Economics and HIV: the sickness of economics by Deborah Johnston, and: South African AIDS Activism and Global Health Politics by Mandisa Mbali (review)

There are numerous articles and books on the HIV/AIDS epidemic. In writing this review I carried out a quick scan of new social science books with the words HIV and AIDS in the titles. I identified seven from main stream publishers in 2012 and six up to mid-2013 (including the titles reviewed here). Readers and scholars, unless they are autodidacts, need to be selective about what they read.

These two books look at the economics of the pandemic at the global scene level and global politics and South African activism respectively. Interestingly both remark on the need for more research in order to understand the issues they address. The point, which neither makes, is we need deeper, nuanced research not simply more.

Mbali’s book is developed from her PhD. This documents and interprets the history of AIDS activism from its beginnings to about 2004, five years after the establishment of the Treatment Action Campaign (TAC) (there is a useful postscript that takes the story up to about 2011). She examines the responses to the AIDS from the emergence of the epidemic in 1982. She goes on to describe political transitions, the changing role of TAC and the development and growth in international alliances. The book is in two parts: ‘AIDS activism and South Africa’s transition’ and ‘the TAC and global health politics’.

Johnston sets out a critical review of the work of economists especially in relation to their perspective on disease. Her book is neatly divided into two parts each with four chapters. The first section comprises chapters looking at ‘The economics of HIV transmission: fads and fashions’, the second part is ‘The economic impact of AIDS: the past, the present and the future’. The opening chapter asks if economics and HIV/AIDS is a failed opportunity, and she ends with advocating for a new approach to economics.

Both books tell stories of disappointment. In the case of Mbali she addresses the inability of government to respond appropriately to the greatest public health and development challenge faced by the state. Johnston considers her discipline to have botched the issue, stating in her preface: ‘Economics has largely failed to provide useful insights on the HIV/AIDS pandemic. The inability of a dominant branch of social science to assist in understanding an illness with significant social, economic and emotional effects is a serious failing in its own right’.

Mbali’s analysis is strongest when looking at the evolution of the TAC and understanding how it built global alliances. The key moments were the emergence and rapid spread of HIV; the development of Anti-retroviral therapy in 1996; the establishment of the TAC in 1998 to advocate for treatment, including prevention of mother to child transmission, which at that point in the epidemic, was fairly simple to provide; the government’s unwillingness to provide this and indeed any treatment; the court case where the administration took on the pharmaceutical industry and won the right to provide cheaper generic medicine; and finally the Mbeki denial of the efficacy of drugs and ultimately his questioning the existence of HIV.

This book might be described as the biography of the TAC. It is written by someone who was intimately involved with the organisation in its critical early years. It is perceptive and, at times, passionate. It is an output of a PhD, and as such is to be applauded. As Mbali grows as a scholar her work and analysis should deepen. There are, in this book, many pointers to directions she could take. One example is describing the emergence of AIDS as ‘coincidental’ with ‘the dying days of apartheid’. This needs to be thought through more carefully. Johnston’s book would help her in understanding the reasons for the spread of epidemic as being more than coincidence.

Both authors have activist, feminist and leftist backgrounds and...