The majority of South Africans will be affected by this epidemic everyone in the nation is likely to know someone among their family members, friends and colleagues who is sick with the disease. Many may well lose any sense that there can ever be a world in which AIDS is defeated (Cohen 2002; Bennett 2002)

Social and political instability may increase as families and whole communities break down and people's belief in post-colonial governance systems fails (

Background of the AIDS Pandemic

Having just argued that AIDS (like other diseases) is as much a cultural and economic phenomenon as a physical one, we will nonetheless begin here with a primer on the biology of the disease. AIDS - the acronym for Acquired Immune Deficiency Syndrome, the name by which it is almost never called anymore - is a disease that destroys the ability of the human immune system to fight off invasions by the variety of microorganisms that are constantly around us. This is the basic biological basis of a disease that has usually been defined more in behavioral and moral terms in the West than in epidemiological or medical ones: The fact that most early AIDS sufferers in the West were gay men and IV drug-users had an immense effect on how the drug was characterized.

The most common means of transmission of AIDS in South Africa has been heterosexual sex (followed by mothers passing the disease to their children in utero, during birth or by nursing; nevertheless, some of the stigma that attached to the disease because of means of transmission in the West also attached to potential Western aid to African AIDS at least initially. This was certainly compounded by racist attitudes that dismissed the importance of the death of Africans (viz. Holmes 2002; Guest 2001; and Shoumatoff, 1990).

Although AIDS can vary quite dramatically from patient to patient (since the symptoms that people exhibit are due in large measure to the specific combination of opportunistic infections that that person is afflicted with), there are general physical symptoms associated with most cases, including dramatic weight loss and fatigue. Many of those with the disease suffer some form of neurological complication that is caused by damage to brain structures.

A number of specific diseases are associated with AIDS - including a number of kinds of cancer, including Kaposi's sarcoma and B-cell lymphomas. These are not present in all cases of AIDS, however, and are generally found in those who live with the disease for a longer period of time, which is more common of those suffering from AIDS in the West than in Africa.

AIDS is not causally contracted but is instead transmitted through intimate sexual contact, through infected blood and from infected mothers to their babies. In the early days of the pandemic, a major sources of transmission was contaminated blood given in transfusions; this is no longer the case in the First World.

One of the major reasons that the disease has been able to spread so dramatically is that fact that it has such a long period of dormancy: People can be infected for up to 10 years before they begin to feel sick, which gives them years to infect their sexual partners, children, or IV-drug needle sharers without knowing it ( lethalness of the long dormancy period is somewhat less evident in Africa where there tends to be a shorter period of time (than in the United States or in Europe) between infection and symptoms.

An AIDS Vaccine

There are a number of different strains of the AIDS virus (the disease that attacks people in South Africa is in fact in key ways different from the disease that infects people in the United States or in China). All viruses mutate, which is one of the reasons that viruses have proven more difficult than bacteria to treat) and AIDS mutates more quickly than many viruses. However, it remains beyond the current state of AIDS research to develop a vaccine that could be given to a population to help protect them.

A vaccine that could be administered a single time and that provided long-term protection against the virus may well be essential in a region such as South Africa in which there is not enough political stability or wealth to ensure that steady, long-term care of those sick with the disease is possible.

Such a vaccine would be particularly helpful in Africa where other remedies for the disease are less available than they are in the First World. In the First World, most of those with AIDS have access to health care once they become infected and when they become sick: This is quite often not the case in South Africa, as Olufemi (1992), Miller (1988) and McClelland (2002) argue.

That such a vaccine is not yet available arises from two sets of facts: One is the biological nature of the disease itself, which makes it difficult for doctors to create a vaccine that is effective against all the current (and future) strains of the virus. The other (and arguably secondary) reason that a vaccine has not been developed is that because the majority of medical researchers working n AIDS are located in the First World they have keyed their research (either intentionally or not) to the modes of treatment that are available to citizens in the First World.

South Africans are both at greater risk of contracting the disease than are Americans; they are also at greater risk of dying within 10 years of infection than are Americans. There are a number of reasons for this that have to do almost nothing with AIDS itself and a great deal to do with endemic political, cultural and economic conditions in Africa (Chirirmuuta 1987).

Africans are more at risk of contracting the virus than are Americans or Europeans who engage in the same high-risk (or, for that matter, low-risk) behaviors because Africans are in general less healthy than those in richer countries and because they have less access to health care (Docking 2001; Baleta 2003). With less reliable access to clean water and enough food and more likely to have other parasitical infections than those living in wealthier countries (Sidley 2002). And Africans generally have less access to medical care than do those in the West, either because of the widespread poverty in the region, because of the rural nature of much of the population, because of wars and civil unrest that prevent people from traveling to clinics and because of traditional ideas about illness (Mascie 1993; Hunt 2002; "Epidemiology" 2002).

It isn't the facts that are in dispute," says African historian Charles Geshekter of California State University at Chico, who took part in advising Mbeki prior to the panel formation. "It's the theoretical construct behind the facts. Yes, there is a measurable decline in African health and increases in African mortality. What is in dispute is whether the symptoms of such illnesses are caused by extraordinary patterns of sexual behavior or whether the signs reflect the deterioration of life on the continent over the past 20 years. The breakdown and decline of public health and medical treatment across Africa is due largely if not entirely to domestic civil war, impossible levels of indebtedness and sharp declines in the prices paid for commodities produced by Africans. This is standard World Bank and IMF micro- and macro-analysis. Where's the mystery?"

Alternative" AIDS Theories

While AIDS exports world-wide agree with Geshekter that these are indeed the factors that have contributed to the spread of AIDS in Africa and to the difficulties of treating the disease in South Africa. However there are alternative models of the disease that have come out of Africa itself. These models, which question whether there is in fact any causative link between the presence of HIV in a person's body and that person's having AIDS, are dismissed by the reputable scientific community. However, they clearly have an important cultural validity to them; it is striking that similar anti-HIV models circulated in the United States amongst some gay activist groups.

Traditional explanations of disease, such as witchcraft, also inform such questioning of established biomedical models.

Both South Africans and gay American men are socially marginalized (within the context of the hierarchy of the world system). Socially disenfranchised groups (and especially socially stigmatized groups, a characterization that is more true of gay men than of black South Africans, but is still true of both) are often targeted by those in power. This reality of human society has tended in many cases to make those out of power suspicious of the conventional explanations for events that adversely affect those minority populations (Spitzer 1993).

This is no doubt one of the reasons behind (for example) South African President Thabo Mbeki's very public questioning of whether HIV does in fact cause AIDS (Baleta 2002a, Baleta 2002b; Baleta 2002c). In some ways his questioning made sense given…