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The South Atlantic Quarterly 103.4 (2004) 769-811
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Perhaps the most coherent expression of President Thabo Mbeki's position on the relationship between HIV, AIDS, and antiretroviral (ARV) therapy is set forth in a document entitled "Castro Hlongwane, Caravans, Cats, Geese, Foot and Mouth Statistics: HIV/AIDS and the Struggle for the Humanisation of the African." The text was distributed throughout the African National Congress (ANC) National Executive in March 2002, and is rumored to have been authored by Peter Mokaba, whose subsequent death on June 9, 2002, at age forty-three of "acute pneumonia linked to a respiratory problem" gave rise to speculations that he died of AIDS. It is not a document to be written off, even though this is how its critics have treated it.1 On the contrary, whether one interprets it as Mokaba's oblique, extended suicide note (explaining why he would not take ARVs even though he could afford them) or as Mbeki's unwilling political last will and testament (allowing a name to be given to his disavowal of a deadly condition's given name), it must be read as a distinctly necropolitical text. In it we find the strongest sustained argument in support of the Mbeki administration's [End Page 769] decision to delay the provision of ARVs to South Africans between 1999 and 2003. This argument may be summarized as follows: HIV is not the only cause of the many immune deficiencies weakening the South African body politic; poverty also causes the acquisition of immune deficiencies; the science grounding HIV's existence and treatment is not only questionable but racist; ARVs can neither prevent nor treat the acquisition of poverty-based immune deficiencies; ARVs are linked to the interests of multinational capital; ARVs are not even a cure for HIV and are toxic besides.2 Whatever the merits of these claims are on their own terms (the racism of HIV/AIDS epidemiology certainly has been well documented), "Castro Hlongwane" adds them up, by a kind of kettle logic, to reach what seems to have been a presupposed conclusion: the Ministry of Health need not rush to include ARV treatments as a part of the fight against HIV/AIDS in South Africa. The Treatment Action Campaign (TAC) estimates that this conclusion has led to the unnecessary deaths of thousands of poor people.
It is tempting to read "Castro Hlongwane" as a mere effect of a more fundamental economic logic, such that the Mbeki administration's hesitation to provide ARVs could be explained because they are too expensive, or because providing generic ARVs would somehow scare off foreign direct investment. But the disturbing probability is that the Mbeki administration's theories about HIV and AIDS operate with a high degree of relative autonomy. Providing ARVs for HIV-positive South Africans is not only economically possible for the Mbeki administration, but may be its most cost-effective policy option.3 The decision not to provide ARVs cannot then be considered a decision made of economic necessity. As Mandisa Mbali argues, the very opposite is true: there is every indication that the theory that HIV is not the exclusive cause of AIDS is the exclusive cause of the Mbeki administration's deadly delay of ARVS.4 "Castro Hlongwane," as the single most coherent formulation of this theory, must be read for the performative force of its death sentences.
The dominant accounts of the Mbeki administration's denialism tend to frame the question as a variation on the tradition of humanistic and social-scientific thought Mahmood Mamdani has called "South African exceptionalism."5 Grasped within this frame, Mbeki's theories would be unique to South Africa, intelligible as only another intriguing turn in the history of a particularly fascinating nation, the politics and culture of which are unlike any other. The corollary of this approach would be the reduction of denialism [End Page 770] to an exceptionalism of a second sort. As the only leader in contemporary world politics to publicly question accepted scientific opinion on the question of HIV/AIDS, Mbeki would appear purely and simply irrational. He...