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Chapter 2: Politicising AIDS

In Africa, the collision of epidemiology with race and politics has led to bizarre deviations from rational debate on the causes of ─ and the possible treatments for ─ AIDS. The cost to the continent ─ in lives and in public truth ─ has been very high. (Edwin Cameron)1 The outbreak of AIDS has been, and still is, a hugely politicised issue all over the world.However, the displacement of AIDS onto the landscape of political discourse has been especially marked in South Africa, where it seems virtually impossible to discuss the epidemic without referring to the political background which has affected its course so dramatically. It is beyond dispute, for example, that the policies of the post apartheid government exacerbated the mortality rate from AIDS in South Africa. This thesis argues that this was largely the result of the fact that AIDS itself was displaced as a central concern, and projected onto a political landscape where it was dwarfed by the discursive power of politics. This is not altogether surprising: the emergence of AIDS roughly coincided with the emergence of the new democracy, complicating a period of radical political and social transformation and resulting in the entanglement of the discourses of AIDS and politics, and particularly ‘the struggle’. 2 In this chapter I consider a selection of texts, including public statements made by political figures; cultural events; and selected creative writing texts, to demonstrate the interpenetration of the discourses of AIDS and politics, and the way that AIDS has been displaced by and subordinated to politics in both public and creative discourse. Political discourse has been extensively used in the long-standing and bitter debate in South Africa about what causes AIDS; its prevalence; how it should be treated;who should be treated; whether or not the treatment is effective; and many other related issues. How these questions are answered depends a great deal on the medical discourse adopted: whether this is the scientific, Western, biomedical model, based on the ‘germ theory’ of disease; or ‘alternative’ approaches (adopted by Mbeki) which are less concerned with identifying specific pathogens and instead place greater stress on environmental factors in the causation of disease. The kind of treatment given the AIDSill follows from whatever discursive medical model prevails. Mainstream biomedical practitioners hold that the HI-virus is the etiological agent and that treatment entails treating the infections that result from lowered immunity and prescribing antiretroviraln medication to inhibit the growth of the virus itself (Downing 2005: 24). This view thus emphasises the role of drug therapy. A more holistic approach to treatment, which stresses nutrition, is favoured by AIDS dissidents, who, at their most extreme, claim that the HI-virus does not exist; and that AIDS is caused by poverty and the very drugs used to treat it, which they believe are toxic. However, there are degrees of dissidence. Some dissidents completely reject the notion that HIV causes AIDS, while others accept it but reject the belief that it is the sole cause, and emphasise the role of cofactors in contexts where AIDS thrives. Dissidents believe that ‘since the problem [of the disease] is multifactorial, solutions need to be as well’ (Downing 2005: 119). It may seem inappropriate that differences between medical approaches should take on political meaning, but when we take into account the implications of the two paradigms outlined above, it becomes clear that politicisation is inevitable. For one thing, the biomedical model’s endorsement of drug treatment has strong economic entailments, since the drugs are unaffordable to the poor, and so must be provided by the State, necessitating policies which reassign budgetary resources. The alternative model’s stress on socioeconomic factors in the causation of disease is also intrinsically political, since the distribution of wealth in the country is largely a consequence of its political history (as discussed in the Introduction), and in order to change socioeconomic conditions, government has to initiate different policies. In addition, the fact that the biomedical model is the ‘standard’, hegemonic one − the biomedical paradigm is privileged over other kinds of medical knowledge and points of view; it holds power −means that challenges to its authority automatically take on political overtones and are regarded as anti-establishment, or ‘dissident’. The expression ‘dissident’ is significant in itself since the word is associated with politics rather than the discourse of health and medicine.

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