May 2002 Interdepartmental Public Health HIV/AIDS Journal Club

The fourth session of the Interdepartmental HIV/AIDS Journal Club was held on 5th May 2002 in the Staff Diningroom, Nelson R Mandela School of Medicine, Durban. Co-presenting on the potential effects of HAART on population level transmission dynamics were Max O?’Donnell and Jennifer Zelnick, both Associate Researchers at the Centre for HIV/AIDS Networking (HIVAN). The second presentation, a paper entitled ?“Mbeki?’s Denialism and The Ghosts of Apartheid and Colonialism for Post-apartheid AIDS Policy-making?” was delivered by Mandisa Mbali, Research Intern at the Centre for Civil Society, based on the University of KwaZulu-Natal?’s Durban campus.

O?’Donnell is in his final year of a combined MD/MPH degree from Tufts University in Boston, USA. He has worked in rural integrated development in Ethiopia, trade union organising in the US and research on the human rights, nutrition and disaster response in Bangladesh. His current research at HIVAN involves policy analysis on AIDS treatment infrastructure in KwaZulu-Natal, with a specific focus on using TB infrastructure to expand AIDS treatment options.

Jennifer Zelnick is a doctoral student at the University of Massachussets Lowell in the Dept. of Work Environment Policy. Her background includes social work as well as trade union, political and community organising. Her research interests include the effect of macro-level policy change on workers?’ health and occupational health policy for health-care workers. Her current research is on the politics of AIDS policy formation in KwaZulu-Natal.

Mandisa Mbali, a Fulbright Scholarship finalist, is reading for a Master?’s degree in History and Development Studies at the University of KwaZulu-Natal in Durban, focusing on civil society and health policy in South Africa. She has a strong background in HIV/AIDS and gender equality activism at student level, serving on numerous committees and in the local branch of the Treatment Action Campaign. She has also presented at key international youth fora on health policy issues. Her broad research interests lie in public health administration and policy-making.

Presentation One:

This presentation topic was inspired by Prof Coovadia?’s talk at the Nelson Mandela Medical School AIDS Journal Club in March 2002, and took the form of a review of an article by Katz and colleagues published in the March 2002 American Journal of Public Health (Katz, M., Schwarcz, S., et al. Impact of Highly Active Antiretroviral Treatment on HIV sero-incidence among men who have sex with men: San Francisco. Am J Public Health; 2002, 92(3): 388-94). The presentation also included a conceptual framework with literature review for understanding the potential effect of HAART on HIV population level transmission dynamics.

The ?“population level transmission dynamics hypothesis?” looks at the ways in which HAART, by reducing the HIV viral load, may affect the HIV-positive individual?’s chances of transmitting HIV though sexual intercourse. This might occur in much the same way that Nevirapine can reduce the chances of an HIV-positive mother passing the virus to her child. On the population level, however, more complicated social, economic and behavioural factors relating to HIV transmission dynamics may overwhelm the reductions in infectivity afforded by HAART. In this presentation, O?’Donnell and Zelnick focused on the policy implications of this hypothesis, including the making of policy in the face of scientific uncertainty.

DISCUSSION: Comments following the presentation noted that greater access to treatment could decrease stigma but could concomitantly decrease vigilance; that, in policy and planning for South African models, prevention and treatment MUST be integrated successfully; and that social scientists working in southern Africa should focus intensely on raising and maintaining awareness of prevention along with treatment regimes.

Presentation Two:

In her paper, Mbali examines South African President Thabo Mbeki?’s controversial denial of the causal link between the HIV virus and AIDS, and his (along with others?’) claims that anti-retroviral drugs are ineffective and lethally toxic, in the face of massive scientific evidence to the contrary. The paper is not intended as an exacting account of the evolution of the President?’s maverick stance on HIV and its causes, effects and implications, but rather as an analysis of governmental policy in terms of both the apartheid legacy of a crumbling and fractured health system, and the legacies of colonial and Western discourse around Africans as inherently diseased.

This understanding introduces a framework of paradigms informing how AIDS infects individuals?’ bodies along with notions of a diseased body politic. Mbeki?’s comments on AIDS, seemingly indicating that he believes several key tenets of science around AIDS to be racist, and that he himself is defending Africans against racism and neo-imperialism through his denialism, are examined. The paper also explores the extent to which this denialism might prevail within the ruling African National Congress(ANC).

The paper concludes by pointing out that while contemporary AIDS science is characterised by a technical, scientific non-moralistic approach which has been yoked with a rights-based discourse, Mbeki?’s denialism is seen as obviating this rights-based vision of treatment by AIDS activists, scientists and doctors. As such, ironically, his stance provides no departure from the coercive and racist discourses that colonial and late apartheid public health policies tended to advocate.

DISCUSSION: Comments following the presentation noted a public policy ?“limbo?” or hiatus following the government?’s ?“U-turn?” on access to Nevirapine, with no clear indications as to how the discourse might now shift or why Mbeki acquiesced at the point that he did. Some surmised that the stigma and fear that typify responses to HIV/AIDS across the world are the factors underlying Mbeki?’s denialism, given that some members of his Cabinet are HIV-positive.

To download the PowerPoint presentations and/or MSWord or Adobe Acrobat versions of these presentations, click on the relevant hyperlinks in the right-hand column.