HIV/AIDS and discourses of denial in sub-Saharan Africa: An Afro-optimist response?

HIV/AIDS – the new image

Indeed, we now have almost an entire continent of sexually hyperactive indigents, with tens of millions of people who only survive because of help from the outside world…. They are now – one way or another – virtually all giving aid to or investing in Africa, whereas Africa, with its vast savannahs and its lush pastures, is giving almost nothing to anyone, apart from AIDS. (Myers, 2008)

The sub-Sarahan region has borne the brunt of the epidemic with AIDS-related mortality rates exceeding those of the rest of the world combined (UNAIDS, 2007). The failure of HIV prevention efforts in many countries, in the light of remarkable success in other parts of Africa, remains an enigma (Govender, 2005).

Discourses surrounding HIV/AIDS have contributed immensely to the western view of sub-Saharan Africa as a continent rife with disease, hunger, poverty, sexual promiscuity and death (Downing, 2005). Discourse, as we use it here, refers to socially referenced ways, or discursive frames, of talking, interpreting and representing. Discourse is framed by ideology which orders content into taken-for-granted interpretive regimes. These are common-sense interpretations that naturalize particular kinds of analysis.

Heartbreaking images of emaciated Africans and imploring children orphaned by AIDS dominate global reportage, and are at the centre of scholarly and other debates on global responses to HIV/AIDS. Just as the myriad images of ‘tribalism’, ‘famine’, ‘disease’ and ‘war’ contribute to particular negative visions of Africa (Epstein, 2007), such images are used in particular ways that potentially discredit the continent, Africans in general, and contribute to negative stereotypes and particular discourses reminiscent of Edward Said’s analysis in Orientalism (1978) applied to Africa.

(Black) African sexualities and other cultural practices dominate commentary on the epidemic (see e.g. Airihenbuwa and De Witt Webster, 2004; Luke and Kurz, 2002; Mensch et al., 2005; Parker et al., 2007). The Independent.ie article by Kevin Myers (2008) argues that while western countries are investing heavily in aid programmes, Africans are doing little apart from reproducing exponentially, and that Africa offers the rest of the world nothing other than AIDS. Myers (2008) asserts that ‘in the almost complete absence of personal self-discipline, that disease is one of the most efficacious forms of population-control now operating’.

Below, we examine the discourses surrounding HIV/AIDS within the broader context of the global imagining of Africa. Certain African leaders, journalists and academics allege that western-generated reports are deliberately skewed to paint a grim picture (Fortin, 1987). Others conspiratorially perceive the epidemic to be part of wider racism designed to control and subjugate people of African descent (Chirimuuta and Chirimuuta, 1989). These perceptions, perhaps, partly explain the profound silence and denialism that characterized early responses to the HIV epidemic in most Southern African countries.

We discuss the historical factors that shaped the emergence of ideological arguments that locate African AIDS denialism as a counter-response to Afro-pessimism. We do not intended to exonerate Mbeki and his allies, whose views undermined responses to HIV/AIDS in Africa. Rather, we attempt to generate a broader interpretation of their controversial position as a translation of genuine political anger at the pessimistic manner in which sub-Saharan Africa has been represented globally. Within this context, the Afro-pessimism debate as it relates to HIV/AIDS is a battle over the global imaging of Africa, rather than over the epidemic itself. This, perhaps ironically, feeds into the representation that has generated such anger while fuelling beliefs in the lack of true western commitment to combat AIDS in Africa.

The arguments presented here are based on analysis of selected texts surrounding what has now come to be known as ‘the African AIDS debate’. We draw on Schleiermacher’s (1998) notion of the hermeneutic circle and the relationship between the text, its source and context. Understanding a text requires transcending the text to decode the spirit that motivated the speaker’s or author’s text. The historical context of the text and that of the author are thus central to the hermeneutic circle. The circle forms the precondition for interpreting the text accurately (Palmer, 1969).

At the grammatical level, interpretation analyses the meaning of a spoken or written word based on the shared features of the language (the code). This, according to Schleiermacher, is the objective form of interpretation. The technical interpretation, conversely, involves the interpretation of written words or spoken utterances in relation to the life and personal development of the writer/speaker (the idiocode). This level of interpretation is subjective and Schleiermacher argues that the key role of hermeneutics lies within the second level. Schleiermacher thus relates hermeneutics not to the text being interpreted but to the mental processes that are involved in the act of interpretation (by Mbeki for example). Hermeneutics is a means of understanding the worldview of the ‘other’ (Bleicher, 1980; Palmer, 1969), the other in this case being the Western ‘same’.

Discourses about AIDS in Africa must therefore be placed within their contexts in order to understand how images and ideas of Africa and Africans can have such discrepant effects and result in such widely disparate truth claims. HIV/AIDS in Africa cannot merely be studied as a medical or biological issue stripped of its political, economic, social and historical processes (see Chin, 2007).

We do not aim to simply read intentionality into Mbeki’s utterances. Rather, we aim to understand his idiocode and outright hostility, expressed through government policy and actions to actively prevent treatment (cf. Steinberg, 2008).

African independence and the rise of Afro-pessimism

The dawn of independent African states in the 1960s ushered in a new era characterized by great expectations among the citizens of the newly independent nations. Besides celebrating the end of the de-humanizing colonial experiences, Africans were optimistic that their countries would soon progress, especially since national resources were now in the hands of national leaders rather than those of their former colonial rulers (Rodney, 1982).

For many countries, however, this optimism was short-lived, especially with military coups in the 1970s and early 1980s. The majority of these regime changes resulted from widespread disillusionment, pervasive corruption and dictatorship among new African presidents, the majority of whom were either leaders in the struggle for independence or, conversely, collaborators with colonial administrators (Asante, 2007). By the mid 1980s, the majority of the independent sub-Saharan African states had failed. Alongside political instability, most states were grappling with the burden of poverty, famine and disease.

By the mid 1980s, many western countries perceived aid to Africa as a waste of their resources. Aid had not strengthened institutions, good governance and democracy nor had it facilitated economic development. According to Ebere Onwudiwe (n.d.), Afro-pessimism appeared in print for the first time in a 1988 story circulated by the Xinhua News Agency, in which France’s Minister of Cooperation, Michel Aurillac, cautioned against an emergent western pessimistic view of Africa’s economic development. Aurillac referred to this perception as ‘Afro-pessimism’, a term that has since been used widely by the media in reference to the perception of sub-Saharan Africa as a region steeped in problems. There is, however, a group of Afro-pessimists who perceive Africa as an irredeemably problematic continent, which should either be re-colonized (Onwudiwe, n.d.) or, at best, be left to carry its own burden (see e.g. Kaplan, 1994).

The predominantly negative image that the western media have created about Africa (Hammond and Jablow, 1970; Hawk, 1992) discourages investment, hence limiting its competitiveness in global markets (Onwudiwe, n.d.). Africa in particular is affected by this pessimism, whereby a failure anywhere is used to caricature the entire continent.

The emergence of HIV/AIDS as Africa’s face of disease

Disease is one of the greatest burdens facing African countries. Between 2000 and 2004 life expectancy in sub-Saharan Africa was 45.9 years whereas from 1980 to 1989 it was 49 years (Jamison et al., 2006). Africa has struggled to overcome these health challenges and has managed to keep some serious diseases, such as smallpox and polio, under control (Jamison et al., 2006). The emergence of HIV/AIDS in the early 1980s compounded the situation.

Despite declining HIV infections recorded in, for example, Uganda and Senegal during the late 1990s (Alan Guttmacher Institute, 2003), in Zimbabwe (Gregson et al., 2006; UNAIDS, 2005c) and urban areas of Kenya (Cheluget et al., 2006; Hallett et al., 2006; Republic of Kenya, 2006), Africa remains the global epicentre of this epidemic. About 64 percent of people living with HIV reside in sub-Saharan Africa, home to ‘a little more than one-tenth of the world’s population’ (UNAIDS, 2006: 15).

Emergence of African AIDS discourses

One of the main subjects of contestation in the HIV/AIDS debate, especially in the late 1980s and throughout the 1990s, was its African origin. Tests revealed some similarities between HIV and a virus called Simian Immunodeficiency Virus (SIV) found in African green monkeys (Alcamo, 2003). Simon Wain-Hobson (1998) linked the origin of HIV to the Belgian Congo (the present-day Democratic Republic of Congo). The death of a Bantu ¹ (African) man in 1959 of an unidentified disease was established as having been caused by HIV/AIDS (Wain-Hobson, 1998). In 1999, the University of Alabama reported that that HIV had originated from a species of chimpanzee found in West-Central Africa and could have been introduced to humans through exposure to infected blood. ² The virus quickly spread among human beings as a result of the socio-economic changes that took place in Africa after the Second World War (Sharp and Hahn, 2008).

Research on the origin of HIV/AIDS drew sharp reactions from a number of African academics and opinion leaders. Among the first to respond were Richard and Rosalind Chirimuuta. In their book, AIDS, Africa and Racism (1987), they query how the origins of a disease that was initially diagnosed among white American ‘homosexuals’ came to be associated with Africa. The Chirimuutas challenged what they perceived as racist attempts to blame the (black) African people for the spread of HIV:

The depth to which racist ideology has penetrated the western psyche remains profound. The association of black people with dirt, ignorance and animal-like sexual promiscuity has in no sense been eradicated. When a new and deadly sexually transmitted disease, the Acquired Immune Deficiency Syndrome, emerged in the United States this decade [1980s], it was almost inevitable that black people would be associated with its origin and transmission…. The western world is now largely convinced that the Acquired Immune Deficiency Syndrome, or AIDS, originated in Africa, and that Africa is responsible for infecting the world…. It now seems almost incredible that the earliest accounts of the disease, in White American homosexuals, made no reference to Africa.… How is it possible that this predominately American disease has become attributed to [the] African continent? (1987: 3)

The Chirimuutas perceive these origin discoveries as part of a continuation of a neocolonial, especially Euro-American, Afro-pessimistic ideology aimed at sustaining the negative image of Africa. Similar arguments were presented in several articles published in the 1990s by The New African, a non-academic English-language monthly based in London. Baffuor Ankomah (1998) challenges the African chimpanzee HIV-origin theory, citing scientific evidence on the unreliability of HIV tests performed on frozen blood samples. He further argues that there was no evidence showing that the man who died of a condition similar to AIDS in 1959 was indeed African and asks, rather sarcastically, if Africans started having sex only in the 1950s.

Some writers have suggested that the epidemic did not originate from Africa but was instead introduced to Africa from the West. Fortin (1987), for example, cites an editorial that appeared in Medicus, an official publication of the Kenya Medical Association, which suggested that tourists could have brought the virus to Africa. The editorial protests against perceived attempts by the West to link the origin of every disease to Africa. The Association’s arguments provide the basis for understanding the African counter-discourse on HIV as contestation of Africa’s image, rather than the disease itself.

The suggestion of the African origin of HIV by the New York Times, quoting Robert Gallo of the National Cancer Institute and William Haseltine of Harvard University, resulted in the confiscation by furious Kenyan government officials of the entire shipment of the International Herald Tribune of 9 November 1985. The International Herald Tribune had begun to serialize the New York Times report on African AIDS research (see Fortin, 1987: 909).

Tensions that emerged as a result of the controversy surrounding the origin of HIV/AIDS forced the World Health Organization to pass a resolution in 1987 that described HIV as a ‘naturally occurring [virus] of undetermined geographic origin’ (World Health Organization, in Alcamo, 2003).

The racial geopoliticization of the debates resulted in a closing off of legitimate scientific search for an origin. It is the racialized backlash to unflattering views that precludes the writers cited above from even considering AIDS as possibly African in origin. The debate thereafter took on even weirder polemical twists, with conspiracy theories and irrational claims of a deliberate ‘AIDS genocide’ (Cantwell, 1988, 1993).

Understanding the African AIDS discourse

Medical science may be seen as another representational regime with its own rules and way of seeing the world that allows for contestation of medical ‘truths’. However, such a regime must be grounded in context. HIV and medical science can be analysed within a larger discursive framework of contested regimes of truth claims. However, these interrelate in networks of meanings that are found, and indeed, grounded in the deaths of people from AIDS. The argument is not that medical science is infallible, but the normative actions required to respond to the crisis require medical interventions alongside the social. The ideological claim being made by Mbeki was an attempt to bring medicine and medical developments to a halt.

Analysis of discourses on AIDS in Africa has concentrated mainly on Mbeki’s idiocode on HIV and AIDS, which has been interpreted variously by scholars across the world (cf. Cullinan, 2003; Downing, 2005; Mbali, 2002, 2004; Tomaselli, 2009; Wang, 2008). According to Nattrass, the point of convergence among all AIDS denialists ‘is the unshakable belief that the existing canon of AIDS science is wrong and that AIDS deaths are caused by malnutrition, narcotics, and ARV drugs themselves’ (2007: 31).

Mbeki’s views may also be read as an attempt to provide an alternative framework for understanding the HIV/AIDS crisis (Geshekter, 2007). ‘Mbeki’s public remarks, in essence, can be interpreted as seeking to promote an understanding of AIDS in Africa in terms of epidemiology, rather than virology’ (van Rijn, 2006: 521). His controversial views, according to van Rijn, were aimed at redirecting attention focused on the causal link between HIV and AIDS to a broader discussion of factors that underlie the spread of disease in Africa.

Raymond Downing (2005) concludes that the South African president had been deliberately misreported and unfairly ‘crucified’ by the western media. Downing compares the coverage of Mbeki’s remarks on HIV and AIDS in both the African media and western media and concludes that African media have been largely supportive of Mbeki’s views while western media have selectively and deliberately misrepresented his arguments. Mbeki never publicly denied the link between HIV and AIDS (Downing, 2005). Downing also identifies sections of President Mbeki’s speeches, letters and interviews that he sees as being deliberately excluded from western media coverage. Downing, however, excludes South African newspapers from his analysis that, without fail, pilloried Mbeki’s position, thereby endorsing the preferred international hermeneutical code.

For other writers, the conflict between Mbeki and his allies in the ANC on the one hand, and the civil society and AIDS activists on the other is a battle over symbolic power (Nattrass, 2004). This analysis sees the controversy as an attempt by the state to assert its authority in deciding the direction the HIVAIDS response strategy will take: ‘Ultimately, policy contestation around AIDS in South Africa can be understood as a series of attempts by the state to legitimately define who has the right to speak about AIDS, to determine the response to AIDS and even to define the problem itself’ (Schneider, 2001: 21). What was under contestation was the code: (1) how Africa was imaged through the lens offered by the epidemic; and (2) how to evacuate Africa from the viralogical code. This led to the state expressing outright hostility to organizations providing free antiretroviral drugs and actually hampering treatment (Cullinan and Thom, 2009; Steinberg, 2008: 92).

Afro-optimism

While HIV/AIDS has added to a plethora of socio-economic and socio-political issues that sub-Saharan governments are struggling to overcome, the epidemic has also significantly influenced the way Africa is viewed globally. Due to the nature of the epidemic, the way of life of (black) African people is claimed to be unfairly under scrutiny where various African socio-cultural practices have been blamed for the faster spread of HIV than has occurred elsewhere. It is therefore plausible to argue that the controversy that has been generated by the scientific debates on the origin and spread of the HIV/AIDS epidemic, the denial of the link between HIV and AIDS, and the resistance to the roll-out of antiretroviral therapy, has been a battle over the global, especially Euro-American, image of Africa, rather than the epidemic itself.

Mbeki and his fellow denialists were challenging the Afro-pessimistic view of sub-Saharan Africa as a region suffering from the burden of disease, war, instability, famine, refugees, genocide and general lawlessness. The main concerns of the so-called ‘AIDS denialists’ revolve around the way Africa has been represented in the whole debate. The authors of HIV/AIDS in Africa: Beyond Epidemiology make it clear that their main concern in the global AIDS discourse is the way ‘that dominant interpretations of AIDS are aiding in the reproduction of problematic colonial and postcolonial African representations, practices and social politics’ (Kalipeni et al., 2004: 4).

In his address to the 13th International Conference on AIDS, Mbeki triggered a barrage of criticism both nationally and internationally when he suggested that extreme poverty was closely associated with the African AIDS epidemic:

What I heard as that story was told was that extreme poverty is the world’s biggest killer and the greatest cause of ill health and suffering across the globe. As I listened longer, I heard stories being told about malaria, tuberculosis, hepatitis B, HIV-AIDS and other diseases. I heard also about micronutrient malnutrition, iodine and vitamin A deficiency. I heard of syphilis, gonorrhoea, genital herpes and other sexually transmitted diseases as well as teenage pregnancies. I also heard of cholera, respiratory infections, anaemia, bilharzia, river blindness, guinea worms and other illnesses with complicated Latin names. As I listened even longer to this tale of human woe, I heard the name recur with frightening frequency Africa, Africa, Africa! And so, in the end, I came to the conclusion that as Africans we are confronted by a health crisis of enormous proportions. One of the consequences of this crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defence against attack by many viruses and bacteria. Clearly, if we, as African countries, had the level of development to enable us to gather accurate statistics about our own countries, our morbidity and mortality figures would tell a story that would truly be too frightening to contemplate. As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus. (Mbeki, 2000)

What was significant about this statement was that the conference came in the wake of the Durban Declaration (2000), in which 5000 scientists had endorsed the scientific proposition that HIV causes AIDS. This was widely interpreted as a response to the debate raging in South Africa at the time, following Mbeki’s invitation of ‘dissident’ and ‘orthodox’ scientists to discuss the link between HIV and AIDS (Downing, 2005). Delegates needed Mbeki to affirm the causal relationship between HIV and AIDS to enable them to replace political with medical discourses. However, Mbeki instead chose to emphasize the role of poverty, hence sparking a walk-out by a sizeable number of participants and fuelling subsequent criticism of his ‘denialist’ views (Downing, 2005).

Mbeki sought to highlight the fact that debates on the cause and origin of AIDS, and the assertion in the Durban Declaration that HIV was originally transmitted from an African monkey to humans, ‘played into the hands of a racial hierarchy that would place Africans on the bottom rung of the ladder, closest to both animal and beast’ (Wang, 2008: 8).

Mbeki thus perceived the focus on Africans in the global AIDS discourse as an attempt to blame Africans for the spread of the disease, hence his refusal to endorse a paradigm that he believed would perpetuate a negative image of Africans. His emphasis on poverty as the greatest cause of ill health across Africa should thus be understood as an attempt to reposition the AIDS crisis, which was by then being associated with Africa, within the broader discourse of poverty, which is a global challenge. This would in effect relocate HIV/AIDS as a global challenge rather than an African problem.

Mbeki tried to situate the debate within a broader position on poverty alleviation. There is no doubt that extreme poverty negatively affects mortality, whatever the disease. However, the broader poverty alleviation strategies failed to challenge the disease in any meaningful way and AIDS is not simply a disease of poverty like cholera.

The debate on AIDS treatment can also be conceptualized as part of the Afro-optimistic response to Afro-pessimism. Mbeki and a number of other African leaders and academics accused the pharmaceutical companies of the opportunistic sale of antiretroviral drugs (see Cohen, 2006). This view encodes distrust of initiatives originating from the West as part of a conspiracy to generate a crisis in Africa and therefore continue to sustain the negative image that Afro-pessimists have painted of Africa. Tshabalala-Msimang’s emphasis on the use of nutrition rather antiretroviral drugs can be seen as foregrounding locally generated solutions rather than interventions originating from the West, a view that has also been supported by some newspaper commentaries in the continent. This would, in effect serve to reduce the perceived dependence of Africa on the West. Mbeki’s call for what he refers to as an African response (the idiocode) to an African HIV epidemic could be understood, within this framework, as reasserting Africa’s ability to resolve its problems; a direct assault on the Afro-pessimistic view (the dominant code) that Africa needs the help of the West.

The various discourses surrounding AIDS in Africa may be seen as two poles of a debate about the imaging of Africa, irrespective of the validity of either of the two poles. The vitriol and polemic that pervades the debate impinges on rational thought, sound scientific debate and issues of treatment. It is tragic for the poorest and most desperate that legitimate anger on the part of those in power over the representation of Africa is translated into intransigence and intolerance with regard to important debates in health and medicine.

Signing off

Negative images of Africa invoke some of the most tragic scenes from the recent past. Such images both opened the world’s eyes to African suffering, but have also portrayed a negative vision of Africa. Kevin Carter’s chilling shot of an abandoned baby being stalked by a vulture during the Sudanese famine/civil war in 1993 is the ultimate consequence of a rabid humanity – produced by processes whose historical causation and underlying structure are hidden under centuries of conflict and interaction.

Herein lies the crux of the problem. Ideas about Africa are couched in the dominant discourse with the accompanying images of famine, disaster, starvation, disease and death. These images have become commodities – like the slaves of old, they unwittingly circulate the world where they are sold also by Africans to other Africans who sell them worldwide. These images are used to bring in much needed aid from charities that assist extremely needy people. Yet, these images, like commodities, are used in contexts in which they have no intrinsic connection to reality. They reinforce the very stereotypes that Mbeki was trying to counter. Thus does the media shape international responses to events, victims and disasters. If ever there was a need for an ethics of the making, distribution and exhibition of victimological media images, now is the time. Perhaps this is the denialists’ intention, but it is misinformed because it tragically mixes its metaphors, muddles its discourses and confuses its sites of struggle. The result is yet more misery, more death and more negative imagery. The denialists are trying to solve one problem (the image of Africa) by denying another, by holding medical science (virology) hostage to ideology, geography and ethnicity.