Side effects

Side effects is a work of narrative non-fiction that asks why South Africa has one of the worst AIDS epidemics in the world, and why all the early attempt to deal with it led to deepening controversy and strife.side_effects_web

The historical narrative reveals how and why AIDS conquered one of the richest countries on the African continent. It is a tale of the failures of presidents and people, of the legacy of apartheid, of bureaucratic indifference and corporate greed. It lays bare the lost opportunities and fateful decisions that led to mass death at a time when medical and social science had cleared the way to the prevention and treatment of the worst disease ever to have afflicted humankind.

Above all, Side effects is the biography of an extraordinary virus. A virus that enters a society, just as it enters the body, at its weakest point: an opportunistic virus that has triumphed over the vulnerabilities of a country in transition.

Based on extensive research and in-depth interviews with key players, Side Effects illuminates the political controversies that have surrounded the government's AIDS programme. It also offers a credible explanation for President Mbeki's flirtation with the AIDS denialists— a departure that reopened the scientific debate on AIDS at a global level, and set back South Africa's AIDS response by many years.

Part One, Fertile Ground traces the origin and early years of the South African epidemic. Up until the late 1980's the apartheid government's political cordon sanitaire had been effective in keeping the virus at bay, although it was already decimating countries to the north. Ironically, it was the late-apartheid reforms, particularly the dismantling of the influx control laws that restricted free movement of black people, which allowed the virus ready passage across the land. These were the heady years of struggle, of guerrilla infiltration, of rapid and uncontrolled urbanisation, of the abolition of the sex colour bar... all factors that gave the virus means and opportunity to infect a jubilant population.

Just as the social dislocation of the reform period provided the catalyst for the epidemic, the political context presented major obstacles to an effective state control programme. The majority of South Africans rejected all discussion of safer sex as part of an apartheid/genocide agenda, referring to the disease as American Ideas to Discourage Sex. During the years of political negotiation, the antenatal prevalence of HIV soared from 0.76% in 1990 to 7.6% in 1994—one of the steepest epidemiological curves ever witnessed in the pandemic.

Thus it was that Nelson Mandela's liberation government inherited an uncontrollable epidemic whose dimensions were yet to be understood.

Part Two, Fault Lines documents the gradual entanglement of the new government's AIDS policy with the process of political transformation. Although the new health minister, Dr Nkosasane Zuma, had carved out a solid reputation as an AIDS expert in exile, when she assumed office, AIDS was but one item on a crowded agenda. This included dismantling the racially divided health system, doing battle with the unregulated tobacco and pharmaceutical manufacturers and providing health care to underserved rural areas, to name just a few. The small vocal group of AIDS experts and activists grew increasingly concerned at Zuma's lack of action on AIDS, and a series of controversies put her and the activists on a collision course. By the end of the 1990's the activists were at loggerheads with the minister over her refusal to provide antiretroviral drugs that reduced transmission of HIV from mother to child.

A second, but related narrative in this period concerns the health minister's battle with the multinational pharmaceutical industry for affordable medicines; and how this battle was adopted by international activists in their campaign for expanded access to antiretroviral drugs to treat HIV. Thus while Zuma was praised abroad for challenging Big Pharma, AIDS activists at home were fighting the minister for access to these same drugs.

While the AIDS issue had been irrevocably politicised, the general populace remained in ignorance about the tragedy on their doorstep. Although by 1998, antenatal HIV prevalence stood at nearly 24%, relatively few people were yet ill or dying of the new disease. From the mass media to the trade unions, from the liberation theologians to the NGOs, denial was the order of the day. It was this climate of benign denial that provided a nourishing environment for a more malignant form of denialism that rejected the scientific orthodoxy on HIV and AIDS.

Part Three, Reason on Trial tracks the dénouement of these complex conflicts, in which the new president Thabo Mbeki questioned the very science of HIV and AIDS; the government whipped Big Pharma in the courts and the activists fought and won their legal and moral case for antiretroviral drugs...

By the time antiretroviral drugs were made available in the public sector in 2003, the social contract between civil society and the liberation government was in tatters and President Mbeki's international reputation had been irrevocably tarnished. There would be little he or his allies in cabinet could do to restore faith in their AIDS policies; or to curb the virus that had already infected some five million souls.

Read the Prologue

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City Press
Sunday Times
South African Labour Bulletin
Sunday Independent 

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