Intended for healthcare professionals

Education And Debate

The politics of AIDS in South Africa: beyond the controversies

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:495
  1. Didier Fassin, director (,
  2. Helen Schneider, directorb
  1. a Centre de Recherche sur les Enjeux Contemporains en Santé Publique, Université Paris 13-Inserm, 74 rue Marcel Cachin, 93 017 Bobigny, France
  2. b Centre for Health Policy, School of Public Health, University of Witwatersrand, PO Box 1038, Johannesburg 2000, South Africa
  1. Correspondence to: D Fassin
  • Accepted 5 December 2002

Discussion of AIDS in South Africa needs to move beyond a simplistic “for or against” stance on President Mbeki's denial of a connection between HIV and AIDS. The authors propose ways to widen the debate and hence to increase understanding of the epidemic

At the beginning of 2000 Thabo Mbeki sent a letter to world leaders expressing his doubt that HIV was the exclusive cause of AIDS and arguing for a consideration of socioeconomic causes. He subsequently invited scientists who shared his view to sit with orthodox experts on AIDS on a presidential panel to advise him on appropriate responses to the epidemic in South Africa. Until April 2002, when Mbeki formally distanced himself from the AIDS “dissidents,” the international scientific community's interest in South African policies on AIDS was almost exclusively focused on the polemic raised by the president. His statements questioning the AIDS statistics, on poverty as a cause of immune deficiency, and on the dangers of antiretrovirals, together with government stalling on the roll out of nevirapine to prevent transmission of HIV from pregnant mothers to their babies, dominated the debate.13

However, the July 2002 Constitutional Court judgment ordering the government to make nevirapine universally available to pregnant women infected with HIV, followed in October by a cabinet statement supporting wider access to antiretrovirals, may have finally ushered in a new era. It should now be possible to discuss the reality of AIDS in South Africa without reducing the argument to simple dualisms (such as being for or against a viral cause of AIDS, for or against the president). We propose an approach to discussing AIDS in South Africa that is rooted in political economy and political anthropology. Such an approach will shed light not only on the objective determinants of the epidemic, especially …

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