Nattrass, an economics professor and the director of the AIDS and Society Research Unit at the University of Cape Town, addressed a mixed audience of students and faculty about the “discursive battle” taking place between policymakers who adhere to the dictum that AIDS is not a realistic threat and those attempting to distribute clinically tested ARV drugs.
AIDS denialists oppose the use of ARV treatment on the basis that pharmaceutical manufacturers are “corrupted” and that AIDS deaths are better prevented by “natural alternatives,” including traditional medicine, Nattrass said.
“[The denialists are] extremely arrogant,” she added, explaining that the denialist paradigm holds that the HIV virus does not exist or that, if it does, it is harmless.
Nattrass said that AIDS denialism has guided South Africa’s AIDS initiative for the past decade and has “cost thousands of lives.”
South Africa has more HIV-positive people than any other country in the world and also has the largest ARV treatment program, Nattrass noted. Despite a well-funded, comprehensive treatment initiative, however, Nattrass’ research shows that less than half the people who need to be treated actually receive treatment.
Leading politicians in South Africa, including President Thabo Mbeki, have given substantial weight to the denialists’ rejection of widely corroborated scientific evidence in favor of ARV treatment, Nattrass explained. Despite clear evidence that providing ARV treatment to prevent mother-to-child transmission of the virus was 17 times cheaper than assuming the cost of children born HIV-positive, Mbeki nonetheless delayed the distribution of ARV drugs.
Nattrass estimated that this delay in government action has cost about 343,000 lives.
“I think [not distributing ARV drugs is] 100 percent ideological,” she added.
Policymakers who sustain the AIDS-denialist paradigm claim that ARV drugs are too expensive to purchase with taxpayers’ money and that they have not been proven to work. South Africa’s long-standing minister of health, Manto Tshabala-Msimang, has repeatedly withheld government funds from ARV treatment programs and has made no effort to negotiate with ARV providers for price reductions, Nattrass explained.
“[Tshabala-Msimang] has undermined the supply of treatment but also people’s confidence in the drug,” Nattrass said, referring to government-supported campaigns against the efficacy of ARV medication. “The business for healers is booming,” Nattrass added, noting that unlicensed doctors are being given access to government clinics and are encouraged to provide cures for the “bewitchment” that causes AIDS.
Natrass said that a traditional local therapy known as “ubhejane” has become widely popular among AIDS patients and has deterred many patients from seeking ARV treatment. Though the efficacy of this bottled remedy has not been subjected to any experimental scrutiny, it has been marketed by the government as a desirable, natural alternative to “toxic drugs” provided by pharmaceutical companies. The cost of a single bottle is equivalent to half of an individual’s old-age pension.
“I think the government has a responsibility to not let people waste their money,” Nattrass said in relation to the “ubhejane” remedy.
“It took massive social protest for the cabinet to overrule what the health minister tried to do,” Nattrass said, describing the civil-disobedience methods employed by South Africa’s Treatment Action Campaign in 2003. The government increased the distribution of ARV drugs, but disparities have by no means been eradicated, and the denialist paradigm persists, she added.
The prospect for change, Nattrass said, is uncertain despite the recent election of Jacob Zuma as leader of South Africa’s dominant African National Congress Party. As long as the Ministry of Health continues to endorse “quackery” against concrete scientific evidence, Natrass added, substantial progress is doubtful.
Education is crucial to combating the government-fueled distrust of Western medicine, Nattrass explained. Patients need to understand “why science can be trusted,” even though clinical trials may not always yield accurate results. “When you keep explaining things, and people keep getting better, then the demonstration rate is bound to go up.”
“I think that [the AIDS denialists’ rejection of ARV treatment] is in general a large problem that needs to be addressed,” Elise Schlissel ’09 said after the lecture, adding that “it requires substantial global and international support.”
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