State of Denial (review)

State of Denial, a documentary written and directed by the South African–born filmmaker Elaine Epstein, depicts the HIV/AIDS crisis that affects millions of South Africans. Concentrating on the government's inaction in providing antiretroviral treatment to public clinics, and showing the struggles of ordinary South Africans coping with the emotional stresses and physical hardships of the disease, the film offers viewers a window into the lives of AIDS victims, health-care workers, doctors, and activists with the express purpose of addressing a sensitive topic so that people will understand the severity, complexity, and urgency of the HIV/AIDS epidemic.

State of Denial begins with the sobering fact that in the year 2000 there were over four million people infected with HIV in South Africa alone. Despite soaring infection rates, President Thabo Mbeki remained steadfast in his position that scientific evidence has not proved that HIV causes AIDS and that the disease might be more a symptom of poverty. Mbeki is shown speaking to Parliament and at the International AIDS Conference, each time refuting the direct link between HIV and AIDS. To support his claim, Mbeki invokes theories advocated by dissident scientists, theories that the majority of HIV/AIDS researchers have long since discredited. One impact of his denial is that some South Africans, believing that HIV/AIDS is a less severe problem than it really is, refuse to take medicines that might help them or to use condoms to help prevent the spread of the disease.

Emphasizing the vital work of health-care providers, State of Denial profiles Buyile Montjane, a volunteer caretaker for ailing AIDS patients who travels two or three times each week to the mining town of Carletonville. Under apartheid, South African men were forced to migrate to the mines in order to support their families and pay their taxes, living far from home in predominantly male townships like Carletonville for months at a time. In such circumstances, alcohol abuse and prostitution were common, condom use was less common, and HIV spread quickly throughout mining towns and beyond. When men went home to visit their families the infection would spread to their wives and most of their future children.

One of the most gripping accounts in State of Denial concerns a mother, Mary, and her two children, Gift and Chipo. All three are HIV positive but only Gift, Mary's son, qualifies for free trial medication. Although HIV drugs are commonplace in developed nations, medications such as Pfizer's diflucan are too expensive for most South Africans, often costing as much per month as an average worker earns. State of Denial follows Mary, Gift, and Chipo, showing the emotional burden of HIV and how it complicates even day-to-day activities.

The film also focuses on Zackie Achmat and the organization he founded, Treatment Action Campaign (TAC). Achmat is an activist who is trying to compel pharmaceuticals to sell their HIV/AIDS antiretroviral treatments for reduced prices and at the same time to persuade the South African government to acknowledge that HIV is the cause of AIDS. Through TAC, Achmat achieves some success in getting nevirapine, a drug that has demonstrated success in preventing the transmission of HIV from pregnant mother to newborn, distributed in public clinics. However, he notes that there is still much work to be done in both advocating for widespread affordable access to treatment and raising public awareness about HIV/AIDS.

The film also examines the stigma that faces many people who choose to disclose publicly that they are HIV positive. While Lucky, an HIV-positive reporter, is enthusiastically received by many people, the AIDS activist Gugu Dlamini was stoned to death by her own community for going public with her condition.

By allowing ordinary South Africans to speak for themselves, Epstein creates a moving testament to the dignity and courage of people living with HIV/AIDS and paints a vivid picture...