moonlights as president of the HIV-AIDS Clinicians Society.

On 26 September the Anglican Church announced that it had adopted a R22.5 million programme to fight AIDS by way of ‘a youth ministry curriculum on sexuality and HIV’, ‘pilot projects for ministry with orphaned children’ and the development of ‘a policy for AIDS in the workplace’. Drawing it up had taken a year, it said, with over a thousand parishioners participating in the process. Every single Anglican diocese in the country would be involved in implementing it. And who would be funding these aforementioned services? Foreign governments and institutions, starting with R1.8 million from USAID, the church announced, to be administered through the Church’s Mothers’ Union and the Anglican Women’s Fellowship. Archbishop Ndungane took off overseas the following week to shake down international donors who had expressed interest in the programme – accusing Mbeki, Tshabalala-Msimang and the government of being sinners and criminals before he left: it was ‘sinful’ to withhold AIDS drugs, he said, and ‘It is criminal that thousands remain at risk of HIV infection and still many more are dying from lack of treatment. This is all because of government’s failure to obey the law and act.’ Maybe we should throw the criminals in jail. Or make them do some penances. For their sins.

On 31 October, at the 6th World Congress of the International Association of Bioethics in Brasilia, Brazil, the Wellcome Trust launched a £34m scheme to finance research into ‘the ethics of biomedical research in developing countries’. The principle target for the imminent funding deluge was suggested by the posts of the guys announcing it: Michael Bennish, Head of the Wellcome Trust’s Africa Centre for Health and Population Studies in South Africa, and Sassy Molyneux from the Trust’s Kenya Unit. Any chance of getting a grant to explore and report the ‘social, ethical, legal and public policy issues’ involved in giving AZT to pregnant women? Rape victims? And South Africans generally?

One of the biggest AIDS projects in South Africa, funded mostly from abroad, is an ‘AIDS awareness’ campaign called ‘loveLife’. All around the country its enormous billboards elevate the most humdrum, timeless politics of sexual negotiation to some sort of urgent contemporary issue. Always suggesting deadly danger below the belt: ‘I only do it skin on skin. James 18.’ As if there’s something reprehensible about that. The deadly hint is driven home by such messages as: ‘Eish, I’m doing too many funerals these days.’ The largely white ad agencies and ‘AIDS workers’ who turn out this slickly presented propaganda assert that everyone’s at risk, but the black township slang and mostly vernacular names appearing in the messages leave no doubt at whom it is targeted. As does the name of loveLife’s toll-free AIDS counselling helpline: ‘thethajunction’ – thetha being Xhosa for talk, but how many whites outside the Eastern Cape know that? And then there’s the location of the billboards – everywhere, but especially on arteries in and out of small towns with colonial names in drab rural backwaters, beaming their brightly coloured messages at their predominantly black inhabitants.

A daily affront to the local poor, the garish loveLife signs sharply exemplify the irrelevance of AIDS ideology and prevention programmes in such regions, where the social and infrastructural investment need is so obvious, the waste of money so gross, and the ignorant arrogance of the city-slickers who ‘workshopped’ their inane messages so offensive. And of course the parallels with Christian mission penetration a century and more earlier are striking. Until recently, the most common loveLife billboard urged parents: ‘Love them enough to talk about sex’ – absolutely foreign to African culture. It was followed by: ‘Tell them sex is worth waiting for.’ The effect of the loveLife messages is to drill blacks with a negative racist sexual stereotype, as ugly and insidious as the lessons in Bantu education textbooks, and they reinforce the same in the minds of whites, and South Africa’s other non-black populations. So that a white caller can phone in on the national Talkback radio show on 27 November 2002, and complain irritably about Mbeki’s questioning of what causes AIDS, because ‘everybody knows it’s promiscuity that’s killing our people, not poverty’. By ‘our people’, of course, he meant black. Since whites are doing swell, as always. And a report of a nationwide survey conducted by the Department of Health, released five days earlier, found that whereas two years ago a similar survey conducted by Soul City found that forty-seven per cent of black and ‘coloured’ people thought they were at risk from AIDS, the figure was now sixty-seven per cent. But only half as many whites did: thirty-five per cent. Since the ‘messaging’ is so obviously not directed at them. Indeed, the report recognised this: ‘White respondents were less likely to perceive themselves, their peers or partners as being “at risk” of contracting HIV/AIDS, and therefore may take less interest in the issue. This highlights the dangers of HIV/AIDS being labelled as a problem affecting particular groups of people and the imperative need to develop a range of messages which appeal to different audiences.’

Too late for the next crop of loveLife billboards, pasted up in November 2002: all but two that I’ve seen feature blacks. ‘Too smart for just any body’ says a pretty black girl. Implying that black girls are congenital sluts. But the billboard will put a stop to it. ‘Sex – worth waiting for.’ Till when? The eager looking black couple on the billboard offer no clue

In his study, The Libidinal Economy, post-modernist philosopher Jean Francois Lyotard set out further objections, both political and practical, against campaigns like loveLife’s: denying libidinal drives is an implicitly authoritarian act, but more than that, in repressing natural processes beyond logic and reason they are always doomed to fail. Because American propaganda on roadside billboards is hardly going to cool anyone’s hots. Sex owns itself. As rivers tend to the sea.

An article in the November 2002 issue of the South African Airways magazine Sawubona revealed the premises from which the loveLife programme proceeds, and the quality of the social science research behind it: ‘The idea was conceived by a group of South Africans along with the [American] Kaiser Foundation because they believed [!] that conventional public health messaging wasn’t working. A loveLife survey found that over half of the girls questioned said they didn’t want to have sex with their boyfriends, but did it anyway because they thought they had to. Sex in exchange for money or food was found to be common, and a high proportion of girls admitted that they had had sex with teachers in exchange for good marks. The survey also found that many young men didn’t understand what constituted rape. These attitudes were all threatening to worsen the spread of Aids.’

The girls in question would have been black. Since no one is suggesting that white boys and girls are spreading AIDS. Given the starting assumptions of the ‘concerned group’ of South Africans and Americans who drew the questions (‘who believed that conventional public health messaging wasn’t working’) the manner in which the questions in the survey were framed are bound to have shaped the answers. Is it really likely, if we could just come down to earth for a while, that more than half of girls who have sex with their boyfriends don’t think it’s the best thing going? And really think ‘they have to’. That screwing for money or food was common? As opposed to occasional. Other than among the destitute for survival – in which case, ‘messaging’ will be totally irrelevant. That ‘a high proportion’ trade sex for marks? And that many young men couldn’t tell the difference between willing and forced, and didn’t know that might in place of a smile to score a home run was against the law?

On 25 September 2002, accompanied by gay actor Kevin Spacey, Bill Clinton flew into Rwanda on a mission to help save Africa from AIDS: ‘I believe reversing the AIDS [epidemic] is the most important issue that is facing the whole world,’ he said. ‘It should unite all people.’ People with nothing better to do. Three days later he hooked up with another retired President – ours – having shared the podium with him in July at the opening of the Barcelona AIDS Conference. The meeting with Mandela was arranged to consecrate the new loveLife Y-centre at Orange Farm, a poor black township near Johannesburg, where they joined Kaiser Foundation boss Drew Altman in making speeches and pledging their support for the loveLife programme. We should be ‘rolling up our sleeves and climbing into the trenches’, said Mandela. Make no mistake, Tata, on the medicine you want everyone drinking – (it’s ‘a matter of time before we will see a huge infusion of anti-retrovirals into the health system’) – it’s into the trenches we’re headed, the ones dug side-by-side. The skull and crossbones on the orange Sigma label leaves no doubt. Mandela spiced his exhortations with a dash of struggle talk: ‘Orange Farm is a product of apartheid. Orange Farm is testimony to our people’s fighting spirit.’ What oubaas failed to notice is that ‘our people’ weren’t there. Other than the BMW set cruising in. It was apartheid again: for ‘security reasons’ local community leaders and residents were excluded from the festivities.

The gap between Mandela’s political naivety, as compared with his incumbent successor’s radical ideological sensibilities – way beyond European left and right – was highlighted by the Anglophile’s wholehearted participation in what was essentially a frenzy of big business dealing, as the Sunday Independent made plain the next day:

A number of new partnerships between business and loveLife were announced and these include reiteration of existing partnerships with the South African Broadcasting Corporation, the Sunday Times and Independent Newspapers, Custom Group Holdings and Spoornet, as well as innovative new partnerships with Mondi Paper, South African Airways, Ster-Kinekor, Sentech, the Vodacom Foundation, the Digital Partnership and ... MedScheme. The value [to loveLife] of these partnerships [discounts and concessions] exceeds R50 million a year. The existing public-private partnership between the government and the Henry J Kaiser Foundation in support of loveLife was also consolidated.

SABC radio reported on the evening news that the Nelson Mandela Children’s Fund and William J Clinton Foundation were pitching their cash in too. Not that loveLife was running short; it’s funded to the tune of $20 million annually, half from the Kaiser Foundation, and the rest from the Bill and Melinda Gates Foundation, topped up to the rim by the Department of Health.

Don’t think for a moment that the business types involved were in it for the love of it. As Fair Lady made clear in June 2002:

Ster-KineKor and loveLife have a new partnership that gives loveLife exposure on screen and in Ster-Kinekor foyers, and branding in Ster-Kinekor’s public toilets. In return, Ster-Kinekor will gain exposure in the loveLife print publications, youth centres and clinics. … Ster-Kinekor marketing executive Odette van Wyk argued that the agreement with loveLife was a win-win one that had a commercial element for Ster-Kinekor, which was ‘very interested’ in the youth market loveLife was reaching.

Pick up either of ‘loveLife print publications’ Scamto and ThethaNathi, included inside the Sunday Times and Sunday Independent, for which favour loveLife pays millions beyond counting, and it seems to be less about Fucking than Shopping. Apart from the latest must-see movie on circuit at Ster-Kinekor cinemas, the glossy supplements punt must-have high-ticket fashion gear like Soviet and Skechers shoes.

Mandela could see no further than a public spirited indaba at which to plan getting the safe sex message across: ‘I applaud the government for ensuring funding and for its far-sightedness in recognising how necessary it is to get the attention of young people.’ Before they all screw themselves to death, as American doctors like Drew Altman fly over to warn. His jaw jutting presidentially in the photo, like Kennedy’s. Or some other Ivy League toff. Mandela admiringly quoted Clinton’s soaring oratory on a previous occasion: ‘... the question is not what can be done for Africa, but what can be done with Africa.’ The kind of paternalism at which Mbeki bridles, but not our grandpa. Mandela’s lines were recited on stage with pitiful cluelessness as to the bigger picture. It wasn’t about sex and nefarious germs and runaway African promiscuity; it was about markets and money and control. By Americans. Relishing the revived power and popularity that his AIDS drug advocacy was giving him, Mandela made plain that he had no intention of quitting the back-seat driving that was proving so irksome to Mbeki and the leadership of the ANC. After calling two of his grandchildren up on stage, he waged his finger at them and then said: ‘I have 29 grandchildren and six great-grandchildren. They are very naughty. They tell me I have lost power and influence, that I am a has-been. They tell me to sit down. That I must stop pretending I am still the president. Now, you have heard all these important people here today, you have heard what they say about me. So, now you must stop telling me to sit down!’ It was really rather pathetic. But at the same time it highlighted a most remarkable switch in positions. We noted earlier that as President, Mandela had showed no interest in the AIDS craze whatsoever. Deputy President Mbeki, on the other hand, had been swept up in it. But within weeks of his succession he began to find out that it was all a lot of nonsense, like the mediaeval witchcraft mania. And as Mbeki’s faith lapsed, Mandela’s took off.

LoveLife CEO David Harrison was quoted in the Sawubona article saying, ‘It’s too early, after only three years, to tell how successful loveLife has been. But so far the evidence is positive.’ Liar, liar, pants on fire: the month before, the popular magazine Bona reported the results of a sex survey that loveLife had just conducted. Harrison was mum about it. Not surprisingly: Despite being bombarded by the loveLife message on billboards, over the air, and in glossy newspaper supplements year after year, seventy-eight per cent of teenagers had had sex by the age of fifteen, thirty-two per cent of young guys never used condoms, and a further thirty-nine per cent generally avoided them. So much for: ‘I told James to wrap it or zip it. Zola 17.’

The results of loveLife’s own survey were hard to match with rather different claims made by loveLife on the little flip-down overhead TV screens of its ‘partner’ in the war on AIDS, South African Airways: ‘Sixty-seven per cent of young people exposed to loveLove say they are now more likely to delay or abstain from sex.’ Giving the kind of answers that will please the researchers. Boyfriends and girlfriends exchanging winks after they’ve left. Probably left with a free loveLife tee-shirt for participating in the study. And some condoms.

Responding to a critical article about his organisation’s programme in the just-mentioned issue of Fair Lady, Harrison began with the old ruse of the AIDS trickster, deflecting criticism with incoherent alarmist propaganda: ‘LoveLife is different, and deliberately so. Up to 50 percent of our children under the age of 15 will, sometime in their lives, contract HIV – unless we change the course of the epidemic.’ The rest of his defence was more of the same flimflam. Thought up in his new Jag on the way in.

The government, we recall, was lambasted endlessly over the Sarafina II episode, in which several million was spent on taking an energetic musical play around the country to sell safe sex to black youngsters. It was conceived, written, produced, staged and acted by black artists. There is no reason to believe it had any more or any less influence on the sexual behaviour of its target audience than the loveLife programme that succeeded it. Especially since official ‘messaging’ has never had the slightest effect on private behaviour anywhere in the world. Be it concerning sex, drugs or rock and roll. Relative to the cost of keeping the loveLife scam going, Sarafina II was small change. Why then, notwithstanding its failure to show anything for all hundreds of millions spent on it, the loveLife programme hasn’t been condemned in similar terms, its executive board locked up as Harksen type swindlers, appears to me to be because loveLife was thought up by and is supported by whites. Local and American. Aiming to control the sexuality of blacks. (As they sought to do while propounding the population explosion myth.) On the basis that it’s black sexual intimacy that’s spreading disease. With the guys at it like excited dogs, and the girls yielding like complaining cats. Or for pay.

In April 2003 loveLife hired actor John Kani and musician Johnny Clegg, both international South African brand names, to recite on radio and television: ‘Most teenage girls who have had sex say their boyfriends gave them no choice.’ The inherent improbability of the implication that for most girls under twenty sex is rape, like so many other outlandish claims in the AIDS age, doesn’t faze them, or anyone else, and it richly reveals the essentially unrealistic, religious character of HIV-AIDS dogma – driven by an ‘all men are brutes’ subtext supplied by American feminism’s lesbian left misandry. As AIDS itself does, I think this American feminist concept of female victimhood springs originally from Christian constructions of sexuality and morality, and succeeds them essentially unchanged – the idea that sexually and morally men are basically bad, and that women need protecting from them. Don’t yearn equally strongly for sexual union either. The pervasiveness of such thinking in the US, this contemporary feminist ideological offensive against men, against masculinity, even against male children in schools, is charted in grotesque detail by Christina Hoff Somers in her book The War against Boys (Simon and Schuster, 2000). And now it arrives on our shores, exported from the US, in the form of loveLife’s current behavioural modification programme. Aimed exclusively at males. Fathers urged: ‘Talk to our sons about the difference between love and sex.’ As if they need telling. As if feeling, suffering in love, is the female preserve. ‘We need to help our sons become real men.’ As if they need helping – and, when it comes to getting down, girls don’t get equally hot and heavy. Instead, stand around frigidly backs to the wall, pigeon-toed, knees clamped, their eyes gazing heavenward like the Mother of God. Keeping the dog off. Aren’t finally in charge of the whole game. Transmitting all the signals to play. And holding the ace always, pouting petals glistening.

Bisexual, post-feminist radical Camille Paglia commented on the modern foundation of the thinking behind the new loveLife project:

A major failing of most feminism is its dumb stereotyping of men as tyrants and abusers, when in fact men are tormented by women’s hemming and hawing, their manipulations and humiliating rejections. … It is woman’s destiny to rule men. Not to serve them, flatter them, or hang on them for guidance. Nor to insult them, demean them, or stereotype them as oppressors. It is not male hatred of women, but male fear of women that is the great universal.

In an article he wrote on 2 April 2003 for , in which he described how he nearly got arrested for asking awkward questions at a university AIDS panel meeting, David Crowe in Calgary, Canada provided a crisp deconstruction of this ‘feminist model of AIDS’ – with its especially horrible implications when applied to Africa: it conceptualises women as

the victim of sexual aggression by men, with HIV being transmitted as a side effect. This feminist argument relies on heterosexual intercourse being the main means of transmission of HIV. Without this, the connection between sexual power politics and AIDS falls apart. The argument has two other weaknesses as well. It portrays men as incapable of love and fidelity, stereotyping them as interested only in satisfying their own lust, with no concern for women. Women on the other hand, are portrayed as sexually passive, as incapable of being sexually irresponsible or adventurous as men are of being responsible. Ultimately, it is a very Victorian view of both genders. But a larger problem is the unspoken, racist, dark side to this view. If all men were like this, then AIDS should be evenly distributed around the world, not just in Africa. Consequently, a corollary of this argument is that it is largely black men who are insatiable sexual predators. People who attend these meetings do care about the world, probably much more than average. Consequently, beliefs about AIDS have to be wrapped in a rhetoric that will appeal to them. The story that people are dying in Africa because men are irresponsible, and women need to be more empowered, is an attractive idea. None of these people would have likely attended if the panel spoke directly of how black men are sexually irresponsible. Yet, this is the racism underlying the feminist sugar-coating.

CHAPTER

There’s a palpable backdrop to all the special AIDS excitement in South Africa. The privileged castes are tense and unhappy. The reassuring certainties of the old order are recently gone, even if they were inherently untenable and unstable, and, by a tiny few of the elites, abhorred. They fret about what the future holds for the country and their children. With Mbeki prioritising poverty relief and development over Mandela’s reconciliation agenda. And always going on uncomfortably about racism everywhere. An editorial by some prominent ANC intellectuals – Netshitenzhe, Jordan and Cronin, inter alios – drew the scene well in the tenth issue of Umrabulo, the ANC’s steam-chamber for analyses of the state of the revolution, published on May 2001:

A variety of classes and strata see in the project of social transformation an immediate challenge to their material conditions and way of life. … Running across the mindsets of most of these classes and strata is a common fear of ‘black majority rule’. This conjures up images of vengeance, collapse of the rule of law, dispossession, and all the frightening things that the Natives can do! To these, the apocalypse has just been postponed. Reconciliation and nation-building meant a reprieve from this outcome; and the ‘miracle’ of transition had to be followed by pestilence and the rumblings of hell and damnation. In other words, the political constructs of the white-based Opposition are not artificially generated. They are a genuine representation of the fears, prejudices and defence-mechanisms of sections of communities that have psyched themselves into a siege mentality.

An AIDS-ridden black populace at the gate is just such a construct, and it perfectly embodies them all. A construct with immense cohesive ideological potency, around which all manner of inchoate apprehensions and dark ideas cohere. AIDS plugs the ideological void left by the sudden collapse of apartheid. Whether you were pro or con. I pick this up over and over at social gatherings. A gay journalist high on E, with whom I was enjoying a friendly conversation at a party in Cape Town in mid-July 2004, became aggressively agitated at the first whiff that I was a ‘dissident’, as he noisily declaimed repeatedly, caused a big scene, and had to be calmed down by others around us. To question AIDS is to experience, as Rian Malan noted in noseweek and the Spectator in December 2003, something ‘very ugly: ruined dinner parties, broken friendships, ridicule’. The psychic power of AIDS as an ideology, over those whose inner world is ordered by it, strikes me afresh every time. It is not to be trifled with.

For ‘the most privileged society this side of the Shah’s family’, as someone once quipped about white South Africa, things are changing rather fast. Such a climate is conducive to ‘hysteriform manifestations’, notes Sirois in his analysis, Perspectives in Epidemic Hysteria (included by Colligan et al.): ‘The climate of the Catholic Inquisition, ... which dealt with the legal examination and sentencing of witches, arose at a time of strains and tearing of the social tissue with the exploration of new worlds, the uprising of free thinking and the rupture of the religious order’ with the Catholic Church losing its complete power over body and soul in Europe and Protestant sects getting going.

The Inquisition into heresies is akin to our post-revolution AIDS mania, a type of ‘maladaptive group response’, assuring a ‘diffused responsibility between members, a displacement of wrongdoings and the taking over of the situation by external agencies (administrators, police, doctors etc)’. And then, with a raspberry for both Cajee and Cameron at the Wits Special Assembly, Sirois moots: ‘Moreover, it might be hypothetically put that the leader who operates as the Ego of the group aligns himself along the wish of the index case, thus fostering the identificatory process of all members to the wish of the affected individuals, increasing the fantasmatic resonance in the group.’

‘It was surprising ... how ... university faculties knuckled under the Nazification of higher learning after 1933,’ noted William Shirer in The Rise and Fall of the Third Reich. He quoted Professor Roepke (fired for resisting): ‘It was a scene of prostitution.’ Well, Prof, you wouldn’t have wanted to be anywhere near Wits on 7 March 2001 – with its speakers exhibiting ‘the zeal of a Goebbels and the fuzziness of a Rosenberg’, as Shirer described the ‘preaching of the Nazi gospel’ by Rust, Reich Minister of Science, Education and Popular Culture. Cooking up a spectacle deplored by Susan Sontag: ‘That even an apocalypse can be made to seem part of the ordinary horizon of expectation constitutes an unparalleled violence that is being done to our sense of reality, to our humanity.’ But violence is the lifeblood of fascism, Susan. You should know that. It’s what makes AIDS and all it implies so attractive to Cameron and what he calls his ‘AIDS movement’.

Culturally, apocalyptic paradigms serve the function of jackboots, as Efron explains in The Apocalyptics:

A frightful catastrophe [is declared] to be imminent, so imminent that there is no time for facts, logic, or the slow, serious development of an authentic predictive science – if such a predictive science is possible. Once adopted, the ‘apocalyptic paradigm’ acquires a pathological life of its own. It leaves time only for hysteria, for ‘suspicion’, for scientific ‘fiction’ and mythology, for demagogy – and for the use of political force to impose moral and political substitutes for science on industry, on the nation – and most crucial of all, on the academic opposition. … It is a profoundly anti-intellectual phenomenon, which, in the realm of science, is to say that it is profoundly antiscientific. … The ultimate effect of the ‘apocalyptic paradigm’ has been to inaugurate a mitigated Lysenkoism … – mitigated because those scientists who dissent are free to publish in arcane journals rarely or never seen by the press or the public. [This, for the most part, is precisely the experience of AIDS dissident scientists.] They are simply not free to argue with the state where the citizens and the press will hear them. [Efron was referring to the state in the context of state-supported paradigms, such as those propounded by its cancer agencies.] … Thus the public has not only been kept from encountering scientific dissent, but has been educated to believe that scientific ‘truths’ imposed by the state are morally and intellectually proper, while dissent from the state in this realm is evidence of intellectual and moral corruption. Whatever other roles it may play, this particular result of the ‘apocalyptic paradigm’ is culturally deadly.

It’s worth noting here that in South Africa the unique situation exists where the democratically constituted state stands on the side of scientific dissent. The resultant fallout is revealing about the extent to which the country remains governed by extrinsic and hostile ideological and economic forces, and how weak it is to resist them. So that in the teeth of their vehement opposition, Mbeki and Tshabalala-Msimang would later find themselves railroaded into shelling out billions to provide AIDS drugs in the public sector.

In his essay The Homofascist Identity, published in the radical American gay journal Magnus in April 2000, Alex Russell (son of film director Ken), queer himself, pounded the particular gay psychology of Cameron’s ‘AIDS movement’ with exploding shells like:

Fascism’s obsession with rebirth, the new man, youth and the cult of the masculine is found in the Leni Riefenstahl-inspired body images promoted in HIV pharmaceutical advertisements. Such HIV Volkisch Kulture imagery is the Nazification of the Queer Body Politic. … AIDS doctors (like Nazi doctors) operate through genocidal bureaucracy using pseudo-science to justify sexual ethnic cleansing. Many gay men branded HIV-positive passively accept that they are marked for slaughter, slavishly sign their own death warrants and run giggling into the gas chambers. … Robert Jay Lifton [a scholar of Nazi medical philosophy] wrote: ‘The genocidal bureaucracy contributes also to collective feelings of inevitability. The elaborateness of the bureaucracy’s organization conveys a sense of the inexorable – that one might as well, as a perpetrator or victim, go along because nothing else can be done. Under certain circumstances, victims’ bureaucracies can be coerced into participating in their own people’s victimization.’ … Today, the many AIDS bureaucracies run by gay careerists are participating in their own queer brothers’ iatrogenic and psychogenic annihilation. … Fascism is said to be an example of the administrative mechanism of power coupled with old symbolisms of blood … HIVism is genocidal bureaucracy initiated by blood testing rites sanctioned by totalitarian science. Plus ça change?

But Russell’s superb piece cast light onto the dynamics of the Wits 9th General Assembly too: ‘Many attributes of the HIV Homofascist Movement (or HIVism) resemble those of Fascism and the psychology of the Freimen: an authoritarian personality; extreme emphasis on the masculine principal, male dominance and blood brotherhood bonding; exclusive membership of an elite in-group; and the fetishization and aestheticization of suffering, self-sacrifice and death.’

Another Russell commenting on the same tricks – the philosopher Bertrand – noted before him: ‘The next step [in a fascist movement] is to fascinate fools and muzzle the intelligent, by emotional excitement on the one hand and terrorism on the other.’ Both in abundance at Cameron’s Wits rally, and in his ‘AIDS movement’ generally – inspiring the deepest terror in the lumpen, and more fervour in its lay preachers than any other contemporary cause. Wilhelm Reich amplified: ‘Reactionary concepts plus revolutionary emotion result in fascist mentality.’ (But you really mustn’t go about saying so because, as Miguel de Unamuno noted: ‘That which the fascists hate above all is intelligence.’)

Russell the younger continued:

One can see actual group hypnotic trance phenomena working within both Fascism and HIVism where devotion, ceremony, and obedience are called upon and used by the cloned membership of the elite in-group. Fascism and HIVism, as products of group hysteria, are psychologically contagious cultural/social beliefs spread through mass hysteria, mass-hypnosis and mass-media. … Theodor Adorno gave an account of the regressive psychology of organized groups which fits the ethos of the HIV Homofascist Movement: ‘What happens when masses are caught up by fascist propaganda is not spontaneous primary expression of instinct but a quasi-scientific revitalization of their psychology – the artificial regression described by Freud in his discussion of organized groups. The psychology of the masses has been taken over by their leaders and transformed into a means of their domination. The collectivization and institutionalization of the spell have made the transference more and more indirect so that the phoniness of enthusiastic identification and the dynamics of group psychology have tremendously increased.’

David Mertz, a philosopher at the University of Massachusetts at Amherst, delineated another dominant current pumping through the safe sex campaigns of the AIDS activist lobby, and immanent in the new AIDS policy announced at the Wits General Assembly, in an essay published in Rethinking Marxism in Spring 1996/7, Sex Wars: The New Left’s AIDS-Related Scientism. He qualified his observation that the ‘so-called Sexual Revolution of the 1960s and 1970s’ died in the 1980s, by pointing out that very little actually changed in sexual habits after it, or indeed during it:

What has changed dramatically in a decade is the ideological tools and strategies used in conceptualizing sexuality, and the relation of sexuality to broader notions of social power, political struggle, freedom and responsibility. Most of the renegotiation of sexuality has been a determined effort on the part of the right-wing to reinstitute its fantasy conception of ‘family values’, normative heterosexuality, and condemnation of non-monogamy. An additional contribution to such a conservative renegotiation of meaning has come from certain self-identified feminists who have repeated the puritanical strains of 1920s ‘first wave’ feminism in its ‘anti-prostitution/anti-vice’ crusades.

He then hit the nail on the head:

AIDS [as an ideology of sexuality] has succeeded in shifting the left-wing discourse of sexuality away from one of liberation, freedom and resistance, to one of responsibility, danger and obligation – concepts much more at home with a right-wing scheme of social control, xenophobia and authoritarianism than with anything on the Left. “Safe sex” has succeeded in performing this conceptual shift – a shift which would be seen through if it came from traditional conservative forces, and which would be largely resisted if it came from anti-porn ‘feminism’ – precisely because the language of ‘safe sex’ is one inextricably signed with the imprimatur of medico-scientific authority. … The altars of science – in particular scientific sounding pronouncements about AIDS – have been the one significant form of social authority generally unquestioned – or at least not very deeply questioned – by academic leftists. Somehow science has served in dismantling the language of liberation in the Left more than any other institutions possibly could have, because the Left has not gone beyond an automatic doxastic presumption in favor of moralism bearing the imprimatur of science.

Wyndham Lewis, the English writer and painter, explained precisely the kind of science that Mertz refers to: ‘When we say science we can either mean any manipulation of the inventive and organizing power of the human intellect; or we can mean such an extremely different thing as the religion of science, the vulgarized derivative from this pure activity manipulated by a sort of priestcraft into a great religious and political weapon.’

Interviewed for Playboy’s fiftieth anniversary edition in January 2004, actor Jack Nicholson commented on this ‘phenomenon’ described by Mertz that he’d

noticed … These have been troubled times in the area of sexual expression. I rank the publicizing of AIDS right up there with the atomic bomb as events that impacted our culture for the worse. We were moving toward a more feeling, freer society until AIDS, which came along and gave the right wing the chance to reinstitute its idea that sex is negative. Anybody who owned a bar in the 1970’s can tell you it was the end of the bar business, period. It was a sign of society reversing itself in term of the enjoyment of freer sex, because sex was associated with death.

When the interviewer countered, ‘There was always safe sex’, as if, contrary to what Nicholson was saying, having sex without donning a condom had always been considered life-threateningly dangerous, Nicholson rebutted:

But safe sex became the equivalent of ‘I won’t kiss you’ for a girl. It became just another obstruction. Most people who investigated this knew that if you were not shooting up or getting fucked in the heinie, you were as likely to get AIDS as have a safe fall on your head while walking down Wiltshire Boulevard. But you could not proselytize this view. The facts were almost useless. You couldn’t give a woman the facts and have her respond, ‘Oh, all right.’

Quoting Frank Furedi in Culture of Fear, Geshekter explained in A Critical Reappraisal of African AIDS Research and Western Sexual Stereotypes (published online) that ‘For conservatives who want to see “the notion of sexual responsibility [shake] off its puritanical image ... public anxiety about AIDS is seen as an important sentiment for popularizing a more restrictive and puritanical sexual ethos”’ – imposed on African sexuality, Geshekter explains, by ‘conservative appeals to restraint, empowerment, negotiating safe sex and a near evangelical insistence on condom use’. With Cameron, the TAC, the churches, and even the unions standing primly in the frontlines.

But there’s another aspect to it. Chomsky often makes the point that fear atomises us, isolates us, and engenders deference to power, promising security and deliverance. The fear of HIV serves the right handily. And yet paradoxically it has been the left not the right that has promoted AIDS most passionately. Perhaps explained by Spectator associate editor Roy Liddle, taking a very different view from Mertz, in Back to basics in the 28 June 2003 issue of that magazine: ‘... the Left has its heart in a dismal, totalitarian and very Victorian ideology which emphasizes the need to restrain, confine and overcome human nature; if you doubt that, read the Communist Manifesto, and tremble’.

On 11 June 2002 the TAC’s Mark Heywood was interviewed on radio by John Perlman about the Department of Health’s announcement of HIV-prevalence statistics in South Africa the day before, furnished by the University of Cape Town’s Actuarial Science Centre: 4.7 million infected – more than one in ten. They didn’t say, but of course they meant blacks. Having her say after the announcement, the DA’s Sandy Kalyan MP predicted that ‘AIDS could claim more than 10.5 million lives by 2015’. And the Medical Research Council followed a couple of days later with the claim that South Africa would be looking after 1.8 million AIDS orphans by the same year – but antiretroviral medication could halve that number, it said. Like the more ridiculous the numbers, the better they go down. As Hitler understood: ‘In the size of the lie is always contained a certain factor of credulity since the great masses of the people ... will more easily fall victim to a great lie than a small one.’ But the epidemic is now stable said the health ministry; the numbers in 2000 were more the less the same as earlier.

Heywood’s diarrhoeal radio commentary bore out Mertz’s point; it was like listening to a pot of pop-corn going off, with the words, ‘control’, ‘vigilant’, ‘vigilance’, ‘responsibility’ and ‘delaying sexual activity’ snapping out, some repeatedly – from Mr ‘No sex please, we’re British’. The Tony Blair sound-alike drumming out pieties like a moral regeneration preacher. Sexually prescriptive like the director of the Junior Anti-Sex League in Orwell’s 1984. Always equivocating painfully, interpolating his favourite word, ‘but’, followed by the briefest theatrical pause. Along the lines of, ‘Yes this holds out hope, but, we mustn’t allow ourselves to be lulled into losing our vigilance. And becoming irresponsible.’ No fan of Oscar Wilde apparently, who advised in The Importance of Being Ernest: ‘Our responsibility to women is to make love to them if they’re pretty and to someone else if they’re plain.’

A big thing Heywood has with telling people what to do with their privates. On 20 August 2003 he was special speaker at a meeting of Wits Positive, a group formed to promote ‘behaviour change’ at Wits University. ‘Does anyone in this room have sex?’, he asked the largely black student crowd. (Laughter at the silly question.) ‘If you have sex you are at risk for HIV infection.’ So, ‘Get tested.’ Do what I tell you. With your favourite organ. Which means nothing at all. Unless under wraps. Then it’s safe. Through a sheet. Of rubber. For a much reduced emotional and spiritual peak, and correspondingly enfeebled sense of primal unity. And there’s to be absolutely no touching down there. That evil muffin. For which we guys are such suckers. Well some of us. But if in the heat of the moment you are transported away, completely forget, and get your fingers wet, dash for the Jeyes Fluid. Rinse similarly if in the heartiness of your protected gusto there’s an inadvertent spill. I mean one can die from these juices. There’s death in them. In any event, ‘Get tested. Know your HIV status.’ Since if the thing lights up, you’re sure to come back to ask me if you can join my TAC. To fight for drugs. As auxiliaries of the pharmaceutical industry. Eroding the autonomy of the most important new democracy in our time. And betraying your government. An immigrant fink like me. Bargaining for the best price.

Pity Heywood’s girlfriend. Sure, you get me all hot and hard whenever you come near, but we must delay our sexual activities. For some other time. Not quite sure when though. Perhaps we can ask our friend Archbishop Ndungane. Meanwhile I’ll keep my hope up. Hold it out also. We have to be responsible. Vigilant and in control. Of ourselves. Also of each other. Since I like being in control. We must call on others to restrain themselves too, and welcome it when they do. And it would be incorrect to imagine you’re getting a squirt out of me without a condom. I mean I have to set an example. It’s called practising what you preach. Do you take me for a hypocrite? Just because, unlike our counterparts everywhere else in the world, we South African drug industry lobbyists are always saying we don’t accept drug money, but when we go on overseas holidays (‘working’, we call them), we’re happy to let GlaxoSmithKline pick up our expensive registration fees at AIDS conferences. We don’t mind accepting their little thank-you for helping to bust the government’s balls over AZT.

As Elsworth Baker captured it in an online tribute, Wilhelm Reich described Heywood’s type:

Reich’s discovery of armor and orgasm anxiety explained many enigmas of human functioning, such as mysticism and mechanistic thinking. One of the most important of these enigmas he termed ‘emotional plague’. This is the character structure that consistently blocks all progress towards natural functioning. No one is completely free of this malady, but there are certain persons who function essentially as emotional pests. These individuals are generally capable, intelligent, and energetic, but they are anti-sexual and prone to attain positions of authority where they can dictate rules of living; they are the bulwarks of society. They cannot tolerate natural functioning because it creates an intolerable longing in them, so their prime purpose in life is to place restrictions on any natural living. At the same time, they rationalize their behavior so very well that it is accepted as being for the common good.

Another famous champion of natural intimacy, DH Lawrence, similarly warned against the Heywood sort in his essay Introduction to Pansies (flowers!), describing ‘certain persons with a sort of rabies, who live only to infect the mass. If the young do not watch out, they will find themselves ... engulfed in a howling manifestation of mob-insanity, truly terrifying to think of. … Sanity, wholeness is everything. In the name of piety and purity, what a mass of disgusting insanity is spoken and written.’

Reich’s ideas, outlined in The Function of the Orgasm, were developed in The Mass Psychology of Fascism – both books banned, curiously enough, along with all his other work (like it or leave it), by a court injunction obtained by the FDA in 1954 at the instance of the American Psychiatric Association. Which order also directed that the police burn all Reich’s journals, as they duly did. Yes, in the US, not Nazi Germany. (Reich died in prison on a contempt rap for defying the interdict.) Baker gives Reich’s explanation of why AIDS activist Heywood always comes over so tight-assed, looks so uptight: overcome the neurotic’s ‘libido stasis’ and his

face becomes relaxed and expressive. His body loses its stiffness and appears more alive. He becomes able to give freely and react spontaneously to situations. What has made this change? His body becomes relaxed where, formerly, it remained rigid through muscular contraction as a defense against feeling and giving. The neurosis had been anchored in this rigidity, this armor which produced and maintained the character, whose dissolution produces the orgasm reflex, the ability of the organism to yield to its functioning. With this finding came the understanding of character.

But Heywood’s personal drive against natural sexual connection has powerful political uses – identified by Orwell in 1984, in which Winston Smith muses:

It was not merely that the sex instinct created a world of its own which was outside the Party’s control and which therefore had to be destroyed if possible. What was more important was that sexual privation induced hysteria, which was desirable because it could be transformed into war-fever and leader-worship. The way [Julia] put it was: ‘When you make love you’re using up energy; and afterwards you feel happy and don’t give a damn for anything. They can’t bear you to feel like that. They want you to be bursting with energy all the time. All this marching up and down and cheering and waving flags is simply sex gone sour. If you’re happy inside yourself, why should you get excited about Big Brother and the Three-Year Plans and the Two Minutes Hate and all the rest of their bloody rot?’ That was very true, he thought. There was a direct intimate connexion between chastity and political orthodoxy. For how could the fear, the hatred, and the lunatic credulity which the Party needed in its members be kept at the right pitch, except by bottling down some powerful instinct and using it as a driving force. The sex impulse was dangerous to the Party, and the Party had turned it to account.

Hence the fact that during the Stalinist terror in Eastern Europe, noted by Milan Kundera in The Incredible Lightness of Being, ‘Soviet films, which flooded all the cinemas of all Communist countries ... were saturated with incredible innocence and chastity.’

Like Heywood, the leader of another famous political movement had issues with intimacy. Two elements of his neurosis were identified by Joachim Fest in Hitler (Classic Penguin, 2002). He suffered an ‘oft-expressed fear of venereal disease and fear of contagion in general. He knew that “microbes are rushing at me.” He was ridden by … fear of the “niggerizing of the Germans.”’

On 2 December 2001, above the caption, ‘Aids Activist Mark Heywood prays at a news conference this week’, the Sunday Independent published a photograph of him, his joyless visage looking up to Heaven, his hands clasped devoutly together like Billy Graham’s – replicated in pressed copper plate and framed in the lounge of every white lower-middle class home. In AIDS Inc, published in Continuum in August 1994, Farber described the Heywood look: ‘[AIDS used to be] believed to be a medical condition. Today it is a multinational corporation complete with its own belief system, figureheads, logos and even facial expressions ... like a Walt Disney that markets pious morbidity instead of cheer.’ On its website, the TAC has a picture of Achmat seated behind the pulpit from which Anglican Archbishop Ndungane offers a prayer on 1 November 2001 for the toxic eucharist mentioned on a placard at his feet: ‘Nevirapine for pregnant women with HIV/AIDS now!’ His face shining beatifically with the satisfied rectitude of a Crusader’s sword, the clergy on his side. Spooky stuff. Having slipped a ring through the nose of the trade unions, Achmat further swells the numbers of his bussed crowds with an invisible host. A battalion of cherubs. About all of which Oscar Wilde commented a century earlier: ‘Self-denial is the shining sore on the leprous body of Christianity.’

The TAC’s public response to the Department of Health’s HIV seroprevalence announcement was full of the same sex-negative alarmism, and more: the figures suggested ‘that prevention programmes that target youth, but are not complemented by equally strident messages targeting older people (and particularly married people), lose their benefits as people enter relationships where they have less sexual autonomy and control’. Can you follow any logical thread? But anyway, we must keep that sex-is-dangerous message ‘strident’! And banging your brains out in the white-hot burst of a new romance means losing ‘autonomy and control’. Hell, who cares? In the restaurant powder-room. Other than Achmat and Heywood, the sex prefects. Isn’t good sex the very antithesis of ‘autonomy and control’? The more surrendered the better it gets? Can these sad prigs really not know this, not have experienced it? That geyser pounding. Riotously. Milk river bursting forth joyously. Into a wide-open, welcoming, enveloping midnight sea. Apparently not among such responsible guys. Instead for God and country. Just close your eyes, dear, and think of England. And hastily resume your nocturnal apparel afterwards.

Like Achmat, Hitler was also hugely drawn to the idea of sexually transmitted disease; and he recognized the political value of deploying Christian culture’s ancient fear of the bogey as an ideological lever for the accumulation of political power and undermining the legitimacy of the extant democratic state. Hitler goes on and on about syphilis in Mein Kampf (translated by Ralph Manheim; Pimlico, 1992), identifying it with the alleged promiscuity of the Jews. ‘Particularly with regard to syphilis, the attitude of the leadership of the state can only be described as total capitulation. To fight it seriously we will have to take somewhat broader measures than was actually the case.’ He stated one of the ‘broader measures’ he had in mind:

Thus, by the use of all propagandist means, the question of combating syphilis should have been made to appear as the task of the nation. Not just one more task. To this end, [it] should have been thoroughly hammered into people as the most terrible misfortune, and this by the use of all available means, until the entire nation arrived at the conviction that everything, their future or ruin, depended on the solution of this question.

Nazi propaganda later coupled the corruption of the Aryan race by germs with its corruption by bad blood. Jewish people were presented as sexually corrupt. ‘… nightlife and syphilis … became aspects of that age-old struggle whereby the lower races attempted to destroy the noble Aryan’, wrote Joachim Fest in Hitler, explaining the manipulation of these ideas by the Nazis in their rise to power. Today in South Africa, everybody knows it’s those blacks who spread AIDS. But the AIDS experts and activists tend to imply it, rather than shout it. Mostly being white liberal people.

Cameron’s gay activist friend Timothy Trengrove-Jones, an ‘Aids researcher and academic’ as he likes to bill himself, but in fact an English lecturer at Wits (believe it or not after reading his prose), wrote in the Mail&Guardian on 30 June 2000: ‘The kind of education vital to simply keeping our population alive is a failure. And this is no surprise when the latest plan itemises as a primary goal the promotion of “safe and healthy sexual behaviour”.’ He didn’t like the sound of that: ‘The document’s very language itself fails to understand the crucial truth that there is no such thing as “safe” sex.’ In fact his stray shot hit the mark, although in a sense to which he was oblivious. Because safe sex, among the young anyway, is indeed an empty idea. But not because of deadly germs. As Celia Farber pointed out at the conclusion of her article, Unprotected (about the eroticisation of ‘HIV-infection’ by some gay men) in the online magazine Impressions: ‘... sex is not a kitchen that can be cleaned up and child-proofed – … sex is not safe.’ Meaning that entry into and especially exit from intimate relationships can be a very turbulent and injurious business. Heaven and hell right here on earth. Taking an overview she added: ‘The only thing that can be guaranteed once a pendulum swings so fast and so far as the Safe Sex pendulum did is that it will eventually swing back, not to the middle, but first all the way to the other end.’ Like all oddball social tendencies. The conclusion to Trengrove-Jones’s piece, Democracy and the pandemic, concluded in his signature garbled English: ‘One retains – following the president – one’s democratic right to question and finds that the issue is a searching one. It is to do with democracy and competent government within that democracy.’ Thanks Tim. We get it now. Did you get your degree in hamburgers?

Slipping in another three hundred thousand – hoping we wouldn’t notice – the TAC concluded its statement on the Health Department’s HIV seroprevalence figures with some jolly hockey sticks: ‘We must all work together to develop better prevention strategies and to ensure that the lives of the 5 million people with HIV/AIDS are valued and saved through treatment.’ To show we care by giving them drugs. But the trouble with Achmat’s friendly calls to ‘all work together’ is that when you decline his invitation walk down the street with him holding hands on one of his marches, he rounds on you, and hotly too, ugly names flying. With guys like Achmat and Cameron, there’s no room at all for a different view.

The TAC should stick to selling drugs for the industry. What it’s good at. Not so much when it gets into a different game off field. Like playing finger-wagging public chaperon. A paper in the British Medical Journal on 15 June 2002 reported the finding that programmes advocating ‘safe sex’ with condoms that rely on ‘alarmism [are] almost completely useless’. The pregnancy rate among teenagers in the US, Canada and Western Europe who participated in pro-abstinence programmes was 50 per cent higher than those who didn’t. So the TAC’s sort of strident ‘scare tactics’ should be abandoned, the researchers urged. And programmes preaching teen celibacy work worst of all. Predictably, since a paper by Susan Moore presented two days earlier at the International Child and Adolescent Mental Health Conference in Brisbane, Australia, came up with the resounding news that young people who have sex are happier than those who don’t, and that virgins had the lowest sense of sexual well-being. It gets even better: Moore said that she had expected to find that young people who engage in ‘unsafe sex’ would have a low sense of sexual well-being. But no, she reported: ‘That didn’t happen at all. In fact, the more unsafe sex they were having, the happier they were.’ How odd! (The biochemical magic in glue we heard about a moment ago.) And she was also surprised, she said, to find that going to church did not encourage safe sex: ‘The young people who went to church were more likely to be virgins, but those who were not virgins were no more likely to practise safe sex than unsafe sex.’

Mertz’s take on what drives AIDS is shared by Sontag; it speaks to a ‘desire for stricter limits in the conduct of personal life. There is a broad tendency in our culture, an end-of-an-era feeling, that AIDS is reinforcing; an exhaustion of purely secular ideals – ideals that seemed to encourage libertinism or at least not provide any coherent inhibition against it – in which AIDS finds its place [resulting in] neo-celibacy and a waning of sexual spontaneity among the educated in this decade [(the eighties), and] a growth of the ideal of monogamy, of a prudent sexual life.’

Playwright Arthur Miller was in the same conceptual boat. In his notes to The Crucible, a play which Showalter notes ‘explored the psychology and politics that created the Salem witch-hunts and, by extension, McCarthyism’, Miller wrote that ‘The witch-hunt was a perverse manifestation of the panic which set in among all classes when the balance began to turn towards greater individual freedom’. As in South Africa, post-1994. The sexual moralising of the AIDS age feeds back into it: Colligan et al. highlight that historically ‘outbreaks of mass psychogenic episodes became more frequent [with a] pervasive concern with religiosity and righteousness’. And in a striking parallel between the ignition of the witch hysteria in 1692 and AIDS hysteria in South Africa after the surrender of the apartheid regime in 1994, Miller noted of the people of Salem that ‘in their own time a revolution had unseated the royal government and substituted a junta which was at this moment in power’ giving rise to a dread of ‘deep and darkling forces’, since ‘social disorder in any age breeds ... mystical suspicions’.

In writing about her subject in Hystories, and discussing a collection of contemporary cases, Showalter missed its most patent instance in AIDS, despite remarkably apt insights such as: ‘Hysterical epidemics require at least three ingredients: physician-enthusiasts and theorists; unhappy, vulnerable patients; and supportive cultural environments. A doctor or other authority figure must first define, name, and publicize the disorder and then attract patients into its community. … The most influential doctors of hysteria are also theorists who offer a unified field theory of a vague syndrome, providing a clear and coherent explanation for its many confusing symptoms.’

Relevantly to post-1994 South Africa, Showalter observes that ‘Epidemics of hysteria seem to peak ... when people are ... alarmed about social change [producing] apocalyptic fantasies [interacting with] social forces such as religious beliefs, political agendas, and rumor panics. Traditional enemies or social scapegoats become part of the scenario fuelling fears. The longer the epidemic continues, the greater the participant’s need to believe it is genuine. … The chain is hard to break, because each new wave of publicity recruits new patients, who feel more and more invested in the search for external causes and a “magic bullet” cure.’ Being precisely the business of the TAC. With HIV, AZT and nevirapine.

Apartheid was built on swart gevaar, the manipulation of whites’ fears, conscious or otherwise, that the conquered black majority would rise up, breach the ramparts and overwhelm and exterminate them. This politically packaged peril was sold with increasing success to the English middle classes, not just the traditionally conservative white Afrikaans constituency. More than a political arrangement, the system was a totalitarian ideological one, tightly setting everyone and everything in a certain order – most crazily during the end-game when it was in crisis in the ‘total onslaught’ era. And then suddenly it collapsed. Quite unexpectedly. The psychic shock for the white man in the street was immense. Apartheid’s ideological framework and controls were gone. The repressive order evaporated. We were all free. Discomfortingly so. And there was no vengeful bloodbath. As had occurred in parts of post-colonial Algiers and the Congo. A new reason to fear the black man replaced the old, or at least to continue seeing him as something less than fully human, as apartheid had implied: just about ever second one of them carries a deadly disease – in their vital fluids: blood and semen. Thus did the black man once again become the scapegoat repository for the anxious apprehensions of the white man in Africa.

Conversely, those South African blacks who, like Makgoba, embrace AIDS, bring to mind the story of the slave set free, who woke his former master saying, ‘Put my chains back on. I can’t sleep.’

Makgoba’s defence of scientific medicine’s martial paradigm – at its apogee or nadir in the HIV-AIDS model, depending on your point of view – against Mbeki’s challenge is interesting for another reason. In their classic analysis, The Political Economy of Health (Pluto Press 1979), Doyal and Pennell highlight the ‘process of medical socialisation’ that occurs in colonised countries in which even the most outrageous, racist medical models get taken on board by indigenous elites. They quote Martinique-born Algerian revolutionary Frantz Fanon telling in his essay, Medicine and Colonialism, how the notion that ‘the native Algerian is a born criminal’ had entered the syllabus at the medical school in Algiers. Fanon quoted a student there: ‘It’s a hard pill to swallow, but it’s been scientifically established.’ Such co-opted elites in colonized countries, like Makgoba, become ‘bearers of Western science and rationality, ... the bourgeois doctors of the neo-colonial state. … This rigid adherence of third world students to the Western medical model is usually accompanied by a largely negative view of indigenous health systems – an attitude which is strongly reinforced by medical education which either gives no account at all of traditional medicine or actively seeks to discredit it.’

The American AIDS model is simple-mindedly monocausal and deterministic, with unseen aggressors to be rooted out and destroyed with maximum violence – by burning with deadly chemicals. Ancient folk health systems across the globe on the other hand broadly have one thing in common: a goal of restoring homeostasis – internally, with family, with community, and with the cosmos. Among Mbeki’s objections to the exported AIDS model, along with all the inhumane values with which it comes packaged, is the fact that it masks the obvious causes of infectious disease – poverty in all its manifestations, thanks to colonial violations and capitalist formations – and it devalues any political programme to address it. But as a high priest of scientific medicine, Makgoba sees only lethal germs spread by African promiscuity. At it like pigeons. All the time. Just as liberal whites like Appeals Judge Edwin Cameron reckon, we’re soon to see. Along with ‘AIDS expert’ Alan Whiteside, an economic history professor at the University of Natal. Who informed Geshekter in a private chat in his office a few days before the first meeting of the AIDS Panel in May 2000 that rural Zulu men working in small factories and on sugar plantations in the Manguzi region of KwaZulu-Natal often had several women on their way home. Explaining all the AIDS up there. Not that he’d ever been up there to establish this physical feat first hand. Much nicer flying around the world, business class always, staying in swanky hotels, and generally having a grand time researching AIDS on USAID millions. In his fancy Chinese-collar suits. Looking radical and all. A Third World Man. His family stashed safely away in England, far from AIDS-ridden Africa. Geshekter shared the amazing tale with fellow panellist and AIDS dissident Professor Sam Mhlongo, whose mother came from there. ‘What’s this I hear?’ Mhlongo challenged Whiteside at the first Panel meeting. Whiteside glared at him without answering before walking away.

Makgoba is a fellow black African who has professed his allegiance to Mbeki’s Africanist agenda, with its humanist foundations, in African Renaissance. But put to test over AIDS, Makgoba finds himself too heavily mortgaged, and sooner turns his back on it than risk the riches and honours bestowed by his secular priesthood. He’s an immunologist, a fitting speciality for him, since of all scientific medicine’s special arts, immunology must be the closest to Scientology – the high mumbo jumbo of its textbook canards about as glaringly incompatible with (and contradicted by) the empirical data as one can imagine. And an aeon away from holistic indigenous healing systems. But there’s a tale for another day.

Sensitive to the profoundly inhumane way AIDS ideology plays out among Africans infected by its poisonous ideas, isolating and terrifying them, Mbeki commented in a newspaper advertisement presenting his Presidential Task Team on AIDS on 28 April 2002: ‘Our common task as a nation is to bring hope to fellow human beings. It is wrong and inhuman to treat anyone said to be HIV positive as a person who should be isolated and turned into a social outcast. To communicate a message of hopelessness is to sentence other human beings to death. And to protect ourselves as a nation, remember, each one of us has a duty to protect his or her health.’ In this regard I have an intriguing story. In February 2003 I asked Iaan Bekker about how open his brief had been to design our country’s new Coat of Arms, the initiative for which had come from Mbeki himself. He told me he’d been given a free hand, but on the inclusion of one element Mbeki had been insistent: our country’s Secretary Bird. Unlike Mbeki, never having once been a herd-boy dodging vipers in the grass, I had to ask why. To signify spiritual protection, Bekker explained; the Secretary Bird is adept at spotting, killing and devouring hidden snakes – one was always safer when the bird was around. A curious coincidence it is that the ancient symbol of Western medicine should be a snake entwined around a sword. How interesting too that the Greek god Mercury carried a staff with two snakes winding around it – the god of travellers he was, but also of thieves. The African weapons of war are spear and knob-stick, taking the place in the Coat of Arms of the Secretary Bird’s long, gangly hunting legs. Lain down, at rest. But at the ready. At the presentation of the design to the Cabinet, Foreign Minister Nkosazana Zuma demurred. As Bekker patiently explained its elements and composition, she persisted. Mbeki rapped the table sharply; ‘Listen to what he is saying,’ he said. And the objection was stilled in a moment.

Mertz makes the point that what is happening in the moral politics of AIDS is nothing new:

What I find most interesting in the history of syphilis is that virtually every argument made today about AIDS was made almost verbatim prior to the 1930s about syphilis: the arguments of the public-health authorities, of today’s feminists, of today’s gay-press, of leftists and liberals, and the arguments of today’s rightwing Christian fundamentalists … myriad confluent groups who united around venereal diseases. Disappointingly, the Left suffered all the same failures in its ideological construction of syphilis as it has with AIDS. It was largely self-identified progressives, and especially self-identified feminists of the nineteen-teens who led the anti-prostitution and anti-vice campaigns which were some of the most widely orchestrated state-repressions of 20th century U.S. history. The victims of these repressive campaigns were, of course, poor women. … the chief argument for these police-state measures was syphilis. [Thousands of frank prostitutes or lower-class single women living near military bases were arrested and interred during the First World War as a syphilis threat to the armed forces.] The very same derivation of moral laws – and thereby state actions – from epidemiological facts was the centerpiece of much progressivism and feminism of the early century, just as it is today. Then, as now, it was only a specifically sexually-related disease which convinced leftists of the need for police action. Other diseases, then as now, never seemed to carry such an imminent demand for the forfeit of freedoms.

No one in their right mind would propose a law to punish a man diagnosed with TB for kissing his wife and children. Not even Cameron and his South African Law Commission.

That liberal Wits University so readily served as cradle to the extreme irrational and reactionary geist of AIDS was foreshadowed on German campuses, as we have noted. But not just under Nazi government, even before it: Grunberger mentions in A Social History of the Third Reich (Weidenfeld and Nicolson, 1971) that during the Weimar democracy at its strongest, in 1927

77% of all Prussian students had demanded the insertion of an “Aryan paragraph” (the exclusion of Jews) into the instrument of university self-administration. … Early in 1931 about 60% of undergraduate university students supported the Nazi Student Organisation, while Nazi support among the electorate stood at approximately half that level. In that year anti-Semitic riots erupted at the universities of Berlin, Cologne, Griefswald, Halle, Hamburg, Breslau, Kiel, Königsberg, Munich and Vienna. (Austrian universities were, incidentally, the pacemakers of Jew-baiting throughout the German-speaking student world.)

The race by German university professors to join the Nazi Party and conspicuously identify with its ideals and programmes we have dealt with already; Grunberger provides an example: ‘A prestigious bloc of 300 occupants of professorial chairs addressed a manifesto to the electorate, asking them to vote for Hitler in March 1933.’ Academics in South Africa lobby for Achmat and his drug agenda in just the same way.

Following upon the roaring success of the Wits General Assembly, ‘Thousands of students and staff from 20 tertiary institutions in various cities and towns nationally staged an anti-HIV-Aids march’ on 29 July 2002 – so the Daily Dispatch reported the neo-Nuremburg rallies the next day. Guest speaker at Wits was the guy they call ‘the safe-sex pastor’, with the unfortunate name of Grippa Khatide. Treating the varsity intellectuals to advice like: ‘If young people have the right attitude to sex [have as little as possible] we can beat HIV-AIDS. We are not victims of HIV-AIDS. But HIV-AIDS is the challenge of our time and we can beat HIV-AIDS by adopting an attitude of sexual responsibility. … We can never begin to address the matter of HIV-AIDS unless we acknowledge that we are sexual beings. If we can change our attitude to one of sexual responsibility we can protect ourselves and future generations.’ Interesting how he chants the hypnotic mantra. Like the Jews, the Jews, the Jews, the Jews, the Jews. But for Heaven’s sake, Grippa, you priests have been threatening us with eternal fiery death as the price of our lustful moral degradation for as long as you’ve been around. Find yourself a new story, man.

Students were part of that ‘especially vulnerable group’ of twenty- to thirty-year-olds, warned the TAC’s Gauteng coordinator, Pholokgolo Ramothwala. Because they’re enviably doing it more than anyone? Wits equity and transformation officer Riedwaan Kader picked up on the theme: ‘For the first time in many years, students are uniting around a common issue that is threatening our futures.’ As the Jewish problem threatened the volk. So pull in to check for bad blood, he urged; a thousand free test kits were available for students who wanted to find out their HIV status.

Frankly, how many ‘thousands’ actually joined the marching is moot, in view of a disclosure in an accompanying article, Rhodians support Aids awareness. Jabulile van Niekerk, manager of the St Raphael (AIDS) Support and Counselling Centre in Grahamstown described ‘about 150’ marchers as ‘a wonderful turnout’. Led up High Street by another academic bigwig turned sanctimonious AIDS fool: Rhodes University Vice Chancellor David Woods.

In his study published in 1999 of the quasi-religious devices by which medical power is maintained, Médecine, Religion et Peur; l’influence cachée des croyances (overviewed online in his English essay, Modern Medicine: The New World Religion: The Hidden Influence of Beliefs and Fears), Oliver Clerc, without mentioning AIDS in particular, provides an explanation of the ready, uncritical acceptance of AIDS by ostensibly irreligious rational people, as a subconscious sink for turbulent irrational feelings, fears, and urges:

even a superficial study of contemporary culture will reveal that the supposed secularization of present day society is just an illusion. Even though most people do not conform to the outward show of religious custom and practice – mostly Judeo-Christian in Western culture – the beliefs and superstitions remain deeply embedded in their subconscious, influencing many aspects of their daily lives without them realizing it.

Whenever he gets carried away, one remembers that Achmat comes from an Islamic fundamentalist family. Clerc invokes a fine illustrative analogy:

Just as the magnetic field of a magnet placed under a sheet of paper controls the way iron filings fall on its surface, revealing the invisible lines of force between the two poles of the magnet, a ‘religious field’ likewise imperceptibly structures and organises the development of modern medicine. Invisible, impalpable, this ‘religious field’ is made up of all the beliefs, myths and values of the Christian – and more specifically the Catholic – religion. In other words, the secularisation of society happened only on the surface. We took away the ‘iron filings’, the specific religious forms, but we did not change the ‘current of thoughts’, the underlying ‘religious field’, which continued to exert the same influence, but through medicine. That is the reason why behind the different structures of medicine and the Church of Rome we find the same fundamental concepts, the same relationships, the same characteristics, the same fears, the same hopes and expectations [– ‘autocracy, centralization, the control and manipulation of people, censorship, propaganda, total obedience, infallibility, the destruction of heretics, the stamping out of individuality. All this, of course, has been done in the name of public health and the general good, just as the Church acted for mankind’s salvation.’] This substitution of medicine for religion has had many unfortunate consequences. In medical research, it influences what should be looked for and what can be discovered. Any discovery or theory that is at odds with the over-arching orthodoxy is rejected, and its authors called heretics. Entire areas of research, as well as promising new lines of approach, are thus disqualified. … The medical credo takes precedence over reality, something that scientists refuse to acknowledge when it does not correspond with their preconceived ideas. And lastly, the hidden religious dimension of modern medicine inhibits the free debating of already fixed beliefs, and preventing them from being properly re-examined and criticised. Indeed, dogmatism, irrationality and passions – all characteristic of the religious experience – take precedence over any calm and carefully thought out argument, even over the most tenuous facts. The same vehemence that led Galileo to be condemned by the Church for his theories, in spite of the scientifically demonstrable facts, is now being used by medicine to reject any thesis that is contrary to its own dogmas. Science has learnt its lessons from the Church.

And there’s the fact that in AIDS medicine, there’s only one way to salvation, and that’s by swallowing the eucharist sold by the drug companies.

My own reflections have been related, and I hasten to record that I’m an atheist with no conventional religious affiliations whatsoever. I’ve long had a sense that, like a ship drifting from its moorings at night towards an open sea, the more secularised, materialised and ostensibly rational Western culture becomes, the more urgently it excites deep atavistic, irredentist yearnings, given expression in extremely irrational concepts and beliefs. Flying in the face of all sense. We fundamentally need an analogical, mythological belief system (Mbeki mocks AIDS subscribers as ‘the believers’) that allows us a mystical experience and participation in the world. We can’t actually do without an irrational, Dionysian component to our lives, and as modern Western industrial culture suppresses it, denies it, it bobs up in a different form. An alternative cosmology. Clung to with inflamed quasi-religious fervour by the sort of educated folks who write for and read the Mail&Guardian. Carrying on like holy rollers. And there’s another element: having mastered the elements and the uncertain environment, and slain or contained all our old predator enemies, we need a substitute to quail before in their place. Like scary sex-germs.

Gugu Dlamini was a young Zulu woman told by doctors that she was HIV-positive; and when the news got out in May 1998 she was stoned to death by her neighbours. Thinking she was inhabited by contagious demons. Well, that’s more or less what the white doctors had told her. How primitive these people are. How appalling. But the whole of AIDS is a vast superstition, and in the mind of whites, no less crude, terrifying, hysterically infectious – and, in the way doctors approach it, murderous. We can’t seem to do without bogeys to fret about. And destroy violently. Whether we live in skyscrapers or straw igloos.

Or sit on the bench of our highest court. Giving judgment in the nevirapine case (discussed in The trouble with nevirapine) the Constitutional Court held:

The HIV/AIDS pandemic in South Africa has been described as ‘an incomprehensible calamity’ [impenetrably mysterious, like the Holy Trinity; a woe like sin] and ‘the most important challenge facing South Africa since the birth of our new democracy’ and government’s fight against ‘this scourge’ as ‘a top priority.’ It ‘has claimed millions of lives, inflicting pain and grief, causing fear and uncertainty, and threatening the economy.’ These are not the words of alarmists but are taken from a Department of Health publication in 2000 and a ministerial foreword to an earlier departmental publication.

We wise Constitutional Court judges just swallow everything written for politicians and bureaucrats by richly paid private consultants. Building professional empires and small fortunes on scare stories – the population explosion, the ozone hole, global warming, the millennium bug, you name it, we believe it. Like loving can kill us, humans only, in the last twenty years, all of a sudden, after millions of years. Due to a brand new sex germ. Mutated from monkeys. Harmless to them but lethal to humans, although on the strangest ever-extending slow fuse. Brought into the US and Europe by gay airline stewards. Also by African-looking Haitian immigrants. (We prefer immigrants fair.) A sex germ that white gays and black Africans are spreading like wildfire, but hardly anybody else. Oddly enough. We believe this because we’re the clever guys. Much cleverer than this race-obsessed new President who can’t see the overwhelming evidence. And who thinks it’s all a lot of baloney. Unlike him we think and see clearly. We see the evidence all about. We fill in the gaps with our sophisticated powers of reasoning. Honed over many years in the courts. Pursuing human rights, some of us. Of blacks. Deprived by the Afrikaners. And the English before them. We like looking after blacks. It’s a calling that’s hard to give up, even though they’ve got their own government in place now to look out for them. But like all African governments they’ve turned out callous and useless and incompetent. Letting their babies die when they could be so easily saved. With what the manufacturer itself admits is an extremely poisonous chemical. A sort of baptism of fire. We’ll save the black babies of South Africa from their parents’ goosing around. What a blessing it is that white people don’t carry on this way. Which is thankfully why HIV-positive babies and AIDS orphans are all black, and black only.

The most learned judges expounded further: ‘In our country the issue of HIV/AIDS has for some time been fraught with an unusual degree of political, ideological and emotional contention. [Could the persistent agitation of Cameron and the TAC have something to do with this?] This is perhaps unavoidable, having regard to the magnitude of the catastrophe we confront.’ Sort of like Sodom and Gomorrah. Perhaps the heat is ‘unavoidable’ rather because it’s all hot air, an essentially religious affair, with the ‘HIV/AIDS issue’ functioning somewhat like the core concept of ‘sin’ – potently dreadful, and around which an edifice of enormous temporal power has been erected, claiming the power to protect us from it. From ‘the catastrophe we confront’.

Mostert reports in Frontiers that English explorers visiting the court of the Zulu tyrant Dingane in the mid-19th century alleged that a quota of about half a dozen sniffed-out miscreants were clubbed to death every week at an execution site permanently circled by vultures. In a lull the inkosi was reportedly wont to say, ‘Call out the doctors, the birds are hungry.’ Western culture has the same simmering need for bloodletting it seems to me. Perhaps it’s why the US, with the most dynamic modern form of it, is permanently at war, periodically turning on and sacrificing its own, when not venting its extreme mechanised violence on other cultures that it has first demonised. To be perfectly honest, from this side of the ocean, American culture sometimes looks completely psychotic to me. Certainly it regularly displays an uncommon susceptibility to extreme hysterical contagions. Concerning internal and external enemies. Concerning drugs too – with the hardest, most addictive and most destructive lawfully traded, and the softest classified ‘hard’ and fiercely outlawed. (There’s none softer than heroin.)

Dingane’s ‘doctors’ in modern guise continue to enjoy unrivalled pre-eminence in modern industrial societies: ‘The hospital has succeeded the cathedral as the archetypal institution of Western culture,’ noted Irving Zola. (Appreciated by the Church long ago, which is why it got into the hospital business early: St Marys, St Augustines, etc.) The medical-industrial economy is second only to the military. We even pay it tithes, called ‘medical aid’, with an express or implied ticking off (‘irresponsible’) in store for anyone refusing to pay. Unlike the help in the hardware store, we look up to pharmacists working on raised podia in their shops when purchasing our drugs. We address medicine’s rote-tutored functionaries with their bachelor’s degrees as ‘Doctor’. Like ‘Father’. We simply do what they say. After their little tapping, listening, peering and touching game is done. (Especially women’s breasts – my girlfriends have consistently complained. It’s an old problem: Hippocrates found it necessary to include in his Oath an enjoinder from ‘all seduction, and especially from the pleasures of love with women or with men be they free or slaves’.) We tolerate their administration of useless and deadly poisons to those sniffed out as harbouring HIV and cancer. Et cetera. And when such victims die in their hands, we take it that this is right, this is fitting. After which, even their struggle to survive their doctors’ violence is commemorated in the newspapers in martial terms: ‘He died after a brave battle with cancer’, or ‘AIDS’, and so on. All is well as long as the quota is killed. Nowadays by the chemical in the bottle with the skull and crossbones.

The Cameron interview on Carte Blanche was like watching a cup of sugar spun into candyfloss, all touchy-feely pink goo, the disdained gay man being loved by everyone at last. All thanks to his virus. A soul saved, having discarded his erstwhile death-hex dread (‘I’ve regained my life’), his testimony implied the ‘sex kills’ credo that founds it all. But with a scientific spin: he referred to his declining ‘viral load’, as if the expression means ‘infection level’, as the words might suggest. He said he’d ‘fallen ill in December 1998’, well after his diagnosis. Even without the toxic drugs to confound the picture, who wouldn’t eventually get very ill, having accepted his doctor’s suggestion that he was certain to die soon, and worried sick about it all the time? Indeed, Cameron said he felt like a man condemned: ‘And one of the reasons why I didn’t tell the Judicial Services Commission in December 1994, when I was appointed [a judge], that I had HIV, was that I hoped to stay well, although I feared that I was going to die.’ But back before the JSC again in 1999, trying to get promoted to the Constitutional Court, he figured it was no use having a banjo and not playing it, and sprung the news. This crass manipulation didn’t work, though. It tugged everyone’s heartstrings alright, just the way he intended: ‘They listened partly horrified, partly also engrossed with sympathy and I think also with respect. … I was scared of reaction and I didn’t expect the extent of public support and love that I got. It was an outpouring.’ Unfortunately they didn’t feel sorry enough to give him the job.

Cameron said that thanks to the umuthi he was taking: ‘You cannot find the HIV virus live in my blood anywhere now. It’s still somewhere in my body – it’s lurking there, but the medicine is keeping it down.’ Hawu! Sceptical Zulu folks watching the interview, who think this new ingculuzi business of white amadokotela is more in the latter’s minds than the blood would recognise a protracted bout of umfufunyane, with this umlungu’s head full of creepy bogeys, ‘lurking’, as he put it, in dark corners. They’ve been purged from his blood by the strong medicine. Nice clean blood he’s got now. But, he says, they’re still there in dank redoubts where they’re holed up invisibly, kept at bay by drugs. Like by red-hot pincers sorting out those medieval hairy sprites with horns, tails, cloven feet and dragons’ wings.

If you’re one of those credulous medically docile guys, unhesitatingly believing the doctor when he tells you that you’re as good as dead, on borrowed time, even though feeling fine – perhaps because you’re uneasily gay in an aggressive hostile authoritarian patriarchal culture, with a history of stoning, psychiatric violence and until recently imprisonment for such deviance, and so therefore half expect it – you’re going to happily swallow whatever potions he dishes up to you, certain they will be as beneficent as the isangoma’s seawater, bark and wild herb preparations to purge that inyongo. And feel much better afterwards. After throwing up. And/or blowing it out the other end. Then go around giving testimony for the good cause, the wonderful drugs: ‘And we know that that isn’t the case, we know it’s no longer true that AIDS is necessarily a fatal illness. So it’s changed the social nature of the disease, and if we offer people hope, if we offer people the good news about treatment, the hope and possibility of treatment, we’re going to reduce the stigma.’

A coincidentally big thing among gay AIDS activists – this stigma business. But how can pills conceivably reduce it? Please don’t despise me anymore. I may be a dirty sick fag or nigger, but I am taking my medicine, I really am. I’m being obedient. My doctor says I’m being ‘treatment compliant’ as I continue to swallow what my body is telling me to reject.

Of course there’s a better way to ‘offer hope’ than by handing out poisonous chemicals. One simply has to wind down the propaganda, so that everyone can just forget about AIDS, like we’ve forgotten the syphilis and herpes scares. Which came to absolutely nothing. Apart from those poisoned on the way.

Black friends of mine have commented on how homosexuals, nearly all white, dominate the South African AIDS activist scene, presuming to represent their straight black countrymen and keeping their alleged affliction on the front page. Stirring up crowds with rousing Sturmabteilung devices. Like that short fat guy in the brown shirt whom Hitler had popped off during the Night of the Long Knives, Ernst Roehm. Along with the rest of the queer clique that ran his SA with him. Such as Karl Ernst, leader of the SA in Berlin. And Edmund Heines, SA Obergruppenfuehrer of Silesia. Found in flagrante delicto, announced Hitler’s press chief Otto Dietrich – ‘a scene that defied description’ to those paragons of Lutheran morality, the SS goons who arrested and shot him. Along with his rented pal.

It’s Cameron’s high standing, the gifted demagogue Achmat’s too, that keeps AIDS’s shares so high in the media and in the public mind. Interviewed in Continuum in 1993, Camille Paglia revealingly explained the waning of AIDS as a news item in the US terms of gay activism, gay activist energy:

There was a period of absolute hysteria, cover stories just constantly in the public eye. And that would have been in the late 1980s and early 1990s. I think there’s been a slow decline in the attention paid to the issue at all here. Part of it was that ACT UP was very, very active at that time. … AIDS, the way AIDS has gone to the back burner here in America, is simply a part of the general loss of prestige of the gay leaders. We don’t have a Martin Luther King. There’s been no figure who’s been particularly talented.

Cameron’s evangelical ‘good news’ talk is clever because it makes us go all warm and fuzzy. As it did at Sunday school. Indeed, the word gospel means good news – god spel in old English. Also because ‘good news’ is what everyone craves every single day, making the expression a hit in drug propaganda. Spotted by John le Carré in The Constant Gardener: ‘GOOD NEWS FROM KVH: DYPRAXA is a highly effective, safe, economic substitute for the hitherto accepted treatments of tuberculosis. It has proved itself to be of outstanding advantage to emerging nations.’

Every sentence in the Cameron interview was a mess. It reminded me of the kind of unexamined cliché-strewn bromides that I used to draw when raising problems within the HIV-AIDS paradigm with South Africa’s ‘AIDS expert’ scientists. In my many conversations on the telephone and in correspondence by post and email, I was always left with the appalling sense that our ‘AIDS experts’ at universities around the country were myth-bound simpletons lacking the wherewithal to follow my inquiries, let alone answer them. I felt like a mathematician trying to discuss a problem in calculus with primary school children. If this sounds exaggerated and arrogant, you should read our exchanges. As dismal as Makgoba’s cretinous conversation with the Perth Group’s Turner (posted at for all to see) concerning the HIV isolation question. No wonder they didn’t want him at Wits. And opposed him at Durban.

So let’s not waste any more time wallowing in the syrupy mire of the interview, and instead put our gears into reverse as we trace the likely trajectory of Cameron’s recent life, following his calling to participate in the drama of AIDS. But before we do, an illustrative short story.

Several years ago I did a murder case for a Zulu bloke, Makhaye, with kind eyes and a wide smile. He’d been feeling ill at ease. So he duly consulted a local traditional healer, who asked among other things: ‘Is there anyone who bears you any ill-will?’ ‘Well, yes, come to think of it, one of my work colleagues does.’ A discussion ensued in which the history of some smouldering strife was related, the evidence it disclosed debated, and the proofs identified. At the conclusion of these ratiocinations the isangoma made his diagnosis. ‘Your colleague must have sprinkled umuthi on the backseat of your car.’ Our man took this news badly. Having heard that his colleague was importuning evil forces to do him in, he became frightened half to death. His health now took a serious dive. But being a cautious, measured fellow, he sought a second opinion, travelling to a distant village in which another isangoma worked, with such reputed success that his fame had reached the city. And there the cycle of suggestion was repeated and the hypothesis consolidated. But the implications of this second identical divination, and the absolute imperatives it prescribed were awesome, so he left the country for a third opinion. Eminently sensibly, who’d disagree? He queued for ages to consult another isangoma in Swaziland, no doubt admiring his nice fleet of Mercedes Benz cars parked outside his hilltop mansion while he waited. Bearing out his expertise. Needless to say he was told the same thing. The long and the short of it is that soon after Makhaye’s return home, and via the agency of a contracted hit-man, the maledictor divined took a bullet in the back of the neck, not suspecting or feeling a thing. With that the spiritual and moral equilibrium was restored. Makhaye’s health recovered completely. Gone were his terrible nosebleeds that had seeped like stigmata. The buckling lameness of his legs was over. But best of all, alleviated was that terrible sensation of monstrous poisonous insects crawling all over his face all day and night. No matter that he couldn’t actually see them.

‘Killing witches went out centuries ago among civilised people,’ thundered the culturally sensitive liberal white Natal-English judge. (In fact such lynchings persisted until the late nineteenth century in rural England.) He might have added: ‘Slaughtered in their thousands, by guys like us sitting in English courts like this. Ardently, right up until 1736, when the government repealed the witchcraft statute. In cases presided over by such prominent jurists as Lord Chief Anderson. Who warned in 1602: ‘The land is full of witches. They abound in all places. [Without prompt, firm measures against them, they will] in short time overrun the whole land.’ And if in a bright mood in our country assize from a good breakfast in the morning and a pleasing local tart the night before, we permitted a benevolent hanging before the burning. Otherwise it was ‘alive and quick’. Quick meaning feeling every minute at a leisurely pace, not hastily. And you can say thanks for not having to watch your entrails drawn out of your slit belly too, after your neck had been stretched for a bit by hanging, and your limbs thereafter simultaneously plucked from your torso by ropes fastened to four horses, whipped to gallop north, south, east and west. At the same time. The deserts of rebels and traitors. Not to mention blinding and castration. To cure poaching. Of the gentleman’s deer. Getting the message across. We English being a civilised bunch. Not like you people.’

‘To think that people like you have the vote,’ he said instead – he really did – before throwing away the key. Moved by this counsel’s pleas in mitigation as the face of a granite quarry. His head in a terrible spin from observing the inexorable collision of two freight trains yet again, laden with millennia of incompatible cultural formations, as grievous a spectacle as the World Trade Centre movie.

There was no room in that angry court to make the argument that its members, wives, children and friends in their Sunday best probably attended temples every week, fronted by the statue, not of a philosopher-prince in deep meditative repose, but of a man pinned to a gibbet, being tortured slowly to death, a human sacrifice for their benefit two thousand years earlier, in order to appease a vengeful spirit. And that the accused’s ideas were scarcely more barbarous. The expungements in question putting things right all the same. Nor more preposterous than the European court’s rule that before telling what he knew, every witness was required to swear an oath to the same unseen Aztec ghost and call down its help to speak honestly. Right there inside the white courtroom at the close of the 20th century. But just as long as the witnesses didn’t then go on, as English witnesses from all walks of life used to do, to depose in the High Courts to the mischiefs of imps such as Peck-in-the-crown, Pye-wackett, Grizel-Gredigut, Ilemazar or witches’s familiars such as Sack and Sugar, Jarmara, Holt, Newes, Dandie, Tibb, Fancie, Ball, and Vinegar Tom, or their Zulu equivalents. Or to needles somehow swallowed or pricking in the dead of night – an old hysterical penetration delusion resurfacing in the AIDS age in the paranoia about ‘needlestick injuries’ and pinpricks at schools and young folks’ nightspots. Also in kooky reports of probes put up jacks by alien abductors.

Incidentally, if you find still having to swear oaths by the book bizarre, you can thank your lucky stars that we’re currently relieved of the antecedent rule for such occasions prescribed by the early Yids. Or your day in court might have gone something like this: ‘Before I sing a note, pal, you’re going to have to climb off that high bench of yours and come down over here. Dropping your drawers and parting your robe in short order. Because I need to stretch my hand in there, and fix myself a firm grip around your puckered old nuts. As you stand patiently by in your uplifting pose until I’ve said all my say. If it takes all day. Offering a salutary squeeze from time to time, as needs be. To make sure your Lordship is paying full attention. And not drifting off during the technicalities. Especially after lunch. Since it’s well known that, as is the wont of one top beak among you, amadoda alele emini. Actually snores. Beats shouting for his attention.’ And if it’s a junior Milady that you draw to hear your case, Hallelujah.

The words testimony and testicle share the same root in the Latin word testis. In euphemistic King James English, Genesis 24:2-3 reads: ‘And Abraham said unto his eldest servant of his house … Put, I pray thee, thy hand under my thigh: and I will make thee swear by the Lord ... that thou shalt [‘keep certain promises’].’ And later in that book at 47:29-31: ‘And the time drew nigh that Israel must die: and he called his son Joseph, and said unto him ... put, I pray thee, thy hand under my thigh, and deal kindly and truly with me; bury me not, I pray thee, in Egypt: but I will lie with my fathers, and though shalt carry me out of Egypt, and bury me in their burying place. And he said, I will do as thou hast said. And he said, Swear unto me. And he sware unto him.’ A Commentary on the Holy Bible edited by Dummelow explains awfully proper: ‘It is from the thighs that one’s descendents come, so that to take an oath with one hand under the thigh would be equivalent to calling upon these descendents to maintain an oath which has been fulfilled, and to avenge one which has been broken.’ Guthrie et al., editors of the New Bible Commentary, explain a touch more directly: ‘Under my thigh is probably an allusion to the genital organ.’ And add the remarkable note that the practice reportedly survived in modern times among Egyptian Bedouins. Something to think about long and hard if ever called upon to testify up there.

In December 1986 Cameron’s doctor, a family friend about to retire, drew his blood. Why we don’t know. What we do is that without consulting him he sent a sample of it for testing for HIV antibodies. Probably because before AIDS was reconstructed as everyone’s disease (but especially blacks’), it was conceived to be the malady of gay men and other social undesirables like poor black Haitian immigrants and heroin addicts, so aware that he was gay, the doctor thought this guy’s at risk for AIDS so best do a check for HIV. Point is he lit up the test. As perfectly healthy people who have telephoned me have done, some remarkably prominent, scared to death at first but sceptical in the end. Properly so, because as we read in my article, Why the ‘AIDS test’ is useless and pathologists agree in Debating AZT it is. Completely. The administration of HIV antibody tests by doctors ranks alongside the use of callipers by Nazi doctors to measure suspected Jewish noses. Or swimming a woman suspected of witchcraft, by tying her left thumb to her right toe and vice versa and pitching her into a pond – with floaters judged witches and hanged, and sinkers, who drowned, posthumously declared innocent.

HIV antibody tests were never designed to be diagnostic instruments, merely screening tools to exclude possibly risky blood from blood banks, and no more than that – but they have become arbiters of life and death. It’s unbelievable. Maddening to ponder too long. As it was to hear former acting Cape Town mayor Belinda Walker, other politicians, journalists and AIDS activists urging everyone to go out and ‘get tested’ on the radio. Cape Town’s ‘City AIDS Testing, Counselling and Support Centre’ still does: ‘Get tested!’, it encourages folk reading its posters stuck in shop windows. An enormous billboard in Butterworth urges the same in Xhosa. Billboards in East London proclaim in English, Afrikaans and Xhosa: ‘I’ve tested and saved lives. Test now and stay healthy.’ Likewise in Cape Town: ‘“I’ve tested. I know.” By knowing you can make the right choices.’ When to start AZT. A lot of the people reading the proposition will be able to afford it: the billboards stand strategically situated next to the highway to Johannesburg, the airport turnoff on the way.

The billboard suggestion that getting tested is a positive step in taking control, like Big Tobacco’s message that that smoking makes you sexy, employs a proven psychological trick. Lauritsen reported in HIV Voodoo from Burroughs Wellcome in the New York Native on 7 January 1991 that the AZT manufacturer had flighted full-page ‘Living with HIV’ advertisements in the New York Times and other newspapers around the world, and in subways and on bus shelters: ‘In a typical ad, a man is shown in silhouette by a grand piano, his head bowed in dejection, and above his head the statement, “I learned I was HIV positive five years ago. I felt angry, deserted, and victimised. Today I’m back in control.” The theme of ‘control’ is echoed in the ad slogan, “The sooner you take control the better.” In all of the ‘Living with HIV’ ads, the body copy is the same:

Every day, more and more people are learning to live with HIV. People are finding ways to stay healthier, strengthen their immune systems, develop positive attitudes. They’ve found that proper diet, moderate exercise, even stress management can help. And now, early medical intervention can put time on your side. Today HIV positive doesn’t mean you have to give up. So, the sooner you take control, the better. For more information on living with HIV, we urge you to call the number below ... anonymously if you wish.

You’re doomed to die soon. Take up a yuppie health-fad and then phone us. We’ll tell you all about our lifesaving drug. We call it AZT.

Into psychology they are. In the same article, Lauritsen tells that early in 1991 the company mailed a promotional video to AIDS specialist physicians entitled The Psychology of Treating Patients with HIV Disease: ‘This video will share with you the psychological reactions we’ve seen from patients who are diagnosed positive for HIV antibodies, and then alert you to the emotions that follow as they encounter the progression of the disease and then are motivated towards treatment with Retrovir.’ And when they get sick on it, and start raising issues about deadly side effects, doctors should help them ‘realize that their fears were unfounded’. It’s just their bad nerves:

Some patients, who have begun AZT, have complained about side effects which, once they’ve talked about it with their counsellors, were determined to be more related to their anxiety about being on the drug, than to the drug itself. Sometimes a person could benefit medically from the treatment, but rejects the drug for psychological reasons, after being on it for just a brief period. Therefore it’s important to recognize that some of your patient’s early reactions may be psychological.

If you haven’t puked already, this will do it: A doctor says with a smile: ‘That pill should be an absolute symbol of life, and not a symbol of, “Oh, I’ve got this…” The whole issue of empowerment here, of people taking charge of their own lives, is involved with this decision making, to take this drug.’

Told by his doctor that he was HIV-positive, Cameron would have inferred the unspoken implication that the test had detected the virus. Or at least antibodies in his blood that would be there if, and only if, he was infected. Like a swat team that only shows up for urban guerrillas. And that he wouldn’t have had any such antibodies if he wasn’t ‘living with HIV’.

What Cameron wouldn’t have been told, because his doctor probably didn’t even know himself, is that the test is not like a burglar alarm, either on or off. It always goes off; it’s just that with some people the siren is louder than with others. Because after the prepared, diluted blood sample is stirred up with the reagents in the test tube, the mix will always go cloudy. It’s a matter of shades of grey, as it were.

See, we’ve all got those antibodies. Are you surprised? Does the question leap to mind: ‘If these antibodies are specific to HIV, how come I have any at all if I’m not infected with HIV?’ Try asking an ‘AIDS expert’ to explain. Or better not.

If slightly to moderately cloudy, not to worry. If darker than that, you’ve got the virus that lurks. Says the ‘AIDS expert’. But not the test kit manufacturer, which produces these tests for a limited purpose only: to identify blood with more immunoglobulins in it than the next guy’s, suggesting that it might possibly have met the lurker and this possibly kick-started its B-cells into producing them. Like cops rushing out for a burglar alarm. Set off by a burglar. Although usually the cat. So you shouldn’t have your blood pooled with the rest at the local blood bank. This is not an entirely senseless precaution. It’s a bit like looking into how many police stations there are in similar sized cities when choosing a safe one for your family, and reasoning that the more police there are, the rougher the streets are likely to be. And so avoiding the risky ones. But your survey does not and cannot tell you specifically whether there are any rapists or paedophiles in town.

Unlike ‘AIDS experts’, the test kit manufacturer knows a few plain facts. First, there are no specific antibodies on God’s earth. Meaning that they react with all sorts of things. In the case of HIV antibody tests, about 70 documented different conditions, having nothing to do with ‘HIV infection’. This is why the instruction manuals are so cagey about what you should deduce from a ‘reactive’ result. The ELISA test kit manufacturer Abbott Laboratories, for instance, is perfectly frank: ‘EIA testing alone cannot be used to diagnose AIDS, even if the recommended investigation of reactive specimens suggests a high probability that the antibody to HIV-1 is present.’ The Genetics Systems ELISA package insert, revised in 2000, states: ‘The risk of an asymptomatic person with a repeatedly reactive serum sample developing AIDS or an AIDS related condition is not known.’ Similarly, the Cambridge Biotech Western Blot package insert published in 1998 points out: ‘The clinical implications of antibodies to HIV-1 in an asymptomatic person are not known.’ Which is not what the ‘AIDS experts’ and doctors tell you. Who consider reactivity to repeat ‘HIV antibody’ tests synonymous with ‘HIV infection’. Unlike the manufacturers of the test kits themselves, and their lawyers, who don’t share that expert medical opinion. Most intriguing is the last part of OraSure Technologies Inc.’s Premarket Approval Information for its brand new OraQuick Rapid HIV-1 Antibody Test. Something to throw at the ‘AIDS experts’. Who always tell you that HIV causes AIDS as a matter of unchallengeable, scientifically proven fact. As opposed to current medical belief – like so many others that have come and gone: ‘Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex (ARC) and pre-AIDS are thought to be caused by the Human Immundeficiency Virus (HIV).’ Thought.

Each and every ‘HIV antibody’ test kit approved by the FDA and currently on the market is licensed for screening blood only, not diagnosing infection. That is, their use is intended for excluding possibly tainted blood, not telling people they’re going to die. Even the CDC, in its CDC 2000 Revised AIDS Surveillance Definition, which sets out ‘reporting criteria for HIV infection’ emphasizes that repeated, confirmed reactive HIV antibody test results mean ‘HIV infection’ for ‘public health surveillance only ... not [for] clinical diagnosis or for any other use’. But doctors use them to diagnose HIV infection among their patients anyway. And researchers use them on their subjects for the same purpose. Because they’re the experts.

How anyone can suggest that a repeat of this bum ELISA test can confirm the result of the first is a mystery. But the ‘AIDS experts’ do. Because they’re clever. In most First World countries, before you’re saddled with a scary HIV-positive diagnosis, doctors use another kind of antibody test to confirm the first two: a Western blot. They say this is because ELISA antibody tests are over-sensitive, over-react and are insufficiently specific. But not in England and Wales where Western blots are not used to confirm reactive ELISAs for exactly the same reason. Isn’t that great? Maybe someone in the UK read the manual – Organon Teknika Corporation’s, for instance, the manufacturer of one such ‘HIV-1 Western Blot Kit’: ‘Do not use this kit as the sole basis of diagnosing HIV-1 infection.’

Where Western blots are used to confirm ELISA results, what are we to make of the fact that their results are interpreted by quite different criteria from place to place? So that you’re infected by or free of the deadly sex-germ according to which lab you walked into. And where should we slot Standstrom’s study in? The paper published in Cancer Research in 1990, reporting that the blood of exactly half of one hundred and forty-four dogs tested with Western blots for ‘HIV antibodies’ was reactive to one or more ‘HIV proteins’?

AIDS doctors might try telling you, ‘No, we don’t rely only on lab testing. We interpret the results in the light of clinical symptoms.’ They’d be telling lies. Because most people diagnosed HIV-positive, and told so to their crushing distress, have no symptoms of any illness. Many are in peak health, such as those dozens of black South African boxers disqualified year after year. By doctors. Ruining their careers. Destroying their lives. For the fee. And in rare cases where the person tested is ill, and is judged ‘reactive’ to the test, the signs are no guide to whether he’s HIV-infected in any event. They can’t be, in any rational system of medicine, because none other than Professor Luc Montagnier – the discoverer of ‘HIV’, he claims – has correctly noted that ‘AIDS has no particular symptoms’. Unlike chickenpox or measles, for example. Distinct illnesses. Real ones.

When Tim Modise pointed this out to Cameron during a radio interview on SAfm on 18 July 2000 – ‘What do you mean, Judge, when you say the symptoms of AIDS itself? Because we’ve heard others say there are no specific symptoms for AIDS. AIDS is merely a syndrome and therefore not a disease’ – the judge knew better: ‘Tim, the people who believe that I think really operate from a position of dogma not from a position of reasoned inference. … Tim, it’s almost like the creationists. … It’s like the white supremacists or the Holocaust deniers. … The Holocaust deniers are very similar.’ (This guy’s a judge, who bills himself as an ‘intellectual’.)

AIDS as an acronym was originally coined by the US CDC as a mere ‘surveillance tool’, a category in a ledger under which some sleepy clerk would enter a count of cases of disparate familiar diseases thought linked by weakened immunity. For the books, not the patient. But like Cinderella’s pumpkin in the magic of our time, AIDS has become transformed into a disease: ‘I’m sorry, but you’ve got AIDS. Take this. It comes with a skull and cross bones on the bottle when we give it to rats and monkeys. But not on the box of capsules I’m giving to you.’ Some doctors even talk of ‘HIV-disease’ now. Among the perfectly well. No, you’re not dreaming. They are. As they were about black bile, from the time of the ancient Greeks until well into the modern era. Causing melancholy if you had too much of it, out of balance with your three other humours: blood, phlegm, and yellow bile – the latter substances all real enough, in a physical if not theoretical sense, since they can all be seen. By us as well as the experts. But never the black stuff, which they said was secreted from our ‘suprarenal glands’ situated above our kidneys. Which don’t even exist. The theory however was elegant. So doctors weren’t going to be disconcerted by the facts. Are they ever? As they wrote volumes about a causal agent that existed only in their learned imaginations. And tapped blood, drilled scalps, branded flesh and purged guts to get it back in balance.

When the manufacturer talks of the ‘specificity’ of its HIV antibody test and puts up an impressive figure of around 99.6 per cent, as it typically does, it doesn’t mean what you think (because it’s what the word ordinarily conveys), namely, how seldom (4 cases per thousand) it lights up falsely in the absence of the virus. How reliable it is. It doesn’t mean that at all. That’s because the performance of the test has never been calibrated by comparing its responses with confirmed viral infections. And without confirmed viral infections to assess the performance of the test by, you can’t establish its positive predictive value: its reliability, its accuracy. The correlation between ‘positive’ and ‘infected’ is completely unknown.

Are your eyes beginning to smart as you read this? If they are, best quit peeling this onion right now my friend, and find a rugger match to watch instead, because it gets much worse. You’ve no idea. You see, we are approaching the nub of this whole catastrophe, and it’s not something for the feint-hearted. But it’s not hard to grasp either. If you’re not intimidated by the mumbo-jumbo of lawyers and priests – the abracadabra they’ve developed to keep ordinary folks off their turf like iron pales – you are not going to be put off by ‘AIDS experts’ and their shibboleths. Take cheer from Einstein: ‘The whole of science is nothing more than the refinement of everyday thinking.’ Consider that reading and writing were once the elusive, daunting weapons of the elite against the laity in the Middle Ages, but as we’ve found out, it’s not so impenetrably hard after all.

The gold standard for measuring the performance of an indirect test for a viral infection – such as an antibody test – is the virus itself. Just as a foetus is an absolute reference for the performance of a pregnancy test. ‘Yes, obviously,’ you retort impatiently. Well eat this: ‘HIV’ has never, repeat, never been isolated and electron photomicrographed like other viruses – on its own, separate from bits of cellular debris and objects that look like infectious viral particles (‘mock-virus’) but aren’t. This is why you read incredulously in the test-kit manual, your mouth agape: ‘There is no recognised standard for establishing the presence or absence of HIV antibodies.’

As I mentioned in my antibody test article in Debating AZT, the specificity of the HIV test has been determined in a manner rather like treating thin women as controls for non-pregnancy and plump women as controls for imminent mothers in an exercise to ascertain how reliably a new pregnancy test is working. And then reporting the results as sensitivity and specificity values. Fair enough for a very rough anonymous screening survey in a nation of generally slender people perhaps, but criminal for a test used to make life and death diagnoses. Yet now in use as such everyday. Unchallenged, because what crimes have in common with debts is that the bigger they are, the better your chances of evading them. The crimes of the Church for instance.

The New Shorter Oxford English Dictionary defines a virus as a ‘submicroscopic organism that can multiply only inside host cells, has a non-cellular structure lacking any intrinsic metabolism and usually [comprises] a single DNA or RNA molecule in a protein coat’. (Let’s stay with this.) The definition implies that it can be seen. So what distinguishes the HIV theory of AIDS from the witchcraft theory of crop failure and family misfortune is that unlike the putative causative agents of the former, the cause of the latter can notionally be captured and visualised, like a criminal suspect standing in a dock. And that when ‘AIDS experts’ talk of HIV, they are implying to you not only that HIV can be seen, but also that it has been. You understand that they are referring to more than a trail of ambiguous chemical clues suggesting that HIV is in town. (Let’s further accept the conventional view for present purposes that viruses are the cause of disease, and not the result: particles expressed from stressed cells.)

By ‘submicroscopic’, the dictionary means too small to be seen with a light microscope. Very small indeed: about 120 nanometres (thousand-millionths of a metre) in diameter for that class of viruses they call ‘retroviruses’. But visible at that size to electron microscopes with a magnifying power of about twenty thousand. Now being so very small, you can’t easily isolate one of them for inspection and characterisation, like a dogfish scooped out of a rock-pool in your son’s fishing net. So you do the next best thing. You concentrate them. Separate from everything else. Thereby purified. Like a trawler’s net containing nothing but mackerel. So that when you gaze into this teeming mass you’re looking at and working with nothing but a very specific creature and nothing or very little else. If you mince the contents of the net, you can be sure to get mackerel meat, mackerel bones, mackerel scales and mackerel tails. Pure mackerel.

There’s a tried and tested procedure in virology for isolating viruses – variously named but involving the same essential steps. Call it isopycnic zonal density gradient ultracentrifugation if you like, but that’s only half the thing. Which is where the guys who claimed to have isolated HIV in 1983 and 1984 screwed up, raining a disaster on the world bigger than New York’s. By the end of 2003 the American government had spent $132.4 billion on AIDS according press releases issued by the Department of Health and Human Services, with another $14.2 lined up for 2004. All wasted. Let alone inestimable fortunes privately raised and spent. And more heartache and terror than all of it put together.

The viral isolation procedure is a trick a bit like royal English or Zulu huntsmen getting their vassals to beat the fens, forests or veld to drive antelope into a killing zone, to concentrate them for easier shooting and spearing. Separate from hares, snakes and birds. A procedure discussed and written about at a dedicated symposium of some of the world’s top virologists convened at the Pasteur Institute in 1972. I’ve got their papers, and this is what they tell us to do. You get hold of some cells you think are virus infected. (And some cells that aren’t, so that you can run a parallel control exercise.) You dismember them with solvents and enzymes, and then plop a drop of this mess atop some sugar syrup in a test tube prepared such that its density gets lighter bottom to top. You spin it at high speed for several hours, and what happens is that the stuff separates out in fractions, or layers. It’s like shaking up muddy water in a bottle and leaving it to stand over-night: in the morning you’ll have clear water on top, followed by dusty silt, and then grittier sand, with tiny stones at the bottom.

All retrovirologists accept that because of their characteristic buoyant density, retroviruses will band in a particular spot in the syrup, at a density gradient of 1.16 grams per millilitre – say like where the silt is. Here’s the next absolutely crucial step: You take a snap of what has collected there through an electronmicroscope, and you examine it carefully. You do this because although all retroviruses present will collect as aforesaid, so can other things – bits of cellular debris and intact parts of cells: enclosed minifactories called microvesicles. It’s like landing other kinds of fish, seaweed and sharks in your mackerel trawling net. You look out for the retroviruses you’re after, orbitally shaped with suckers all round – as ‘AIDS experts’ conceive and describe them in the textbooks. If that’s all that you see in your micrograph, or at least the preponderance of stuff there has the structural appearance of retroviruses as described, you’re in business. You incubate some virgin cells with these particles and repeat the whole procedure, to make sure they’re infectious. And thereafter, when you take a dip into this stuff, you can be sure you’ve got retroviruses. In abundance, with which to work, and make a heap of money from. Like a net full of mackerel – verified by peering into the net. You can use the proteins derived from this purified viral concentrate in antibody tests, confidently claiming that they are retroviral proteins that will react with corresponding antibodies. You can use the RNA you find in there in a test that seeks out matching RNA in a person’s blood, and likewise confidently claim that whenever you get a match you’ve shown a retroviral infection.

This procedure is commonsensical you’ll agree. It’s viral isolation. Nothing less will do. No short cuts. Not finding some proteins thought to be HIV-originated. Like a pair of sunglasses found near a crime scene, assumed to be the criminal’s. But equally possibly the victim’s. Especially since Papadopulos-Eleopulos and her colleagues demonstrated in their June 1993 paper, Is a positive Western blot proof of HIV infection? in Bio/Technology (now renamed Nature Biotechnology), that each and every protein that has been considered uniquely retroviral by ‘AIDS experts’ is actually cellular. Meaning part of us. For heaven’s sake. We are talking about the proteins used as antigens in HIV antibody tests. Alleged to be ‘HIV’. Actually human.

Nor will it suffice to find a peak level of this enzyme that ‘AIDS experts’ call reverse transcriptase. Because it’s not specific to retroviruses. Everyone in biology knows this. Even dopey South African ‘AIDS expert’ Professor Ruben Sher (on the documentary The Truth on AZT): ‘Now reverse transcriptase is also present in many other functions of the body. So although we were assured originally that [AZT] acted only on the HIV reverse transcriptase because it was specific to HIV, it would seem that it is not quite the truth.’ The plot thickens: the presence of ‘reverse transcriptase’ is never established directly. It is deduced from a biochemical phenomenon called retrotranscription. Which can be achieved by ordinary cellular enzymes. Which puts ‘reverse transcriptase’ in the same scientific category as the ether, electrical fluid and phlogiston. All of which substances, we know now, don’t exist – never did, except in the minds and books of scientists and their students, to explain things. For ages too.

And likewise in the words of ‘AIDS expert’ virologists in the employ of the mighty US CDC (in Emerging Infectious Diseases 2001, Vol 7 p756): ‘Detection of viral nucleic acid is not equivalent to isolating a virus.’ Right, although you might reasonably wonder on what basis they call the molecule ‘viral’, when they have not yet collared the suspect from which to take a sample for comparison purposes. But anyway, it’s why Roche Diagnostic Systems, Inc., manufacturer of the ‘HIV RNA’ detecting ‘viral load’ test, cautions: ‘The Amplicor HIV-1 Monitor test is not intended to be used as a screening test for HIV or as a diagnostic test to confirm the presence of HIV infection.’

Because babies inherit their mothers’ antibodies, ‘AIDS experts’ in the CDC appreciate that they can’t usefully be tested for ‘HIV infection’ with an antibody test kit, because it will detect the mother’s antibodies in the child’s bloodstream. Which puts them in a quandary. What to do? It’s easy. They just close their eyes to Roche’s warning that its test ‘is not intended to be used as a ... diagnostic test to confirm the presence of HIV infection’, and proceed to use the test to diagnose ‘HIV infection’ in babies, irrespective. Being ‘AIDS experts’. Who know what they’re doing. Sometimes they ‘confirm’ the result with a similar test, known as a qualitative (as opposed to quantitative) test – Roche’s other one, its Amplicor HIV-1 test (without ‘Monitor’ in the name). They likewise do so in defiance of the manufacturer’s express contraindication: ‘For research use only. Not for use in diagnostic procedures.’

It’s this abuse of the word ‘isolation’ by ‘AIDS experts’ that has caused all the trouble. (And ‘HIV isolates’.) They can’t even agree among themselves what they mean by it, as we saw in a spectacular performance by our National Institute of Virology at the second meeting of Mbeki’s AIDS Panel on in July 2000 – with virologist Lynne Morris telling us glibly in the morning that ‘HIV is easy to isolate. We do it every day’, followed by her boss Professor Barry Schoub contradicting her in the afternoon: ‘HIV is very difficult to isolate.’ Morris probably meant achieving a nice peak of reverse transcriptase in a cell culture stressed with various mitogenic chemicals. (Like nails hammered into an avocado tree to induce it to fruit.) Or finding some proteins as discussed. Or some protein interactions. And then jumping to the characteristically sloppy conclusion. Like a dull cop with a bad hunch. What Schoub had in mind when talking about isolating HIV is anyone’s guess, for reasons we’ll discover in a moment.

You’d assume then that all steps in this purification procedure were observed when HIV was allegedly isolated in the early eighties. Now that the American Robert Gallo’s plagiarism has been exposed, Luc Montagnier of the Pasteur Institute in Paris is generally acknowledged to have first isolated HIV (then called LAV) in 1983. Even though his idea about what HIV’s constituent proteins are is way out of joint with Gallo’s. Like giving a description of a grape for a banana. But in 1997, in a videotaped interview by a sharp French-Algerian investigative journalist, Djamel Tahi (I have a copy), Montagnier made some extraordinary concessions. As the camera purred Montagnier was asked, ‘Why do the electron micrographs published by you [in Science in May 1983] come from the culture and not from the purification?’ His bumbling reply should have marked the end of the HIV theory of AIDS:

There was so little production of virus it was impossible to see what might be in a concentrate of virus from a gradient. There was not enough virus to do that. Of course one looked for it, one looked for it in the tissues at the start, likewise in the biopsy. We saw some particles but they did not have the morphology typical of retroviruses. They were very different. Relatively different. So with the culture it took many hours to find the first pictures. It was a Roman effort! It’s easy to criticise after the event. What we did not have, and I have always recognised it, was that it was truly the cause of AIDS.

Montagnier had thought so as early 1990, at the San Francisco AIDS Conference: ‘HIV’ needs ‘cofactors’ to do any harm, and he had a mycoplasma in mind. But the conference organizers wanted none of it and refused him a podium, with the result that he had to present his paper on this in a nearby hotel, after which, the atmosphere being so chilly for him, he flew back to Paris immediately. Yet he didn’t see any contradiction in later stating in his book, Virus (W W Norton & Company, 1999): ‘I did not think, when I first began writing this book, that I would have to explain once again why AIDS is an infectious, communicable disease caused by a retrovirus, HIV.’

How in the light of those micrographs he could have gone on to claim that he’d isolated anything, let alone a new retrovirus, is incomprehensible, except that I’m afraid that Montagnier is a dreadfully stupid person, aided into print by a very powerful crook. (Asked in the interview whether Gallo had isolated HIV after him, he answered: ‘I do not believe so.’) Far from isolating a new retrovirus, all Montagnier had achieved was to obtain what appeared (from indirect clues) to be peak levels of reverse transcriptase in his 1.16 density gradient. And he found some objects swimming around the stressed biopsied cells in his test tube culture that didn’t even look like a textbook retrovirus – as sketched by the experts. Indeed, ‘a French specialist of electron micrographs of retroviruses publicly attacked me saying: “This is not a retrovirus, it is an arenavirus.” Because there are other families of virus which bud and have spikes on the surface, etc.’ Can you believe what you’re reading?

Probably not: it’s surely incredible to suggest that a leading virologist could publish a peer-reviewed claim in America’s top scientific journal that he’d isolated a new retrovirus when he hadn’t. Except that it had happened once before. In January 1975 Gallo, then head of the Laboratory of Tumour Cell Biology at the National Institutes of Health, alleged in the headlines of the Washington Post that he’d isolated the first observed human retrovirus – which he called HL23V. Type C RNA Tumor Virus Isolated from Cultured Human Acute Myelogenous Leukemia Cells, published soon thereafter in Science, formally staked his claim – backed up by a convincing electron photomicrograph of virus-like particles. But when he made a presentation the following year at the annual meeting of the Virus Cancer Programme, his colleagues in the game were waiting for him. They openly mocked his alleged discovery, joking that a better description of his alleged new ‘tumour virus’ might be ‘the rumour virus’. In 1980 two papers formally poked holes through Gallo’s find, and the following year, in a paper of his own, he conceded himself that the antibodies which he’d claimed were reacting with his alleged new virus had actually reacted with cellular proteins, not viral ones. With that, ‘HL23V’ finally evaporated. Right off the face of the scientific earth.

Significantly, however, Gallo’s evidence for his isolation of HL23V was even stronger than that which he put up in April 1984 in support of his rival claim, against Montagnier’s, to have first discovered HIV. Because unlike his ‘HIV’ pictures, his ‘HL23V’ micrograph depicted duly concentrated identical particles banding in sucrose where one expects retroviruses to mass after being spun by a centrifuge. And secondly, no mitogenic chemicals had been sprinkled onto his cell culture – to confound the show by stimulating the production of particles that look like infectious viruses but which aren’t.

Robert Gallagher, Gallo’s collaborator, who was cited as lead author of their co-authored Science paper, lamented to Linda Marsa, author of Prescription for Profits (Scribner, 1997): ‘There has never been for me an adequate explanation to this day as to how you could have all this positive data, and then all of a sudden there’s no evidence and it is totally discredited. The most likely explanation is that someone just got sloppy.’ Another is that you guys in Gallo’s ‘Bob Club’ mob didn’t know what the fuck you were doing. Borne out by your even crummier claims about HIV in 1984. Before the police came knocking for patent fraud. But making up for scientific incompetence with a good head for politics. For pulling funds from Congress, hand over fist. And most importantly, knowing how to play the media – and taking it on its biggest ride ever.

I met and spoke with Montagnier in Pretoria at the first meeting of the AIDS Panel in May 2000, and later sat at dinner with him, across the table a few chairs down. I eavesdropped aghast as New York journalists Celia Farber and Mark Drescher chatted to him, taking it up on hand-held video camera, adroitly teasing out the scientific ideas that fill his head. Like HIV is spread by insect bites. And then I had to turn away, unable to stomach any more. It was incredible, like a rerun of the Peter Sellers movie, Being There, in which the comedian played the retarded gardener Chance, mistaken by Washington movers and shakers for a Thoreau-like philosopher, and fêted as such. The tentative proposer (and later the recanter) of the retroviral theory of AIDS has the brains of a flea.

After a string of cracks from German-born Duesberg sitting at my left – a famously funny man in good spirits – I added one at the expense of dissident French Canadian pathologist, Emeritus Professor Etienne de Harven, sitting opposite us, telling how when Debussy went to visit Brahms, he was met at the door by his valet, who went up to announce his arrival. ‘Who’s Debussy?’ asked Brahms. ‘French composer,’ answered the butler. ‘No such thing!’ retorted Brahms. To which Duesberg added, pointing diagonally across the table at Montagnier, ‘Just like French virologist’, thereby bringing the house down again.

To those who’ve really looked into this mess though, Duesberg and Montagnier sit at the same table scientifically-speaking too. Their disagreement is trivial. Duesberg accepts Montagnier’s claim to have isolated HIV. Actually argues it against Papadopulos-Eleopulos. Ineptly, even a layman can see. And at the second meeting of the AIDS Panel in July 2000 he theatrically supported Makgoba’s assertion, ‘Even Peter agrees that HIV has been isolated.’

But the world’s most notorious AIDS dissident, Duesberg, and the world’s most famous HIV expert, Montagnier, agree: HIV cannot possibly cause the onset of AIDS diseases. Duesberg says not at all; Montagnier, since 1990, has asserted the need for causative co-factors. HIV needs help, he says, because it can’t do it on its own. Are you amazed to learn this?

In championing Montagnier’s HIV isolation claims, Duesberg’s dismissal of Papadopulos-Eleopulos’s more radical critique has frequently been rude and scornful – reminiscent of Galileo’s attitude to Kepler in dismissing his discovery of the lunar influence over the tides as a ‘puerile superstition’. Hubris gets in the way with these guys sometimes. Even the bravest and the best. So we have Duesberg demeaning as ‘impassioned’ Papadopulos-Eleopulos’s dry-as-bones, meticulous repudiation of his claim to the Continuum prize – offering the jackpot to anyone showing ‘HIV’ to have been isolated (see the Missing Virus debate at ); ‘unfortunately or fortunately’ she hadn’t attended an AIDS dissident conference in Colombia in October 1997, he said; ‘The Perth Group are dead,’ he said dismissively of her case to his audience on the veranda of the Sheriton Hotel in Pretoria at the first meeting of the AIDS Panel meeting; when she approached him at the second AIDS Panel meeting in Johannesburg to mend the bridges he’d burnt, he coldly turned his back on her; and a day later walked out as her HIV isolation experiment was proposed there. Yet she continues graciously recognising his tremendous contribution and exemplary courage nonetheless, crediting him in her subsequent opus, Mother to child transmission of HIV and its prevention with AZT and nevirapine, ‘for showing us that tenacity and perseverance are needed by scientists in their search for truth’.

But one can sympathise. It must be harsh for Duesberg to contemplate that much of his career as a retrovirology specialist has been a lost diversion. Like those ‘phlogiston’ experts grappling with Lavoisier’s discovery of oxygen, which explained the oxidative process much better: oxygen coming in, not ‘phlogiston’ going out. Or those guys who were experts in ‘the ether’ filling the universe. Or ‘electrical fluid’. Non-existent entities upon which they had erected their careers, misled along with everyone else by deceptive appearances and clues. And tough it must have been hearing his erstwhile supporter Nobel laureate Kary Mullis scorning him at dinner during the Colombian meeting as a ‘proctovirologist’. Mullis had been won by Papadopulos-Eleopulos’s case, presented by Colombian research biologist Dr Helman Alfonso and supported by German virologist Dr Stefan Lanka, demonstrating that the study of ‘HIV’ – and indeed the whole of infectious retrovirology – is a load of, shall we say, scatology, coprology. Irritated by Duesberg’s unexamined reiteration of the claim of the ‘AIDS experts’ that the ‘HIV genome’ has been sequenced, Mullis let loose a shower of sarcastic remarks. (He’s another amusing bloke: ask him what the acronym PCR for his invention means (polymerase chain reaction) and he’ll tell you ‘post-coital reverie’.) Duesberg sat stung and silent. At last. Having earlier attempted to shout Alfonso and Lanka down. Misbehaving dogmatically with stopped ears, just as he did at the first and second meetings of the AIDS Panel, repeatedly getting up and walking out.

Duesberg is wrong about a number of things, including critically important ones: the specificity of the HIV antibody tests, the HIV isolation question, and the real reason why AZT is so poisonous. And as mentioned, he has behaved very badly towards his detractors on his left flank. His scientific manners in his engagements with them have been as lacking as those who have pilloried him from the right for his efforts in exposing the more obvious anomalies, paradoxes, insufficiencies, and predictive failures of the HIV-AIDS model. Because to the guys who make their living fanning the hysteria of AIDS ideology, Duesberg is like the Moslems’ Shaatan. Good only for stoning. That’s why you seldom hear his name uttered without execration. Like their favourite: ‘discredited’. By whom? His published critiques of the HIV-AIDS causation model, identifying its gross failings, at an epidemiological level mostly, have never been properly addressed, much less refuted. They stand timelessly like the heads on Easter Island. The author of the HIV-AIDS theory, Robert Gallo, broke his promise to write a rebuttal of Duesberg’s magnum opus debunk in the journal Proceedings of the National Academy of Sciences in 1992, a promise made in a notice published alongside it. It bears mentioning that Duesberg remains a member in good standing of that exclusive outfit, and has recently published his novel theory of cancer aetiology – aneuploidy – in its said house journal.

Until he started causing trouble for the AIDS industry, by refusing to buy the mob line, and telling why with irksome logical force, Duesberg had been regarded by his peers as one of America’s most distinguished biologists. He had identified oncogenes (an irrelevance, he later admitted), had been the first to map retroviruses genetically (we await a similar concession), and for these and other achievements had notched up a California’s Scientist of the Year award in 1971, had won a seven-year Outstanding Investigator grant from the National institutes of Health in 1986, the largest research grant available in biology, and had been admitted to the prestigious National Academy of Sciences. There was talk of a Nobel Prize. Students flocked to his courses to sit at his feet, leaving other teachers’ lecture halls embarrassingly empty. (At Berkeley where Duesberg is tenured, there are over a hundred professors of biology in his faculty.) Also to laugh at his cracks, because when he gets going, he’s a very funny guy. I can confirm that first hand because he asked me to sit opposite him to catch up at dinner on Friday night at the Sheraton Hotel in Pretoria before the first weekend meeting of Mbeki’s International AIDS Advisory Panel in May 2000. Let me report that the humour at the table was unsurpassed. Aching ribs. Round after round. And it was the same at meals at the second AIDS Panel meeting in Johannesburg in July. None other than Gallo once described him as ‘a man of extraordinary energy, unusual honesty, an enormous sense of humour, and a rare critical sense’. In short, it would be safe to say that before his fall from favour, and he found himself on a McCarthyesque blacklist for critiquing the HIV theory of AIDS, Duesberg was biology’s brilliant blue-eyed boy.

He may be its turbulent priest, but Duesberg is no radical Beyers Naude of biology dogma. Even less a sort of Robert Altizer thanatheist. Actually he’s about as faithful an old dog conservative biologist as you can get. Too stubbornly so, some of us think. He just sticks to the old rules; he won’t let them go, and he says that the rules he keeps have no room for the HIV theory of AIDS. But even if Duesberg’s rocket fuel runs out half way down the road, the truth is we love him from the bottom of our hearts. Like your children no matter what. It has to do with scientific integrity and its price, expressed in the working title of Bialy’s authorised biography: Unbuttering his own bread: The scientific life and times of Peter H. Duesberg (published by the National University of Mexico in 2004 as Oncogenes, Aneuploidy, and AIDS: A scientific life and times of Peter H. Duesberg). For his courage, his determination, his sacrifice and his humanity, Duesberg, I propose, is the Mandela of AIDS.

Apart from an eccentric sect of Unitarians who call themselves Christadelphians, nearly all Christians believe in the Devil. (As they all believe in HIV.) One of the top gods of their religion. The big bad one. On whom lots can be blamed. His mischief alone being ample proof of his existence. That he’s not ever directly seen doesn’t count. To the faithful. His works are, and they evidence his hand. Satan has much in common with HIV. A scary ugly name for a start. Implying great wicked power. Invisible too. In the sense of never physically seen.

Imagine a sudden itch. Your eyes zoom in on a speck at the site. An unfamiliar tiny freckle. With a scratch it comes away. You peer at it a foot from your nose and recognise it as a pepper tick. Under a strong lens you’ll see the mandible that pierced your skin, along with the rest of its particulars. No doubt, to any right thinking guy, the tick bite caused the itch. But what of odd, disobedient, gangly behaviour among children. Today they’ll be drugged with Ritalin. But during the European witchcraft epoch, such kids were prone to being tried for witchcraft and thereafter hanged and/or burned. Yes, not only grownups. Because the devil was in them. It was obvious.

So it is nowadays: when someone’s syringed blood happens to react more colourfully than the next guy’s in a test-tube of what ‘AIDS experts’ call HIV proteins, they’re said to have the virus in them. Kind of the opposite of being filled with the Holy Spirit. And if and when they take ill for whatever reason, obvious or occult, well there you go, they’ve got AIDS. Caused by the virus.

Something else in common between the two bogeys is the fact that if you believe in the Devil, even a little bit, no amount of persuasion can change your mind. Certainly not such unreal talk as the virus never having been isolated and seen.

Another respect in which AIDS medicine keeps company with devilry is that, as we noted earlier in regard to the latter, a vast body of learning, hierarchies of experts, and even state sanctions can all flow from notions that are purely mythical, especially when dressed in the garments of scientific authority. And with power comes money and vice versa, and the next thing a vast St Paul’s Cathedral has been raised. For the veneration of morbid superstitions. Peculiarly Western ones.

That Mbeki himself entertains something of this perspective – that HIV-AIDS is essentially a superstitious fancy – emerged in the first week of April 2003. Asked whether he’d consider his just established Presidential Press Corps successful if it changed journalists’ opinions concerning government policy on AIDS, he replied in the negative; right on the button, he explained why he didn’t expect they would: ‘You have prejudices, superstitions, all sorts of things.’

Montagnier’s astounding concession to Tahi did not come entirely out of the blue. Turner told me that when he mentioned to Papadopulos-Eleopulos back in 1983 that Montagnier had reportedly isolated a new retrovirus, her answer, having just read his paper as well was, ‘Oh no he hasn’t,’ waving her finger in the air between them. And thus began an extraordinary odyssey together as they published one paper after another taking apart every piece of the HIV-AIDS paradigm, brick by brick. Nearly all their papers have since been archived on the Internet. Duesberg’s key papers too.

After Montagnier’s concessions to Tahi on video in 1997, a second pivotal development occurred that year: two papers by independent research teams led by Julian Bess in the US and Pablo Glushankoff in Germany were coincidentally published in the March issue of Virology, putting up the very first micrographs of what were supposed to be concentrated HIV isolates in banded density gradients – only to report in their titles and reports that the overwhelming majority of matter in the pictures was cellular, not viral. A few blobs were arbitrarily identified by the researchers as HIV, ‘co-purifying’ with all the junk. But all were wrongly sized and wrongly shaped. Rather like a ringmaster assembling an assortment of circus animals, pointing at the ponies among them, and saying, ‘Look, my performing cats.’ The Bess team also published data (in the form of electrophorectic patterns) on the proteins that they found in their ‘infected and ‘non-infected’ cell cultures. One would have expected that the ‘purified’ material from the ‘infected’ cells would have contained unique, distinct viral proteins, and that such proteins would not have been present in the centrifuged material from the ‘non-infected’ cells. But no: the ‘non-infected’ cells contained the same proteins; the only difference between the ‘infected’ and ‘non-infected’ electrophorectic patterns being quantitative. Bess himself conceded this when it was raised with him by the Perth Group. A somewhat awkward state of affairs for the ‘AIDS experts’, if you get the point.

Sadly it was all too much for the president of the Medical Research Council. At the second meeting of Mbeki’s AIDS Panel in July 2000, and in correspondence thereafter, Makgoba dismissed the Perth Group’s identification of these problems in the following terms (in full grammatical and spelling glory):

The Perth Group themselves in our correspondence recognised that own deficiencies and were critised by several members for living and present outdated data eg Dr. Carolynn Williamson and Dr Lynn Morris. [In fact neither commented on the Bess data]. If the recordings are correct that is what you will find. I do not use rhetoric but I equally cannot be deceived by presented electrophoretic patterns that are completely wrong as they attempted to do. My whole PhD thesis was based on doing and reading minute differences in electrophoretic patterns on cell lysates, so I know what I am talking about here.

Bess himself didn’t think so. Invited by the Perth Group to comment he said:

I would like to answer any questions you have about my work. However, I do not understand the quote … Was it spoken in another language and translated directly into English? Please read it carefully. It has significant syntax problems. Also, I suggest that you re-read my manuscript. You will discover that I presented no data on cell lysates. As to how the electrophoretic patterns can be ‘completely wrong’ – you will have to get that one answered by the questioner. I have no clue how they could be wrong. It is possible that the questioner is not aware of what material was electrophoresed (e.g. a cell lysate vs. microvesicles). If the questioner thinks these are cell lysates, he will likely come to an erroneous conclusion.

Over the last two decades of the HIV-AIDS nightmare, the original source of the proteins and RNA’s used in HIV tests has been the bands of what has been assumed to be concentrated HIV particles. Mass production resorts to genetic engineering techniques to produce the same in bulk and to higher uniform standards – such as recombinant proteins in antibody tests. But the crucial assumption that the proteins and RNA are viral was disconfirmed in 1997 when the stuff assumed to be nothing but mackerel, turned out to be kelp, clams, seals, sardines, stingrays and eels. English lacks words sufficient to carry the scale of this disaster. But the Juggernaut rolls on, with lives daily crushed under its wheels.

If you find yourself heaving under the weight of this, join the club. But here’s a hot tip. Leave it here and call it a day. Don’t talk about it, and don’t scratch any further. At stuff like Rabies, Polio, SARS, Mad Cow, Foot and Mouth, virology generally, immunology generally, syphilis, germ theory generally. Modern oncology’s constructions of cancer and its treatment. Or the possibility that the central dogma of molecular biology – the notion that genetic information is stored exclusively in DNA – might better be described as its central fallacy. And that it’s high time to yank the chain on it, flushing all of ‘retrovirology’ down the pan too. Turn from ruminating about what ‘HIV-AIDS’ as a new medical ideology says about the metaphysical foundations of modern medicine. From what kind of ground would sprout such a poisonous weed. And what kind of culture would support an allopathic ‘healing’ system currently dominated by such grotesque, perverse, death-fomenting superstitions and practices. Rather than kicking out the bums who propound them as wicked charlatans. Because this is where the fire under your feet starts getting uncomfortably warm. You’ll quickly appreciate that your inquiry is not innocently scientific as you naively supposed it was when you began. It is taboo and it is absolutely forbidden. Einstein’s advice, ‘The important thing is to never stop questioning’, doesn’t apply here. Fortunes derived from the settled notions you weigh dwarf the Vatican’s holdings to farthings. You threaten jobs and you expose reputations to ridicule. It would be like going around saying, ‘The Trinity is ridiculous. It’s a pagan idea not even in the Bible and it was only established as the Christian religion’s central creed by the whims and forceful exertions of the Roman emperor Constantine. Stamping out a bothersome doctrinal squabble – potentially dangerously divisive, because the two sides were pretty evenly matched in terms of the eminence and numbers of their supporters. Three hundred and fifty years after his government sanctioned the lynching of the guy he now decided should be turned into a god.’ Imagine the atomic crescendo of stuck pigs squealing, the vast pack of snapping Dobermans charging.

The world’s most famous Jew was murdered to satisfy a popular call. Because he was going around saying the wrong things. Uncomfortable things. Hanging out with working girls. And washing the sores of those absolutely ostracised and stigmatised ‘AIDS sufferers’ of his day, lepers. Laughing off the universal belief that their condition was infectious. If to the touch, most certainly via lovers’ secretions: in The Group-Fantasy Origins of AIDS, the late Casper Schmidt, a Namibian-born psychiatrist and Afrikaans poet who practised in New York after a stint in Soweto, quoted the famous Gui de Chauliac, medieval physician to the Papal Court at Avignon, advising doctors interrogating male patients ‘to enquyre yf he hath had the company of any lepresse woman. And yf lazar [a leper] had medled with her afore hym, and lately, because of the infect mater and the contagious filth that she hadde received of hym.’ The idea that leprosy was sexually transmitted was current on the other side of the Channel too: Ziegler notes incidentally in The Black Death that Edward III banned lepers from London in 1346, since ‘by carnal intercourse with women in stews [brothels] and other secret places, detestably frequenting the same, [they] do so taint persons who are sound’.

Schmidt observed that

The fantasy complex of AIDS (i.e. the triad of promiscuity, poison blood, poison sperm) is not new. It is identical to the one in vogue in the Middle Ages to explain the origins of leprosy. It was generally accepted that leprosy was associated with violent sexual excitement and moral impurity … ‘the filth of lechery’, ‘the impurity of lust’ … It can be seen today that this fantasy complex has not changed and is encountered intact today, except that in the AIDS epidemic the fantasies have been translated into modern idiom (so that ‘contagious filth’ becomes ‘semen containing cytomegalovirus or HTLV-III’ [the old name for HIV] or more sophisticated still, ‘immunosuppressive sperm’). These unconscious fantasies are found not only in the lay press, but they determine the direction of our scientific thinking, so that in scientific magazines usually sceptical clinicians subscribe to them without sufficient proof.

Like Mbeki during the AIDS craze today, the carpenter among lepers then was remarkably sharp to the obvious fact – in the face of conventional wisdom – that those suffering the disease were generally the desperately poor and hopeless, conveyed by the Xhosa and Zulu adjective, hlupekile. And that he wasn’t going to get ill by embracing them – the germ Mycobacterium Leprae being ubiquitous like its cousin, Mycobacterium Tuberculosis. Colonizing the weak. Not the strong. As Alfred North Whitehead once noted, and it applies to both men: ‘It requires a very unusual mind to make an analysis of the obvious.’ Christ’s compassion for lepers provocatively flouted the popular taboo. The taboo on people branded HIV-positive is enforced hardly less viciously – as Mbeki has discovered in disregarding it, spat on in all the media, and flatly accused of mental illness and of incompetence to hold his office. And curiously, like those circumcised matrons in certain Northern African countries, who defend their mutilation of young girls in turn more strenuously than anyone else, it is those under the hex of HIV-positive diagnoses themselves who have been Mbeki’s most virulent detractors.

The antagonistic vehemence of the mob, high-brow and low, offended by Mbeki’s and Christ’s scorn of the contemporary popular opinions is explained by Arthur Schopenhauer from a simpler tack: ‘There are three steps in the revelation of any truth: in the first, it is ridiculed; in the second, it is resisted; in the third, it is considered self-evident.’ A fact of life noted by Denis Beckett in his delightful Madibaland (Penguin, 1998): ‘A delusion after it has died is a wonderful thing to attack; everybody rolls up to kick its corpse, especially the people who once believed it and are thus doubly angry. But a delusion in full swing is hard to see as a delusion. A delusion in its own time is a holy cause, and its adherents become irritated if doubt is expressed.’ So when entering into these matters you have to be careful. At the least of it people will begin to look at you askance. They might even call out the constabulary. As they did for the freethinking sceptic Bruno Geordio. Before burning him in Rome in 1600 for the offence of being just that.

Anyway, knowing none of the trouble with the HIV tests and with AIDS medicine that we’ve been talking about, Cameron is freaked, broken hearted, and in tears. This is the standard reaction to a medical sentence of death. As absolute as a judicial one.

Cameron told his interviewer Evans that his quack had nonchalantly told him over the phone in December 1986, ‘By the way, you’re HIV-positive.’ His mind glowing in overdrive, he understood that he was infected with the virus that lurks. He traced his infection ‘to a specific, single unrepeated act of unsafe sex’ – receptive, he’d explained on Carte Blanche. A one-night stand apparently. ‘Barebacking’ as these guys call it, Cameron taking the ‘bottom’ role, his temporary mate the ‘top’, as they say. For him ‘it was a tremendous shock, a nightmare. I went into deep clinical depression. I didn’t tell my family’. Not for four years. ‘I only told my lover after a delay, and it had a profound effect on my sexual confidence, capacity for sexual interaction even. … It was the most appalling thing.’ Understandably. In the olden days in South Africa, men, invariably black, standing in criminal docks and being told they were to swing from ropes didn’t feel so cheerful either. Served a chicken and a bag of sweets to lighten their mood the night before their big day. Likewise women finding lumps, or being confronted with terrifying mammograms, given what modern medicine-men make of them. And do about them. Using scary language like ‘malignant’. But don’t worry, it can be treated. I keep my knife shiny and sharp. Dark bottles in my bag. And a kind of nuclear microwave oven for you over at the oncology centre.

So like Makhaye bewitched, Cameron gears up to die. The news they’ve got is as flummoxing as a right to the jaw. It’s been called the ‘nocebo’ effect. He’s seized with the kind of horror conjured up by the Nazi newspaper the Völkische Boebachter in Germany in the twenties and thirties, describing syphilis, which, ‘born of brief, forbidden lust, beginning with a small hard sore, gradually attacks all the limbs and joints, even all the flesh, down to the heart and brain’. (Sure, if treated with arsenic injections, alone or mixed with mercury and or bismuth.) After a few years Cameron starts drinking venomous brews recommended by the ‘AIDS experts’. Replaying a script from the era of the syphilis terror. (The protease inhibitor story is as vile as AZT’s.) Fungi start to thrive on his poisoned tissues. But even as the drugs sicken him, he believes the opposite. It’s known as hypnosis. Eventually his body rallies, and the fungal infestations pass. He quits the protease inhibitors and right away his health is restored. Not only can he feel it, like a Christian reborn, but the tests confirm it. He believes, because his doctor has told him, and unlike George Bernard Shaw – ‘To be frank, I don’t believe in doctors’ – he believes everything his doctor says, that there’s this test that measures levels of HIV infection in his blood. That’s the next big cock-up, because in fact it doesn’t.

Mullis who won the Nobel Prize for the technology employed in these ‘HIV viral load’ tests has repudiated them as an abuse of his invention. Quite right. And quite a thought. Since the test is said to be counting molecules of genetic material thought to comprise part of the ‘HIV genome’ and thereby revealing the number of viruses ‘lurking’ about in your blood, you’d imagine that it would run with fingerprint matching precision. Yet this test is not allowed even for screening, let alone diagnostic or confirmatory use. It’s like a test for the number of marbles in a schoolboy’s pocket, except that it can’t tell whether he’s got marbles, chips of windscreen glass picked up off the road or even sweets in there. Does this make any sense? Is such a test really counting marbles? Is it even counting? A study published in 1997 in the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, entitled Effect of HIV-1 genetic diversity on HIV-1 quantification in plasma: comparative evaluation of three commercial assays by Coste et al., reported counts ranging from zero to hundreds of thousands of ‘HIV-1 RNA copies’, depending on the ‘HIV-1 clade’ and test used. Demonstrating, at bottom line, that ‘viral load’ testing is utterly worthless. (For elaboration, see the particulars of claim in An AIDS Case in the appendices to Debating AZT.) The name ‘viral load’ popularly given to this type of PCR test is entirely misleading. It most certainly does not tell you how many viruses you’ve got per millilitre of your blood, as your doctor tells you, and ‘AIDS sufferers’ like Achmat and Cameron believe it does. Nothing of the sort.

‘AIDS experts’ might try putting you off your slide into bewildered HIV agnosticism by assuring you with scoffing condescension that the ‘HIV genome’ has been sequenced – meaning its genetic architecture has been mapped. It hasn’t: ‘AIDS experts’ cobble together bits of what they think is HIV’s genetic heart, so to speak, and call it HIV. Like a stranger flying over New York, surveying the debris, and, not having seen the twin towers before, describing the building plans. Or someone picking up some grit in a field and asserting: ‘These are fragments of a great temple that stood here once.’ When the grit looks exactly the same as the dirt for miles around. To convince you that they are talking about a distinct creature, a distinct species of virus, ‘AIDS experts’ talk of clades (mutants from a common ancestor), wild-type virus, and HIV-1 and HIV-2. Tests for the former not the latter, and so on. All variations of the same nursery rhyme. The genetic makeup of humans and chimpanzees is more than 99 per cent homologous (identical) – that is, between different species of great ape, it differs by a fraction of a per cent – in a comparison of an enormous amount of genetic material. Just think then how much smaller the genetic variation is between humans: Koreans, Swedes, Masai. But ‘AIDS experts’ find nothing remiss in calling infinitesimally minute stretches of genetic material that differ by up to 40 per cent ‘HIV’. The clever guys.

Cameron didn’t mention it, but the judge with the great government sponsored medical aid scheme that he spoke about in the interview probably also had his CD4 cells counted from time to time, on the house, thinking – because his doctor had told him – that their number was an index of the strength of his ‘immune system’. They aren’t. It’s another total waste of time. The absence of a correlation between their ever varying numbers and the clinical health of their trial subjects led the Concorde AZT trial overseers to report ‘serious doubts on the value of using changes in CD4 count as a predictive measure for the effects of antiviral therapy’. But this was hardly news, because the irrelevance of CD4 cell counting had been discussed and reported in legion papers in the medical literature well before 1994. And after it too. It’s just that ‘AIDS experts’ like to keep busy, earn money, and feel relevant performing their little tests. Like those criminologists who used to measure the space between prisoners’ eyebrows to determine criminal propensity. So they pay no attention.

Duped by all this junk medical science, Cameron goes on a crusade. Boiling down to promoting GlaxoSmithKline’s drugs. With the best will in the world. Isn’t it usually the case? And the rest we know well. As journalists swoon at his every utterance. Like John Perlman interviewing him on SAfm morning radio, gushing with AIDS-think solidarity, chuckling along sycophantically, his laugh like a hen clucking, his humour as flat as his vowels, delivered in an unbearable sing-song nasal whine with random cadences, a little boy giving a classroom speech, or talking to his mummy – ‘What do you do when you get scared and lonely?’ he actually asked HIV-positive AIDS journalist Lucky Mazibuko – drenching the airwaves with adulation. We’re in this together. I’m on your side. I also wear a red ticket on my tit. To show that I care. I’m a new age guy. And like Cliff Saunders interviewing National Party politicians before me, you never have to worry about any difficult challenging questions when I’m around.

On 19 November 2001 Perlman interviewed Tshabalala-Msimang following her public statement that her department had made mistakes. In service delivery, she meant. And in the interview made unambiguously clear. But you could hear that the doctor’s son, sold on GlaxoSmithKline’s propaganda mouthed faithfully by Cameron and Achmat, wasn’t interested in any of this. He took off like a bluebottle fly straight for its favourite landing place, and pressed her on why she wasn’t dishing out antiretrovirals. She parried the question on cost alone. Like Kellogg’s All Bran, Perlman keeps it nice and regular, with at least one slot booked every Thursday morning for an interview with an ‘AIDS expert’ or activist, telling us how the fight against AIDS is going.

In his Evans interview Cameron reproached Mandela for not selling for Durex, as the judge was doing for GlaxoSmithKline:

Of all the leaders of the 20th century who might have had an impact on people’s behaviour [he means black men having sex – we’ll see in a moment], he was the one who could have done the most, but without a doubt this was one of the grievous omissions of his presidency. Mandela did 199 things that contributed to our nation’s salvation, but the one thing he didn’t do as president was to take the lead on Aids. We tried to get to him in every way, but he didn’t take it up. It was a tragedy.

Everything seems to be ‘a tragedy’ for this sad sack arriviste from a broken home, dragged through ‘seven schools’, suffering ‘quite severe material and emotional deprivation’. From boarding houses to children’s homes. Yearning for love and belonging. Eventually finding it in the ‘AIDS movement’, like those stray souls taken in by cult churches: ‘The response was overwhelming’ to his statement that he had AIDS at a public hearing of the Judicial Services Commission weighing his application for a Constitutional Court job: ‘The most moving thing was that I’m a white, gay man in an epidemic that overwhelmingly affects black heterosexuals but I was claimed as an African who spoke out on the fact that I had AIDS.’ Well, by whom exactly? The peasantry? Or the narrow coterie in the room, white journalists mostly? Hanging on his every word. Like Elvis among them. Cameron was too moved, apparently, to wonder why among whites in South Africa, doctors should largely locate AIDS among homosexuals, but among blacks, among the lot of them. Or consider whether it really made sense to blame HIV for AIDS, if HIV infection in the US, as determined by antibody tests, is spread equally across the sexes. As it is here. But about 90 per cent of AIDS case diagnoses in the US have always been among gay men.

In his address to the Durban AIDS Conference, Cameron described in more detail the glowing happiness that flooded into his life after he came out with the news of his diagnosis:

I had many, many, many hundreds of individual responses … almost without exception generous, affirming and loving responses. For me personally it was a turning point in my life, it enable me to integrate in many ways the personal, the political and to lead a single life, it has had enormously positive benefits in terms of people’s support for me, in terms of the strength and energy with which I feel that I have been able to speak on these issues since then. It has been very positive. At the time that I disclosed I thought that my public statement would be a precursor to other people in politically and publicly prominent positions coming out, that has not happened. I thought there would be cabinet ministers, entertainers, sports stars, people in business life coming out, speaking out but that has not happened. It shows how intensely fear-laden and personal the issue of AIDS remains.

Maybe it shows instead what a narcissistic exhibitionist he is. Inspired by the delusion that he’s the queer Messiah. With the sexy disease. And that other gay men just weren’t buying it.

Most anyway. Photographer Michael Meyersfeld published a collection of photographic portraits of gay South Africans entitled Gaze (Bell-Roberts Publishing, 2003), for which he got Cameron, South Africa’s leading gay man, to write the foreword: ‘Open this astonishing collection of portraits anywhere. You will find gay men and lesbians. Their poses are open, challenging, exultant, revealing, and affirmatory.’ What Cameron’s own pose sought to affirm, it’s difficult to say. Seated in a black suit, sans shirt or shoes, he stares grimly at the lens. It’s a most unpleasant photograph, and leaves one ruminating darkly over just what it is that Cameron imagines he conveys by such peculiar showing off. Because, but for his hands crossed in front of him in a pair of translucent lacy gloves, an SS cap with a silver skull badge covering his sparse pate wouldn’t have been out of place.

Apparently paraphrasing Cameron, Evans wrote, ‘Mandela’s successor’s activism, on the other hand, was absurd. Thabo Mbeki famously sanctioned a second look into the scientifically discredited “Duesberg hypothesis” that Aids is not caused by HIV and suddenly no one in his government was prepared to acknowledge the link with sex.’ It may sound ‘absurd’, bro, but then so has every critique of bad medical and scientific ideas during their heyday. Goldberger in the US was vilified for decades in the early 20th century for having had the temerity to contradict the universal expert consensus that pellagra was caused by germs, and for proposing that it had something to do with diet instead (Vitamin B was identified after his death), a proposal denounced with that very word, ‘absurd’. And if anybody can show me the research paper demonstrating that having sex spreads HIV and AIDS, he or she can have my entire jazz CD collection.

As Goldberger in the US did, Robert Koch in Germany before him was ridiculed for proposing in 1882 that a strange, spongy-walled germ, Mycobacterium Tuberculosis that he’d just observed with the help of a new stain, Erlich blue, to illuminate it, might cause TB. Not heredity, foul air or anything else asserted by ‘the experts’ in their textbooks, at their conferences and to their patients. (Actually the cause of TB is rather more complicated than infection, or maybe simpler, but a discussion of the rise of germ theory, as the foundational marketing paradigm of the pharmaceutical industry, would fill another book). I can still remember being mortified by the big herpes scare in my schooldays – completely bogus it turns out. It was syphilis in my father’s. Toilet seats and everything. To contend back then that there was simply no proof for any of this, and that medical knowledge based on overwhelming evidence was mere superstition, would have been to risk confinement in the nuthouse. Because it was ‘absurd’.

Yet it is difficult to imagine a more absurd, superstitious account of syphilis than the standard exposition appearing in the 13th edition of Black’s Medical Dictionary in 1936. Before reciting it, it is noteworthy that English doctors (from a culture with moral qualms about sexual gratification) see syphilis, like AIDS, only among humans – and the darker their skins, the more prevalent the disease. But curiously enough, among the people Western doctors claim syphilis is rife, it doesn’t exist as an indigenous disease construct. There are two possibilities accounting for this: Africans across the continent, in all their vast variety of cultures – Indians, Chines and South Americans too – have been blind to the obvious since the beginning of time. Alternatively, European doctors have been superimposing a culturally generated and conditioned received wisdom upon vague signs and symptoms – their diagnosis confirmed by their hopelessly non-specific Wasserman antibody test and its successors. (As the Oxford Companion to Medicine (3rd edition, 1986) puts it: ‘It was not until the early 1940s that it was fully realized that many diseases could be responsible for a positive Wassermann reaction.’) And English doctors have classically believed syphilis to have spread to England from Europeans speaking the romance languages – thought less straightlaced in pursuing amorous adventures.

Black’s Medical Dictionary tells us that: ‘Syphilis may be acquired from persons already suffering from the disease, or it may be inherited from one or both parents. … Not only may the disease be spread as a venereal infection, but cups, spoons, towels, sponges, sheets, which have been used by the diseased, have been known to convey the contagion to others. … Accordingly any one acting as a wet-nurse to, or even frequently handling [‘infants suffering the inherited form’] runs great risk of infection, although the mother may handle it with impunity (Colle’s Law). … [Black’s Medical Dictionary then sets out various non-specific symptoms.] Still later effects are apt to follow at a subsequent period of life, such as ... early mental failure; also certain nervous diseases, of which locomotor ataxia and general paralysis are the chief. … The drugs possessing a special influence upon the progress of the disease are salts of mercury and arsenic, and arsenobenzol compounds, which seem to be most beneficial in the earlier stages.’ And are most effective in achieving early dementia and paralysis. Attributed to germs burrowing up your spine into your brain. In fact numerous different germs are found in ‘syphilis’ sores, but the one they like to blame has an exotic corkscrew tail. They call it Trepona pallidum. Some imaginative doctors suggest that the germ takes numerous different forms when they find the wrong-looking one. They say it’s pleomorphic. Black on syphilis talked like ‘AIDS experts’ do today. First you experience a ‘flu-like illness’. And then you feel perfectly fine. But thereafter: ‘Still later effects are apt to follow at a subsequent period of life, such as ... early mental failure’ and paralysis. If, in the olden days, you were put on mercury and/or arsenic. And when, as a woman treated with these neurotoxic substances, your baby was predictably born blind, deaf and/or otherwise brain damaged, doctors called it ‘congenital syphilis’. But as ridiculously as Black’s Medical Dictionary reads on syphilis, the extensive entry on the same subject in the current edition of the Oxford Textbook of Medicine comes over in much the same way. As with AIDS, the idea with syphilis seems to have been: construct a new disease paradigm, link it with sex and blast it with the most deadly chemicals available in medicine’s arsenal. The patient too, but that’s incidental to the higher purpose. Sort of like collateral damage. Only, blamed on the disease: in 1952 the 23rd edition of Martindale’s The Extra Pharmacopœia, doctors’ standard reference for what to give people when sick, advised that injected arsenic

may cause severe, and even fatal, reactions … a few days to several weeks after administration; these include jaundice, acute yellow atrophy of the liver, acute purpura, aplastic anaemia, and agranulocytosis. Severe nervous manifestations may occur after an interval of weeks or even months of treatment; these include cranial nerve palsy and neuritis of the auditory, optic and facial nerves; these are generally regarded as being syphilitic rather than of arsenical origin and their occurrence calls for more vigorous arsphenamine medication.

This is the medical mind at work. At the highest level. Martindale again:

The standards of treatment laid down by the League of Nations Committee in 1934 are now almost universally accepted. They include … treatment as early as possible [with] comparatively heavy individual dosage of the arsenobenzene and of the bismuth and mercurial compounds, the doses being administered in comparatively rapid succession … persistent attack on the disease, avoiding intervals of such length as to afford the parasite an opportunity of recovering.

(That’s Martindale in 1952 – not today, of course, when these ‘almost universally accepted … standards of treatment’ are not just unthinkable, but criminally insane.)

Bovine stubbornness in persisting with barbarous, violent and useless drug treatments that cause the very disease symptoms they claim to be treating is not the preserve of modern AIDS doctors and their AIDS drugs. It’s apparently a trimeless trait of the sort of people drawn to the profession.

And the harm these people do going about caring for the sick (or those they declare to be sick) – not intuitively as in folk cultures, but rather as they’ve been taught – has had a massive negative impact on the evolution and shape of Ango-Saxon culture. If we allow, just for now, the awesome idea that historically syphilis has largely been an iatrogenic disease – and indubitably so in its severe, late manifestations – then DH Lawrence’s insight in his essay in 1929, Introduction to his Paintings, acquires an an additionally dreadful significance: ‘I am convinced that the secret awareness of syphilis, and the utter secret terror and horror of it, has had an enormous and incalculable effect on the English consciousness and on the American. Even where the fear has never been formulated, there it has lain, potent and overmastering. … The appearance of syphilis in our midst gave a fearful blow to our sexual life.’

Of course, these days no one in South Africa even thinks about syphilis when eyeing a prospective partner in the hope of a possible yentz – other than doctors in clinics self-importantly administering their useless tests, on blacks mostly). Syphilis is completely absent from our consciousness today. But not at a time when it’s ghastly manifestations couldn’t be missed: ‘Wherever syphilis, or “pox” came from, it was fairly new in England at the end of the fifteenth century. But by the end of the sixteenth its ravages were obvious,’ wrote Lawrence of the gross physical and mental harm, missing the fact that these ‘ravages’ coincided with the introduction of calomel (mercurous chloride) as a treatment. Curiously – and here’s a mighty clue – the ‘pox’, he said, ‘entered the blood of the nation, particularly of the upper classes’ (who could afford the ministrations of quacks plying their mineral medicine, having just elbowed their way past herbal medical practitioners in the medical hierarchy by dint of some clever political manoeuvring).

In his popular book recounting Historical Blunders (Andre Deutsch, 2002), Geoffrey Regan revealed that ‘The true dangers of mercury as a medicine had been hidden from physicians since the sixteenth century, because its characteristic indications – skin eruptions, ulceration and neurological effects – were usually attributed to syphilis itself … from the sixteenth century mercury was well established in every medical textbook for its therapeutic value … the majority [of physicians] insisted that mercury was the only substance to get syphilis to relinquish its hold on the body. … By the mid-nineteenth century doctors were beginning to realize the severe limitations of mercury … Unfortunately, those who strove to replace mercury as a medicine frequently suggested arsenic as an alternative. … The use of mercury as a treatment for syphilis inflicted suffering on a scale almost beyond comprehension.’ As did the alternative, arsenic, which followed it – peaking in popularity in the first half of the twentieth century, despite, like mercury, the terrible harm it obviously caused, again invariably ascribed to syphilis.

Lawrence made the terrible point that

no man can contract syphilis, or any deadly sexual disease, without the most shattering and profound terror go through him, through the very roots of his being. And no man can look without a sort of horror on the effects of a sexual disease in another person. … we are all at once horrified and terrified. … Our consciousness is a strange thing, and the knowledge of a certain fact may wound it mortally, even if the fact does not touch us directly. … The terror-horror element which had entered the imagination with regard to to the sexual and procreative act was at least partly responsible for the rise of Puritanism, the beheading of the king-father Charles, and the establishment of the New England colonies. If America really sent us syphilis, she got back the full recoil horror of it, in her puritanism. But deeper than even this, the terror-horror element led to the crippling of the consciousness of man. Very elementary in man is his sexual and procreative being, and on his sexual and procreative being depend many of his his deepest instincts and the flow of his intuition. … Intuitively we are dead to one another, we have all gone cold. … Modern people, but particularly English and Americans, cannot feel anything with the whole imagination.

Just to think then how doctors have poisoned our lives, our culture, with their poisonous allopathic medicines, and how they continue to do so today. The root evils for which they are responsible. Calling for a robust remedy of the Stalinist sort, one might argue, approved by Pope Innocent VIII in his Papal Bull of 1488: ‘Cut out the gangrenous members from your Christian community. It is well worth sacrificing some lives in order to save the souls of many. With this scripture as your father it shall empower you to extract the evil and destroy all those who contribute to its spread.’ After all, doctors themselves heartily apply this philosophy in the treatment of their HIV-positive patients – justifying, for example, in one paper after another, the appalling harm they find AZT does to unborn and newly born children on the basis of their governing myth, the one that has them by the throats and from whose mental lock they are unable to break: that HIV-positive means HIV infected, and is an augury of fatal disease and a certain early death. So the benefit, they say, outweighs not just the risk, but the repeatedly demonstrated damage.

The power of the idea of AIDS on these people I’ve experienced firsthand. A recent girlfriend of mine was a plastic surgeon. To her, the possibility that there might be anything wrong with the HIV theory of AIDS and with the traditional medicine for it, AZT, was simply out of the question. The entire subject was simply off limits. Needless to say our thing was doomed.

Evans’s conversation over tea in the judge’s chambers (or perhaps in his funky modern house with the ducks in the garden) drifted overseas: ‘Thailand and South Africa had identical rates of HIV infection in 1990. Today Thailand is down to 2 per cent. In South Africa it is 12 per cent and rising.’ Cameron commented: ‘You have to put this down to sexual practice, but there is a lack of will about confronting this fact and its implications.’ By the black government, he meant. Because white liberals like Cameron carry on endlessly about the ‘facts and implications’ of black African sexuality. Different from white sexuality, claims Cameron – we’ll see soon. Did the intellectual ever wonder what happened in Thailand to the ten per cent between these two figures? Fallen down dead but unnoticed? Or divinely rewarded for their new Catholic chastity by conversion from HIV-positive to negative? Or is there some other Ptolemaic adjustment on offer to add to and prop up the HIV-AIDS creed? This teetering tower. Something perhaps like the hilarious explanation for the anomaly of busy HIV-negative Nairobi prostitutes proposed by ‘AIDS expert’ Francis Plummer in Science on 18 June 1993: ‘... the uninfected women have rare alleles to genes coding for the class I major histocompatibility complex (MHCI), an integral part of the immune system that allows the body to distinguish self from nonself.’ A rare and mysterious immunity in other words, to account for the failure of the HIV-AIDS model to pan out, as planned by ‘AIDS experts’, in Kenya. But no, said Luc Montagnier, the world’s top ‘AIDS expert’; on 7 September 2000 Africa News quoted him announcing that

his research has shown that the prostitutes would eventually succumb to Aids once they left the streets. The sex workers acquired the immunity because of repeated exposure to the virus a temporary immunity that wears off once the body is no longer in contact with the virus, the scientist said in Kampala last week. The ‘immunity’ to the virus also explains why discordance occurs in marriages, where only one partner develops Aids while the other remains HIV negative. ‘When the immune system in the body is exposed to small doses of the virus, it develops immunity,’ Prof Montagnier said.

Unprotected sex is good for you, in other words; it’s when you stop having unprotected sex that you get AIDS. Indeed, confirmed Ugandan virologist and AIDS researcher Ben Biryahwaho in the same article: ‘The immunity thus acquired has a short life and without repeated contact, the immunity fails.’ So the more you bang your HIV-positive partner the better.

Was Cameron seriously proposing that the ancient cultures of the Thai people had suddenly adopted the behavioural norms preached by Western AIDS missionaries? Abandoning their own? And that they had been more libertine than the Americans’ and Europeans’ in the first place? The Durex Global Survey 2001 into ‘sexual attitudes and behaviour’ didn’t find so. By far the most promiscuous society in the world, Americans have more than twice the number of sexual partners, get down much more often and start doing so at a much earlier age. It’s their favourite activity. Thais voted sleeping as theirs. Was there even a smidgen of evidence to sustain the ‘fact’ that anybody in Thailand gave two hoots about what any of these ‘AIDS counsellors’ were selling? In fact Durex found that only 26 per cent of Thais were concerned about getting AIDS, against 40 per cent of Americans. Or is it just that because the judge says so, and the TAC and the white liberal press applaud in agreement, therefore it is so – as in his judgments settling questions of fact forever? The guy with the final say. As a judge of our highest court of appeal.

The Evans interview suddenly hotted up. And drew up to the racist root of the African AIDS construct. Rolled right off the tongue of the intellectual liberal white judge. His sickening insinuations now express. Asked how he managed ‘as a white gay person [to] confront the issue of risk behaviour among heterosexuals without being accused of bias’, he replied evasively: ‘It’s the one issue I can’t tackle directly.’ But then he blurted it out: ‘Instead I talk about how promiscuity in the gay community contributed to its spread [a baseless canard] and that gives me the opening to ask, “Do you think sexual practice among African men has contributed?”’

Here we go. Cameron recoils from sun-fired, black African virility, disgusted by those repulsive conceptions of it subscribed to by the English from the time their missionaries set foot here. And by Americans with the same sick Hellenic dichotomous body/spirit religious heritage too. Their religion fed originally by Judaism’s harsh sexual strictures – mandating the sexual mutilation of male babies, the murder of homosexuals and outlawing sex outside marriage, and even in it for two weeks in the month. Although notwithstanding this, Jewish people were presented by Nazi propaganda as sexually corrupt. ‘…nightlife and syphilis … became aspects of that age-old struggle whereby the lower races attempted to destroy the noble Aryan’, wrote Joachim Fest in Hitler, explaining the manipulation of these ideas by the Nazis in their rise to power.

At the hearing of his application to the Judicial Services Commission for a Constitutional Court judgeship in mid-1999, where his AIDS ace failed to trump it, Cameron’s characteristic hide and seek with race came up again. When Chief Justice Ismail Mahomed complimented his performance, ‘It seems that you were so devastating in your replies that it was a technical knockout’, Cameron replied peevishly that ‘certain considerations’ might defeat him. What he scaldingly implied by this was that because he was running against a black competitor for the gig, Judge Sandile Ngcobo, he was handicapped in the running. Also that he, Cameron, considered himself to be the better man. A man of Africa. Better able to interpret the new constitution of Africa’s most important new democracy. In touch with the feelings, outlook and aspirations of the African man. And articulating them on his behalf. Even though white to his marrow. But I’m an intellectual liberal, it doesn’t matter.

Everyone there on the JSC panel understood Cameron’s ‘certain considerations’ barb. But a judge on the panel wasn’t going to let him get away with this hypocrisy and pressed: ‘What are those other considerations?’ ‘Race,’ Cameron answered with tremendous courage. Fortunately the panel didn’t then get into discussing his opponent’s penis when deciding whether to promote him. As they did at the Senatorial hearing before raising Judge Clarence Thomas to the US Supreme Court. (We’ll be onto that affair shortly.)

Before we move on, a shocking fact emerged in Cameron’s indescribably dreadful little book, Witness to AIDS (Tafelberg, 2005): It turns out that his failed AIDS gambit had been prompted by Arthur Chaskalson, then Deputy Chief Justice, and a judge on the panel hearing the applications. Shortly before the hearing, Chaskalson invited the hopeful contender over to his home for lunch, during which, already aware that he was HIV-positive, he suggested that this was a real neat time to break the news publicly. Because ‘Many people have HIV. And the time has surely come for someone in public life to begin by speaking out. Why not simply do it at your interview in two weeks time. The commission offers you an appropriate and dignified environment to do so.’ But the main thing is it will cause a huge sympathetic stir – and give you a foot-up in the bargain. Unbelievable. Here were the progressive white liberals conspiring for advantage, with a top judge scripting his favoured protégé to finesse his application for a judgeship next to him on the same bench. To the disadvantage of the black guy after the same position. (Luckily Mbeki vetoed Cameron’s application in Cabinet, and Ncgobo was appointed instead.)

To the public, though, Cameron naturally spun his motivation for playing his ace very differently: ‘The choice to speak is available to me for very particular reasons: because I have a job position that is secure; because I am surrounded by loved ones, friends and colleagues who support me, and because I have access to medical care and treatment that ensures that I remain strong, healthy and productive. For millions of South Africans living with HIV or AIDS, these conditions do not exist.’ Mbeki, still in thrall at the time by the AIDS scare, voiced his admiration for Cameron’s courage.

Geshekter thoroughly traced and exposed Cameron’s dainty suppositions – his repelling yet delicious fancies about what black men are like in the sack – in his Critical Reappraisal paper mentioned earlier, building on Rosalind and the late Richard Chirimuuta’s searing preceding treatment of similar themes in their book, AIDS, Africa and Racism (Free Association Books, 1989). A passage from their introduction put it succinctly:

The depth to which racist ideology has penetrated the Western psyche remains profound. The association of black people with dirt, disease, ignorance and animal-like promiscuity has in no sense been eradicated. When a new and deadly sexually transmitted disease, the Acquired Immune Deficiency Syndrome, emerged [in the medical, and then the popular mind] in the United States [in the eighties], it was almost inevitable that black people would be associated with its origin and transmission.

And that with missionary zeal and no shortage of pity, white ‘AIDS experts’ would rush in to save Africans from themselves, subliminally driven by what Mark Crispin Miller describes wryly in The Bush Dyslexicon as ‘ancient racist fears of Negro sexuality’. Geshekter cites a study, Sexual Behaviors Relevant to HIV Transmission in a Rural African Population, by Schopper et al., published in Social Science and Medicine in August 1993:

In 1991 researchers from Médicins Sans Frontières and the Harvard School of Public Health did a survey of sexual behavior in Moyo district of northwest Uganda. Their findings revealed behavior that was not very different from that of the West. On average, women had their first sex at age 17, men at 19. Eighteen per cent of women and 50% of men reported premarital sex; 1.6% of the women and 4.1% of the men had had casual sex in the month preceding the study, while 2% of women and 15% of men had done so in the preceding year.

Cameron’s slurs on Africans are too gross to voice openly. So he talks obliquely, dropping Victorian hints, some weak, some in your face. But when weighed against the findings of shoe-leather researchers who have taken the trouble to slog around and gather the facts directly in African villages and cities, Cameron’s white liberal ideas about African sexuality turn out to have dropped from the south end of a horse.

The judge’s fallacies about a characteristically and distinctly promiscuous African sexuality are shared by top ‘AIDS experts’ too. In fact such thinking long antedates the AIDS era, and is as old as European colonialism itself – along with the idea that profligate sex among Africans spread deadly disease that will surely wipe them out. In Epidemiologists, Social Scientists, and the Structure of Medical Research on AIDS in Africa, published in the journal Social Science and Medicine in 1991, Packard and Epstein tell that

Early medical researchers in East Africa concluded that between 50 and 90% of the African population in parts of Kenya and Uganda were infected with venereal syphilis. Col. F.J. Lambkin, a leading British expert on syphilis, who was seconded to Uganda to study the problem, concluded in 1906 that ‘As things are at present, the entire population is in danger of being exterminated by syphilis in a very few years, or at least of being left a degenerate race fit for nothing.’ In explaining this extraordinary situation Lambkin ... argued that Christianity had broken down customs that restricted the social movement of women. At the same time sanctions against adultery had been eliminated at the behest of the British colonial authorities. These changes, he argued, had permitted Ganda women to engage in ‘promiscuous sexual intercourse and immorality’, resulting from ‘their natural immoral proclivities’. … Similar claims were made by observers in Western Kenya [by Gilks for instance:] ‘The whole attitude of the native towards sexual matters renders it certain that venereal disease, once introduced, is bound to spread among old and young.’ … In a similar vein, Daniel Hardy, who is trained in both medicine and anthropology, wrote in an article on cultural practices relating to HIV transmission in Africa [for a ‘USAID/NIAID sponsored conference on “Anthropological Perspectives on AIDS”’], ‘Although generalisations are difficult, most traditional African societies are promiscuous by Western standards. Promiscuity occurs both premaritally and postmaritally.’ … [Such claims] reinforce, perhaps unintentionally, the impression that sexual promiscuity is culturally determined. For example Edward Green ... noted [in AIDS in Africa, edited by Rockwell and Miller (The Edwin Mellen Press, 1988)], ‘Changes in behaviour which promote the spread of AIDS will go against social and cultural norms and values in Africa and against deeply ingrained behavioural patterns.’ … Similarly, Francis Conant writing in the same volume concluded, ‘In dealing with AIDS we are not just dealing with sex; we are dealing with lifeways and complex cultural patterns.’ … As Sander Gilman notes [in Difference and Pathology: Stereo Types of Sexuality, Race and Madness and Disease and Representation: Images of Illness from Madness to AIDS (Cornell University Press, 1985 and 1988)], the association of Africans with sexuality and the tendency to link African sexuality to disease has a long history in western thought. By the end of the nineteenth century ... the association could be found in many works of literature and art in continental Europe and held a central position in the constellation of ideas which made up European perceptions about Africans. As a result, early medical authorities, missionaries, and colonial administrators came to Africa with strong assumptions about African sexuality.

The pre-eminent idea among whites, their doctors especially, that blacks have too much sex, and consequently suffer epidemic venereal disease, is, as we see, a perennial one. It’s popular among South African Indian doctors too – Professors Jerry Coovadia, Salim Karim, Umesh Laloo, Barry Kistnasamy and their colleagues at the Nelson Mandela Medical School in Durban, for instance, and the ANC’s health committee chairman Saadiq Kariem. Dr Michael Gelfland’s The Sick African, published in Cape Town in 1944 (Stewart Printing Co), contains several gems of European medical wisdom about alleged widespread African syphilis, which excited the imaginations of Rhodesian doctors. Following a brief tutorial in typical African sexual immorality (converted Christians aren’t in it for real, and will remain natural polygamists), Gefland wrote:

Syphilis is a subject of paramount importance. The incidence is difficult to gauge, but it seems to be present in 20 per cent. or more of all Natives. Its recognition is important, not because the treatment given to the Native is in any way inadequate, but largely in order to prevent his spreading the infection by contact with the Europeans or his own people. This is accomplished by giving the syphilitic a short course of arsenical injections, to render him non-infectious. … Of course, if ... the Native can be persuaded to attend for a longer course, better results will be obtained. … Perhaps the solution to the problem may be found in the administration of arsenic in massive doses by intravenous injection continued over a few days. Reports from the Union of South Africa … appear to be promising. This is certainly a form of therapy that should draw the attention of the public authorities. … I am confident that the solution to syphilis in the Native lies in this form of treatment, but its potential danger must not be overlooked.

After this neurotoxic treat, the next bit follows naturally:

Certain doctors appear to believe that neuro-syphilis in the Native is rare. This is incorrect, for the disease is by no means uncommon. … No difficulty should be experienced in recognising a case of general paralysis, providing the condition is remembered. It is characterised by gross mental disorders, such as depressive and maniacal states of dementia. The patient may be euphoric or may exhibit grandiose delusions and hallucinations. … Voluntary power is impaired and inco-ordination marked. The gait may be unsteady. Epileptiform seizures occur in some of the cases, or an apoplectiform attack may set in, with resultant hemiplegia or aphasia. In the Native, G.P.I. [‘general paralysis of the insane’] must be distinguished from other causes of psychosis. … The G.P.I [case] should be certified and sent to an asylum for treatment.

With more mercury and arsenic.

In Public Health in South Africa (Central News Agency, 2nd ed., undated, but c. 1940) EH Cluver advises that venereal diseases ‘tend to spread particularly among uneducated non-Europeans crowded together in the less salubrious portions of our towns. … The detribalizing of large masses of natives was also followed by promiscuous habits so that infection rapidly spread over wide areas of the country.’ They’re full of it.

The sort of predictions for Kenya and Uganda, made in 1906 by Colonel Lambkin, the English ‘expert’ on African syphilis (‘the entire population is in danger of being exterminated by syphilis in a very few years’) were resurrected for South Africa a century later by American ‘AIDS experts’, reflected in a report in the Washington Post on 6 July 2000: ‘More people are infected with HIV in South Africa than in any other country – one in five adults in a population of about 41 million. AIDS threatens to slow social change and undo economic development with the staggering costs of caring for the sick, the dying and those they leave behind.’ An editorial in the New York Times on 4 November 2001 painted a similar phantasmagoria:

Thabo Mbeki’s views on AIDS have drawn so much criticism that he has lately kept them to himself. Last month, however, the South African president gave two speeches that showed he remains badly misinformed about a virus that now infects one in four adult South Africans and will kill between five and seven million over the next decade, the vast majority of them poor black people. … Mr. Mbeki came to politics after a lifetime of fighting white rule in South Africa. Though it is hard to imagine a more malignant evil than apartheid, AIDS has already taken more South African lives. If Mr. Mbeki does not begin to address the crisis, millions more deaths will follow.

And, as Packard and Epstein recall, whereas English experts ‘advocated public health policies which centred largely on the development of measures, often draconian in nature, to control the behaviour of prostitutes’, while ignoring ‘problems associated with living conditions and sanitation’, American expert opinion reflected in the New York Times presses for the most drastic imaginable medicinal approach – blanket, indefinite chemotherapy administration in the form of AZT, in the same league as ‘arsenic in massive doses by intravenous injection’:

Mr. Mbeki downplayed the problem, exaggerated the toxicity of antiretroviral drugs and suggested that advocates for treating the disease are racist. South Africa, with a medical infrastructure capable of providing antiretrovirals [the Health Systems Trust disagrees], should be a global leader in AIDS treatment. Yet even though thousands of affluent South Africans buy these drugs, the government has done nothing to make them available to the poor. It has not accepted international offers of free or low-cost medication and runs only a few programs to cut mother-to-child transmission.

(Not a word from the Americans about social and living conditions.) An editorial in Science on 16 May 2003 went the same way: ‘In that country, skepticism from the Mbeki government has hampered progress for the five million citizens who are already infected … 20% of adult South Africans.’ The millions should be grateful. The reason why the nobility, in times gone by, tended to have a shorter life expectancy was that unlike their less fortunate subjects they had access to professional medical care: bleeding, mercury, arsenic, antimony, the works.

Geshekter exposed a few more ‘AIDS expert’ racists in his Critical Reappraisal paper:

At the 10th International AIDS Conference in Yokohama (August 1994), Dr. Yuichi Shiokawa claimed that AIDS would be brought under control only if Africans restrained their sexual cravings. Professor Nathan Clumeck of the Université Libre in Brussels was skeptical that Africans will ever do so. In an interview with Le Monde [on 14 December 1993], Clumeck claimed that ‘sex, love, and disease do not mean the same thing to Africans as they do to West Europeans [because] the notion of guilt doesn’t exist in the same way as it does in the Judeo-Christian culture of the West.’

UNAIDS’s AIDS epidemic update published in December 1999 concluded from its own numbers concerning the alleged African sex plague that ‘since not every encounter between an HIV-positive and HIV-negative partner will result in a new infection, a sustained heterosexual epidemic suggests that a substantial proportion of the population, both male and female, have a number of partners over their lifetimes’. Implying a lot more than the American norm. In fact half as many in South Africa – 8.2 here versus 14.3 in the US, the former figure sitting around the international average, and the same as in Germany, according to the Durex Global Survey 2001. A paltry 4.2 in Nigeria, 4 in Mexico, 3 in India, and 2.1 in China at the bottom of the pile. People in the First World (mostly) – in Italy, Holland, Britain, New Zealand, Russia, Japan, Greece, Turkey, Canada, Australia, France and the US, in ascending order – typically had between 8.5 and 14.3 sexual partners.

But the idea that rampant black male promiscuity is the cause of AIDS in Africa is nonetheless very much at the core of UN Special Envoy on HIV/AIDS in Africa Stephen Lewis’s thoughts: interviewed by Health-e on 6 August 2003 the white Canadian ‘said that while changing male sexual behaviour had to be addressed, this would take generations as there was “nothing more obdurate”. However, the empowerment of women “can be done more rapidly” and there was “no time to lose to stop losing all the women that we are at present.”’ Being killed by their amorous men.

To escape the destructive implications of Durex’s findings for their racist theories, one might hear from ‘AIDS experts’ that, unlike sexually irresponsible black South Africans, Germans, who typically have the same number of sexual partners, wear condoms. Not so. In his review discussed at the first meeting of the AIDS Panel in May 2000, It’s 20 years we live with HIV/AIDS: A call for an open discussion of contradictory facts, panel member Christian Fiala, an Austrian gynaecologist, pointed out that following the outbreak of the AIDS scare in Germany, official prevention campaigns had virtually no effect on condom use at all. According to Deutsche Latex Forschung, Kondom-Abatz in Deutchland, Düsseldorf and Statisches Jarbuch 1996, whereas the ‘annual usage in 1980 was 2 condoms per inhabitant, in 1995 it was 2.3’. In fact Germans are about the world’s worst when it comes to ‘unsafe sex’. Noting that internationally ‘Almost four in ten people (38%) admit they do not take measures to prevent HIV/AIDS or another STI’, the Durex survey found that the ‘Taiwanese (59%), Germans (57%) and Chinese and Poles (both 54%) are the least likely to take prevention measures’. Conversely, ‘South Africans and Nigerians (both 81%) and Thais (77%) are most proactive when it comes to protecting themselves’. A local study released in mid-November 2002 conducted by the Community Agency for Social Enquiry found that sixty-seven per cent of South Africans worry about contracting HIV, up from forty-seven per cent in 2000. Forty-nine per cent of those interviewed said they always used condoms during sex. Hard to believe. Seems we’re a nation of believers: fifty-eight per cent also said they thought antiretroviral drugs could beat HIV.

In an interview by the Zambian Daily Mail on 14 November 2000, visiting American ‘AIDS expert’ Robert Shell felt uneasy about saying out loud what he thought accounted for his assertion that

the pandemic marches forward. Every day we get 1,700 new cases. … Promiscuity is a loaded word. I would say that AIDS is a result of unsafe sexual practices, and unguarded sexual behaviour is the most important factor. Ignorance about reproductive health is the biggest factor and it is related to poverty and illiteracy. Ten per cent of the Africans in my province [the Eastern Cape] have other sexually transmitted diseases.

In his Analysis: Mbeki and the Aids sceptics on 20 April 2000, BBC News Online’s Martin Asser wasn’t so coy: ‘If [the AIDS dissidents] were to consider Africa, they might conclude that HIV and Aids have spread so dramatically because of heterosexual sex in increasingly mobile and sexually promiscuous communities.’ Similarly, in Aids: A Battle Of Sex, Race And Politics, the London Independent on Sunday asked on 9 July 2000: ‘After all, why is Aids particularly rampant in Africa [‘and in South Africa – the country worst affected by Aids’]? Are local parasites, which reduce human immune levels, responsible? Or is it due to the promiscuity of black Africans, and Africa’s higher levels of untreated sexually transmitted diseases?’ The newspaper made the same point again on the 15th, quoting the Economist: ‘In the year since he took office, Mr Mbeki has impressed many with his grasp of arcane policy detail but, sometimes, he seems to lose sight of the big picture. Take Aids, which threatens to kill a third of his people. A less wonkish president might have urged South Africans to sleep around less and use condoms more.’

University of KwaZulu-Natal academic, now professor, Suzanne Leclerc-Madlala, an American ‘medical anthropologist’ disenchanted with her understandably bored and wandering Zulu husband (so a colleague told me), published a liberal libel in the Mail&Guardian on 11 August 2000:

For a variety of reasons, all strongly rooted in the continent’s unique political, economic, social and racial history, there are layers of denial and silence that preclude a serious grappling with sexual cultures. There are widespread beliefs that males are biologically programmed to need sexual relations regularly with more than one woman. … Social science studies point to high levels of premarital sexual activity, extramarital relations and sexual violence, making African societies more at risk for HIV/Aids than those in other parts of the world.

Not according to the latest international sexual behaviour survey by Durex, we recall; for promiscuity, Americans like her take the honours. And as for the allegation that African men are the most sexually violent in the world, Suzanne and Charlene appear to twitter at the same book club: ‘In many communities, women can expect a beating, not only if they suggest condom usage, but also if they refuse sex, if they curtail a relationship, if they are found or suspected to have another partner, or even if they are believed to be thinking about someone else.’ More tea?

A week later in the London Observer David Beresford described Leclerc-Madlala’s ‘analysis’ as ‘most compelling … a lengthy and sensitive article on the subject’; it called for ‘strong national leadership’. That South Africa under Mbeki lacks. Leading African men into a reformed kind of manhood.

Tragically, in Mbeki the country seems to have precisely the opposite – a man who is not only in denial himself, but whose sensitivity on the race issue points to a previously undiscovered psychological trauma. Nursing dreams of an Mbeki-led African ‘renaissance’, in the cradle of which he sees the rebirth of black pride, he seems driven to deny the reality of Aids. He has tried to force an alternative explanation of the pathology of the disease on a scornful and appalled medical world. He is allowing his people to die painful, lonely, and at times unnecessary deaths. Nero fiddled while Rome burned. And while Mbeki spreads his fanciful opinions about Aids, South Africa sickens and dies.

And while the typewriter cools down, Beresford finishes the bottle.

Leading award-winning AIDS journalist Kerry Cullinan, then recently divorced from her black husband Nat Kekana (a former MP and now a parastatal boss), sounded similar bum notes to Leclerc-Madlala’s in AIDS: the year in review, written for Health-e on 2 December 2002:

Government also has yet to speak out or campaign against the widespread practice of men having multiple sex partners. [In principle even, should this ever be any of the government’s business?] Uganda attributes its success in halving its HIV prevalence rate over 10 years to people changing their sexual behaviour. Ugandan men reduced their sexual partners while teenagers started having sex at a later age.

If only South African black men would take after their Ugandan brothers. But concerning the Ugandan success story, it’s actually white ‘AIDS experts’ in UNAIDS who make such claims. Which we dismantled in Appendix I of Debating AZT.

Since there’s no AIDS among whites in South Africa to speak of, and HIV, the alleged cause of it, is said to be spread sexually, Cullinan was obviously referring to the sexual behaviour of black men exclusively. When I spelt this necessary implication out to her, she denied it: ‘I don’t see any mention of race anywhere in my paragraph.’ However, the characteristic disingenuity of such AIDS activists on this score was laid bare in her piece, A new sexual identity: As men struggle to define their identity, researchers grapple with issues that affect notions of masculinity, published in the Mail&Guardian on 8 August 2003. Cullinan appeared to be struggling with why her ex had cuckolded her (no mystery to me) because the entire piece grappled with why black men, in her view, should be so promiscuous. Quoting three terribly serious white academics as experts on the subject to enlighten us about this, and her too, she teed off by citing an American expounding authoritatively on the allegedly shifting meaning of the Zulu word, isoka (lover). You honestly don’t want to hear the rest. Delegates at the just ended Sex and Secrecy Conference at Wits University, where the papers she cited were presented, had to.

HIV-AIDS consultant Clive Evian, who markets himself as a public health specialist and epidemiologist, contended that South African blacks are having fantastic amounts of sex in ‘Sugar daddy’ syndrome shortens the route of HIV infection, in World Aids Day, a special supplement to the Mail&Guardian on 29 November 2002. Like Cullinan, he didn’t use the rude word black:

the risk of HIV transmission on a single sexual contact is less than 1%. … Yet between 15% and 20% of South African adults are HIV infected. … clearly there is too much sex (multi-partner sex) between too many people, too often. The amount of indiscriminate (or reckless) sex occurring in the society needs to be of such an order and such a magnitude that even in today’s permissive society, this must be considered grossly ‘abnormal’ and needs further analysis. [By white ‘AIDS experts’ like me.] What is it that creates a social environment where sexual promiscuity has reached abnormal levels?

But Evian’s racist insinuation was unmistakeable in claiming that what he called the ‘sugar daddy syndrome’ was especially prevalent ‘in poorer areas, where men are often dislocated from home [as black migrant workers] and seek out sex and girls and young women are most available’.

In his acceptance speech at the University of the Witwatersrand on 24 June 2003, on being awarded an honorary doctorate (these academics seem to spend their lives kissing each others’ butts), Professor Jerry Coovadia revealed himself to be as big a racist as all of them: ‘As we stagger under the massive weight of AIDS’, it is the ‘unbridled sexuality ... of newly independent people ... especially the promiscuity of men’ that has led to ‘AIDS ... ripping through millions of our people’. (In the parlance of South African ‘AIDS experts’ ‘our people’ is a sympathetic reference to blacks (hung like a horse unbridled).) And whence these ‘emerging new infectious diseases’? Why, ‘from a seemingly deep pool of animal reservoirs’. By which he meant monkeys and baboons living deep in the woods – close to blacks. But ‘newly independent people’ like Mbeki reject this medical wisdom, he said, and shift the cause of AIDS ‘from sexuality to other causes of transmission’, because the truth of the matter ‘was too uncomfortably a part of the remembrances of racism to be accepted’. ‘Remembrances of racism ... accepted’ by racist white and Indian doctors teaching them in the country’s university medical schools. Just like in Fanon’s Algeria under the French.

It’s interesting that medical experts should constantly finger African jungles as the evil spring for ‘emerging new infectious diseases’ (always allegedly lethal viruses) since as Miller noted in his commentary for The Crucible, ‘the Salem folk believed that the virgin forest was the Devil’s last preserve, his home base and the citadel of his final stand … the last place on earth not paying homage to God’.

Curiously, it’s not whites and Natal Indians alone who openly subscribe to negative sexual stereotypes about black Africans. Some black Americans too. Of the saved sort. The Canadian Globe and Mail ran an article, Blunt talk on AIDS, on 12 January 2000:

as the AIDS crisis grows, more and more people have begun speaking out about its social roots and calling for a transformation in sexual attitudes and behaviour. Among them is Rev. Eugene Rivers, a black preacher renowned for his work with inner-city youth in Boston. … ‘Promiscuity and rape now function as weapons of suicidal mass destruction,’ he said last month. He blames African leaders for ignoring sexual exploitation of women and the sexual misbehaviour of men, and calls for a new ethic of restraint, abstinence and sexual fidelity. ‘We should fight the behaviour, not make up fancy excuses for it.’ … his ideas have inspired the Vice-President. … Al Gore took a break from campaigning for the presidency of the United States this week to talk about AIDS, sex and Africa. It was an unusual foray for a presidential candidate. Mr. Gore, Vice-President since 1993, appeared before an extraordinary session of the United Nations Security Council in New York to discuss the AIDS crisis in Africa. It was the first time the 15-member council has departed from its usual menu of diplomacy and security to discuss a health issue – a token of just how serious the crisis has become. … In an interview with The Boston Globe, Mr. Gore said African nations must accept sex education, sexual abstinence and the use of condoms by sexually active people. Migrant workers must learn to refrain from visiting prostitutes, and people should start speaking up against the rape and sexual exploitation of teenaged girls by their male teachers. Africans in general should fight the disease by ‘stigmatizing promiscuity’. ‘AIDS is relatively difficult to transmit from one person to another,’ said Mr. Gore. ‘There has to be an exchange of bodily fluids. Once that simple fact has been understood, then the only other thing that is needed is widespread awareness and the constant reinforcement of the public knowledge of what steps interrupt the transmission.’ And that, said Mr. Gore, means changing behaviour. ‘It means providing condoms. ... It means promoting responsible sexual activities and habits, it means abstinence for those who can practise that approach.’

It means buying into and promoting racist sexual stereotypes. It means Americans emasculating Africans. As Americans sleep around more promiscuously than in any other country on earth. Sneaking side nookie too: in reply to Shere Hite’s renowned probes concerning sexual experience in the US, collated as Women as Agents of Revolutionary Change: The Hite Reports 1972-1993 (Bloomsbury, 1993), seventy-two per cent of American men married for over two years reported having had sex outside their marriages, as had seventy per cent of women married five years or more. Research in the UK and Europe, employing equally widely disseminated questionnaires similar to those drawn by Hite, turned in comparable findings. But to white ‘AIDS experts’, politicians, journalists and activists, it’s those Afs who egregiously sleep around.

In his harrowing history of English aggression towards the Xhosa people in the Eastern Cape, Frontiers (Pimlico, 1992), Noël Mostert recalls British missionary attitudes to Xhosa sexual style in the mid-nineteenth century – epitomised by Robert Niven’s deprecation of their ‘hereditary vanities and polluting amusements’. Their ‘carnal minds’, he said, were ‘an enmity against God’. Henry Calderwood, commissioner to the Ngqika clan, likewise criticised the Xhosa chief Sandile as a ‘promoter of the grossest sensuality among the people’. Mostert explains that

it was the unselfconsciousness of the Xhosa about their bodies and their sexual life that most affected the missionaries, being surrounded as they were by a largely naked people and constant demonstration of their wholly uninhibited attitude to sexual matters. They wanted to cover the bodies and to veil the minds, and to create a sense of sinfulness where there was no concept of it in the Xhosa. Much of their outrage was spent on the fact that Xhosa boys and girls began their sexual experience at an early age. Love-making [short of coitus] between young people was freely accepted, notably at joyfully explicit dances that accompanied the rights of passage for young men and women alike.

Xhosa culture ‘had no libidinous guilt’, its ‘cosmology ... devoid [according to Xhosa historian JH Soga] of “any reward or punishment in a world to come for acts committed in this life.” The missionaries found it difficult to suppose a moral code without this. Vengeance, social or eternal, was at the core of their own moral outlook.’

In the AIDS era, sexuality construed as illicit by the same Christian rules will be punished, say ‘AIDS experts’, activists and journalists, with much the same sort of penalty threatened by the missionaries: a horrible, fearful, painful, lonely, drawn-out terminal disease – with an emphasis, they love to lay, on ‘painful’. Our Constitutional Court talks the same way: ‘the nature of the suffering so grave’. You know, like expiation in purgatory.

Such notions as Cameron’s, of race-determined sexual difference, have persistently informed the white liberal discourse about AIDS, rooted, I propose, in European materialism and its Christian industrial ethic – forever postponing present enjoyment against a hope of future material benefit. Not a principle that 19th century Xhosa people had much truck with; High Commissioner Harry Smith wrote how he ‘embarked on the task of rescuing from barbarism thousands of our fellow creatures endowed by nature with an excellent understanding and powers of reasoning as regards the present’ but no idea of ‘futurity’. Perhaps because their ‘excellent understanding and ... reasoning’ had led them to the appreciation that his culture’s extreme preoccupation with ‘futurity’ had spiritually impoverished it profoundly, draining out much of its soul, and culminating in the modern consumer culture. With its funny ideas about sex. Corrupted it too: in the shadow of 19th century social and sexual rigidity, prostitution back home in London flourished like a gold rush. And by 1976, according to Forbes magazine, pornography in the West was making more money than the regular film and music business combined.

Cameron’s charge about a distinct, blameworthy kind of ‘sexual practice among African men’, to be civilized and changed, derives from a common white sense, of centuries-old vintage, that there’s something sexually nasty about black men, that unlike whites, they don’t crave perfect unions cemented with visceral emotions, don’t love and cherish their wives (for as long as they’re not turning into bitches), and that affectionate intimacy isn’t their thing – instead goatish lust, spreading disease wherever they plunge, randomly, faithlessly, brutally, abusively. Oh, and indefatigably and insatiably. (But the 14th century English poor, poking at their betters, had a delightfully ribald answer: ‘When Adam delved and Eve span, who was then the gentleman?’) The concomitant idea is that in negotiating and transacting genetic fusion – or trial runs for the same – black African women don’t make their own choices, are politically powerless, and lack instinctive and socially acquired wiles to deploy in these elemental arts. Variously purring or voracious. In short, they’re not people but things. Not strong. Not vibrant pillars of the nation. With chocolate eyes. They’re not like us. They don’t have the same feelings. So it never occurs to white South African industry and mining bosses that there might be an unutterable violence done to black labouring men by posting them in vast single-sex dormitory compounds. With white suburbia doing the same to black women, confined to tiny backrooms as live-in servants, hopeless miles away from their husbands. And children. While the braais come along nicely, and the beers go down, next to the pool.

This background construction of women as male prey and not equal hunters, running through AIDS awareness programmes, surfaced in a radio ad in late 2002 in African accents: ‘Did you know that one in four South Africans is HIV-positive? Brothers, protect your women, use a condom. Sisters, if you’re not ready to have a sexual relationship, you have the right to say no. When you know you can’t say no, use a condom. Brought to you by YouthAIDS.’ The implicit message that men generally, black especially, are violent sexual predators is sometimes express: Tandeka Teyise wrote for Health-e on 15 October 2002: ‘Khaya Nkontso, coordinator of PPASA’s Men As Partners programme, is trying to help raise men’s awareness around issues of reproductive health, sexuality and HIV. Khaya says not all men are violent and want to dominate women.’ One is tempted to retort, Khaya, that not all women are duplicitous, grasping, superficial, materialistic, intolerantly judgmental, controlling, wasteful, ungrateful, emotionally capricious, conniving, cowardly, extravagant, quarrelsome, cold, humourless, fickle, cruel, unreliable, nurse ancient grudges, are incapable of apologising, likewise forgiving, take reprisals by way of collective punishment for early hurts, gossip faithlessly, prize social reputation over social justice, lack any artistic sensibilities or political and moral passions, are given to cretinous religious enthusiasms and life-negating pieties, throw and break precious objects to make points in arguments, express and enforce fierce antipathies towards their husbands’ vintage close friends, kick up raucous ructions in public places, commit perjury vindictively, and are fair-weather friends whose affections inversely track the overdraft. And who can’t drive motorcars. ‘He says many men are showing a greater willingness to become involved in health issues that affect themselves as well as women and children. One of Khaya’s aims is to educate men about HIV/Aids, sexual violence and how to work in partnership with their wives or lovers.’ Men need re-educating – in the new sexual ideologies of the AIDS age. Heartless raptors that they are.

As illustrated by a story put out by Health-e on 1 January 2003, HIV/AIDS won’t disappear unless men become decent humans:

‘A 10-year old boy is arrested after a five-month old baby is raped’, read one newspaper headline as we were still celebrating the New Year. ‘Police arrest four men out of six in the act of gang-raping a woman at gun-point’, read another. These are only two of countless sad and horrific tales of the brutal rape of women and children that still form part of South Africa’s daily life. In the face of HIV/AIDS, these reports further confirm the assertion, and rightly so, that it is the behaviour and actions of men that feed the growth of this epidemic. And unless men are challenged to change their attitude, the fight against HIV and AIDS will but remain a losing battle.

Part of South Africa’s daily life?

Health-e continued the theme on 9 September in What’s wrong with South African men? The white author, some twit called Laura Twiggs, was talking about blacks:

Ask most men what’s wrong with South African men or why they’re so abusive, and the response is equally unsatisfying. South African men, it appears, are in deep states of denial, usually blaming women for ‘emasculating’ them or ‘giving them a bad name’ before speaking out against other violent males. … The price we’re paying for male dominance is mounting, and fast. It’s driving our rising HIV infection rates [among blacks] and threatening country’s development as a whole. And it is a price that men, as well as women, will pay unless men start to address questions about masculinity, about what it means to be a man.

A black man.

In 1959 John Howard Griffin darkened his skin and disguised himself as a black man to find out what being black in America was like, and wrote up his experience in Black like me (Signet, 1962). In his conversations with white men, especially offering a lift after dark, their enquiries invariably turned to sex, their salacious imaginings revealed in their questions – how big, how often: ‘All showed morbid curiosity about the sexual life of the Negro as an inexhaustible sex-machine with oversized genitals and a vast storehouse of experiences [and all] presupposed that in the ghetto the Negro’s life is one of marathon sex with many different partners.’ Perennial fancies showing up in that perfectly tasteless but screamingly funny Jim Carrey flick, Me, Myself and Irene: A crop of dusky kids are born to the cracker cop after his wife’s affair with a black guy. He loves them just the same. A buzz-cut hick at a barbecue tries nudging him to the rea