{"id":1236,"date":"2012-01-23T09:00:20","date_gmt":"2012-01-23T13:00:20","guid":{"rendered":"http:\/\/blogs.shu.edu\/ghg-development\/?p=1236"},"modified":"2012-05-22T12:04:42","modified_gmt":"2012-05-22T16:04:42","slug":"aids-crisis-joshua-busby","status":"publish","type":"post","link":"https:\/\/blogs.shu.edu\/ghg\/2012\/01\/23\/aids-crisis-joshua-busby\/","title":{"rendered":"Part II on the AIDS Crisis and Learning from History: Lessons from South Africa \u2013 Joshua Busby"},"content":{"rendered":"

Part II on the AIDS Crisis and Learning from History: Lessons from South Africa<\/strong><\/p>\n

Joshua Busby, Contributing Blogger
\nAssistant Professor of Public Affairs, University of Texas at Austin<\/p>\n

This is a cross-post with Joshua Busby\u2019s blog on \u201cThe Duck of Minerva.\u201d<\/em><\/a><\/p>\n

In my last\u00a0post<\/a>, I profiled the\u00a0Origins of AIDS<\/em>,\u00a0Jacques P\u00e9pin’s masterful\u00a0study<\/a>\u00a0of how the virus that causes AIDS in humans originated in chimps and then jumped to humans and later took off as a result of a complex series of events involving local populations uprooted from traditional practices, the spread of prostitution, and widespread use of injections to fight infectious diseases, among other factors (see Donald McNeil’s compact summary\u00a0review<\/a>\u00a0in the\u00a0Times<\/em>).<\/p>\n

If\u00a0P\u00e9pin’s book is of a scholar\/detective sifting and sorting evidence to advance an argument, Geffen’s book represents the history if somewhat impersonal memoir of the experienced social pugilist.\u00a0His efforts remind the world of the achievements of the Treatment Action Campaign (TAC), the South African AIDS advocacy campaign that challenged the government of Thabo Mbeki to provide antiretroviral \u00a0(ARV) therapy to those suffering from AIDS.<\/p>\n

\"\"<\/p>\n

Geffen is one of TAC’s longtime leaders, and this book chronicles TAC\u2019s clashes with both the South African government and a series of quacks and denialists who sought to promote anti-scientific remedies that likely contributed to the deaths of thousands of those suffering from HIV.<\/p>\n

Geffen casts Mbeki (and his health minister)\u00a0as villains in the struggle to extend treatment to those with HIV.\u00a0For those familiar with the work of\u00a0Nicoli Nattrass<\/a>,\u00a0William Forbath<\/a>, the political cartoons of\u00a0Zapiro<\/a>, and\u00a0others, Mbeki’s indulgence of AIDS denialism rings\u00a0both true and familiar.<\/p>\n

Alongside retellings of the legal wrangling by TAC with the Mbeki government and the quacks and hucksters, Geffen peppers the narrative with stories of people who took the their advice rather than the guidance of the medical community. The examples of failed and ultimately fatal vitamin and garlic treatments are sober reminders of the price paid by so many.<\/p>\n

Geffen’s last chapter seeks to understand how it was possible that the African National Congress government, the movement of liberation from apartheid, could sully its legacy by embracing AIDS denialism. Here, Geffen engages a debate taken up in Evan Lieberman’s important\u00a0book<\/a>\u00a0Boundaries of Contagion<\/em>:\u00a0\u201cWhy have some governments responded to AIDS more quickly and more broadly than others?\u201d Geffen’s asks a slightly different question: “Why did Mbeki’s views on AIDS prevail for a while?”<\/p>\n

Geffen writes:<\/p>\n

As president of the ANC and by far its most powerful member,\u00a0Mbeki was able to impress his personal positions on the organisation. Despite an essentially democratic structure \u2013 branches and sectors elect their leaders, who in turn elect the organisation\u2019s leadership at provincial and national level \u2013 the ANC has much within its culture that is anti-democratic and renders it vulnerable to and easily manipulated by the personal views of its strongest leaders (p. 193).<\/p><\/blockquote>\n

This argument, essentially about Mbeki\u2019s leadership, is contingent upon the ANC exercising significant, largely unchecked, power over the country\u2019s direction. As Geffen describes, the ANC possessed such status:<\/p>\n

The ANC together with its allies liberated South Africa from apartheid. It is recognized and admired as the liberator by about two-thirds of the voting population. This enables it to exert a powerful hegemony over South African society (p. 194).<\/p><\/blockquote>\n

By appeals to African nationalism, Mbeki and his allies were able to stave off vigorous contestation from AIDS advocates for several years. Though TAC was ultimately able through the court system to push the South African government to change direction, the damage was done with at least two studies estimating that 330,000 plus deaths could have been averted with different policy.<\/p>\n

\"\"<\/p>\n

This explanation \u2013 emphasizing the leadership role of Mbeki himself and the dominance of the ANC \u2013 fits my own understanding of the South African case as well as the Ugandan case where President Museveni took a much more aggressive stance in addressing the AIDS crisis.<\/p>\n

Here, Geffen\u2019s book intersects with the Lieberman book mentioned above. The recent\u00a0issue<\/a>\u00a0of\u00a0Perspectives on Politics<\/em>\u00a0features three (!) reviews on Lieberman\u2019s book by Macartan Humphries, Eduardo Gomez, and Daniel Posner. While Geffen’s book is obviously limited to a single case and represents the work of an activist rather than academic, I found his answer more persuasive than the account, at least of the South African case, featured in Lieberman’s book.<\/p>\n

Through mixed methods including sophisticated econometric analysis, Lieberman attempts to show that the fluidity of ethnic boundaries explains the reason why some countries addressed AIDS more than others. Where boundaries are rigid, groups less affected fail to support policies to help out others, as they see themselves less at risk and those communities disproportionately affected by the AIDS crisis fail to mobilize, given their marginalized status. Where ethnic boundaries are weaker, there is a greater sense of shared fates.<\/p>\n

Here, I share with Humphries and Gomez some of the concerns about Lieberman\u2019s treatment of key cases and rival explanations. Humphries writes:<\/p>\n

But South Africa remains puzzling. One would expect that if there were any place where the effects Lieberman describes would not be determinative, it would be in a case in which the affected group was both a large majority\u00a0and in control of policymaking (pp. 875-876).<\/p><\/blockquote>\n

Gomez echoes this view:<\/p>\n

While he provides evidence showing that state capacity and the presence of NGOs is insuf\ufb01cient for predicting policy responses, it is hard to say the same for political leadership. The dismissal of AIDS leadership fell on President Nelson Mandela\u2019s avoidance of the issue in South Africa, Thabo Mbeki\u2019s interest in AIDS prior to election, and then his avoidance of it once in of\ufb01ce, notwithstanding ongoing political support. In Brazil, Lieberman claims that aggressive policies predated Presidents Fernando Henrique Cardoso\u2019s and Luiz In\u00e1cio Lula da Silva\u2019s political leadership. Yet this is factually incorrect. Prior to Cardoso\u2019s and the World Bank\u2019s loans in 1993, there was no aggressive AIDS program. Thus, leadership under Cardoso, at the presidential and bureaucratic level, was important for reform (p. 878).<\/p><\/blockquote>\n

In Lieberman\u2019s view, leadership is unsatisfying because: \u201cThe relationship between cause and effect is so close that they are almost indistinguishable\u201d (p. 19). However, one can identify differences in state structures where personal rule is possible. As Robert Jackson and Carl Rosberg argued in their classic\u00a0article<\/a>\u00a0\u201cPersonal Rule: Theory and Practice in Africa,\u201d many newly independent African states lacked institutionalized checks on individual leaders. While that portrait has started to change, it is still a recognizable feature in many African countries. Though South Africa possesses more of the societal and institutional checks than the rest of the continent \u2013 an independent judiciary, a free press, and a vigorous civil society \u2013 the ANC\u2019s legacy as liberator and Mbeki\u2019s privileged position within the party gave him significant scope to pursue an idiosyncratic agenda for several years.<\/p>\n

While social scientists tend to dislike individual level explanations in favor of more domestic structural and international systems level explanations, one cannot understand critical cases like South Africa without bringing in agency and leadership. For that matter, we can\u2019t understand PEPFAR without acknowledging the role of President Bush and his personal interest in the problem. Here, I\u2019m reminded of the\u00a0piece<\/a>\u00a0by Dan Byman and Ken Pollack in a 2001 issue of\u00a0International Security<\/em>, \u201c\u2018Let us now praise great men: bringing the statesmen back in.\u201d The challenge is to recognize the conditions under which leaders may exercise agency. The structural impediments\u00a0 to action vary by country and circumstance. Sadly, in these tough economic times, the scope for more aggressive efforts to address the AIDS crisis appears much more circumscribed than it was just a few years ago.<\/p>\n

Leaving this more theoretical social science question aside, Geffen\u2019s book supports the notion that the Mbeki government did the wrong thing when it could and should have done something different. It is heartening that the Jacob Zuma government did an about-face on AIDS and has dramatically changed course to extend ARV therapy, support male circumcision, and enacted a host of other measures to treat and contain the epidemic.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Part II on the AIDS Crisis and Learning from History: Lessons from South Africa Joshua Busby, Contributing Blogger Assistant Professor of Public Affairs, University of Texas at Austin This is a cross-post with Joshua Busby\u2019s blog on \u201cThe Duck of Minerva.\u201d In my last\u00a0post, I profiled the\u00a0Origins of AIDS,\u00a0Jacques P\u00e9pin’s masterful\u00a0study\u00a0of how the virus that […]<\/p>\n","protected":false},"author":585,"featured_media":1255,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[7,15],"tags":[111],"class_list":["post-1236","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health-governance-blog","category-hivaids","tag-joshua-busby"],"_links":{"self":[{"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/posts\/1236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/users\/585"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/comments?post=1236"}],"version-history":[{"count":16,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/posts\/1236\/revisions"}],"predecessor-version":[{"id":1360,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/posts\/1236\/revisions\/1360"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/media\/1255"}],"wp:attachment":[{"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/media?parent=1236"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/categories?post=1236"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.shu.edu\/ghg\/wp-json\/wp\/v2\/tags?post=1236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}