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The Moral Economy of AIDS in South Africa (review)
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Reviewed by
Nicoli Nattrass (2003) The Moral Economy of AIDS in South Africa. Cambridge: Cambridge University Press

This book sums up Professor Nattrass' criticism, spanning several years, of the South African government's responses to the HIV/AIDS epidemic. It is a sustained demolition of the values, approach and content of HIV/AIDS policies (emanating from the President's office and Ministry of Health) up to 2003. Beginning with an outline of why HIV/AIDS deserves particular attention that revolves around the public debate on the need for national, as opposed to 'pilot', private and independent, anti-retroviral treatment (ART) programmes, she goes on to unpick the rationale of the government's actions.

Her book provides a useful summary of the responses from the mid-1990s, followed by consideration of the key contentious issues that have arisen since. These include the use of ART to 'prevent mother-to-child-transmission ' of the virus; the costs and benefits of a national ART programme; and the relationship between HIV/AIDS infection, poverty and development. Throughout, Professor Nattrass provides a clear exposition of the politics of AIDS and the government's and its critics' economic assessments of the effects of the epidemic, and the demands on the country's resources. At root, she counters the government's assertion that it could not afford to provide ART by showing clearly why it cannot afford not to.

This contention inspires the title of the book; in effect, looking beneath economic orthodoxy - how best to allocate scarce resources - to the values that shape assessments and conclusions. The 'moral economy' in this instance is defined by who is included and excluded through a decision to allocate resources in a particular way. Citing the philosopher, Richard [End Page 166] Rorty, she summarises, "if society lacks the political will to help those in need, then the notion of a moral community of citizens in empty". Put bluntly, by refusing for nearly a decade to institute national ART programmes, the South African government excluded from membership of 'South Africa' a rapidly growing proportion of the country's residents.

In her concluding chapter, Nattrass draws together threads in the preceding chapters to consider how society can help those in need. Here she looks at debate that was simmering in the early 2000s over the government's social security policies, encapsulated in the proposal for institution of a Basic Income Grant and, more broadly, in the quest for a 'social contract' between the post-apartheid state and its citizens. These are issues that Nattrass could only draw attention to, for they have become more open since she wrote the book and were subordinate to the central purpose of her book: to close the debate on whether South Africa can afford to provide anti-retroviral treatment to those in need. [End Page 167]

Tim Quinlan

Tim Quinlan is Research Director in the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal.

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