Tuesday, July 10, 2012

Book Review: Nicoli Nattrass: The AIDS Conspiracy. Science Fights Back

Nicoli Nattrass- The AIDS Conspiracy – Science fights back, Wits University Press, Johannesburg, 2012, 224pp

I left the world of HIV/Aids way back in 1995. Way back then. People with HIV/Aids were few and far between. I was working in a project in Kwazulu-Natal which was largely engaged in Aids education and prevention strategies amongst a very broad range of people, but aimed primarily at young people. Way back then, use of the word “condom” was daring. The young Aids educators we were training would drop their eyes in a charmingly embarrassed way and squirm when we taught them how to speak about sex in rural communities. Demonstrating how to put on a condom, using a life-sized (albeit generous) dildo would routinely send adults fleeing from the room and sometimes generate letters of outrage and complaint to the Witness.

It was a time of relative innocence, I suppose. And a time of rampant infection, because of it. To get taken back into that time in Nicoli Natrass’s book was a bit like watching a movie on a period before the advent of cellphones. You wonder at the strangeness of it all.

The book is about AIDS conspiracy theorists. About who they are and the environment they work within. It is about the strange ideas of the kind of belief-system they peddle and about the damage they inflict. It is a harrowing and disturbing tale. For myself, I could not but help draw personal parallels within the work environments I have found myself working in. Take the church, for instance, where I began my working career. There, one learns very quickly, what is orthodox and what is not. And it really all depends on which side of the divide one positions oneself, but the other is consistently demonised. That is the way these things operate. That is certainly the way faith operates. Because faith is “what I believe”.

Natrass begins by examining what she calls the “Conspiratorial Move” - the range of conspiracy theories about HIV/Aids – from it being manufactured as part of an arsenal of biological warfare, to theories which assert that it does not exist at all, and that it is actually caused by anti-retrovirals. All of these conjectures are fundamentally aimed against the science of HIV and purport to expose the scientific community either as venal or as duped by pharmaceutical companies in a grand and elaborate plot to sell more of their toxic wares to a vulnerable and easily fooled public. The effect of this mistrust of the science is utterly devastating, with evidence of a corresponding rise in risky behaviour, a decrease in consumption of anti-retrovirals and a lowering in testing for HIV.

“What does AIDS stand for?” I would routinely ask the hundreds of black youth in remote rural areas, as part of my job as an Aids educator in the mid 1990’s. They would scoff at me. They would click their tongues. They would dismiss any notion that the thing I was talking about could be in any way serious. “American Ideas to Discourage Sex”, one of them would chime, inevitably. “Yes! American Ideas to Discourage Sex!” they would all respond. It was a plot. It was a white idea to stop blacks having children – that was the form of the denialism in the beginning. Because of the fact that in South Africa, the earliest people infected with the virus were members of the homosexual community – and most of those willing to disclose this in public were, initially, white – the denialist theory that HIV was some kind of plot to get rid of black people did not have the same kind of credence here which it had (as a comparative conspiracy theory) in the United States.

In South Africa, the earlier genocidal theory was hatched in the 1980’s where apparently Israeli and South African scientists had together managed to create the virus. This “ecotype” of the theory gained some credence, particularly as more information became available of the experimental biological warfare waged by the infamous “’Dr Death” – Wouter Basson. It was not a difficult leap, from the nihilist designs of the apartheid state, its cosy relations with Israel and America – where there was absolute proof of mal-intent in the famous Tuskagee Study, where black patients infected with Syphilis were left completely untreated in order for scientists to follow the full life-span of the disease. It was a horrific ‘’study” which meant that black African Americans would seriously doubt the good intentions of white scientists, for a very long time, if not forever.

The connection, for some powerful black South Africans was part of a cocktail of beliefs, mistrusts and prejudices which went towards creating the unforgivable tragedy of the President of the country (Thabo Mbeki) and his Health Minister, (Manto Tshabalala-Msimang), denying infected people (mostly poor and mostly black) the advantages of antiretroviral drug therapies. It worked together, because they were both, in some ways, extremely damaged people. And the reasons for their damage could well have been because of what they had experienced through apartheid and racism in general. But, whatever the cause, the consequences were tragic in the extreme – with some 300 000 people dying unnecessarily, just as surely as if one had taken a gun and shot it at their heads.

Now, I remember Manto Tshabalala-Msimang very well. I worked with her in the same primary health care organisation I spoke about earlier (she wasn’t working in the AIDS section, though). I remember her, on her return to the country as ambitious, greedy, bullying, and immovable when she got a particular idea in her head. Her medical qualifications, from Bulgaria, were frequently the butt of jokes. She was certainly a damaged person. She was paranoid and suspicious. Arrogant in the extreme.

Natrass preceeds the chapter on the South African tragedy with a look at what she calls instances of poor community leadership and the devastating effects which that has on the community in which it is displayed. She highlights an instance within the African-American context where leadership was both entirely captivated by the idea of conspiracy and at the same time exploitative of it. “Nation of Islam” leader Louis Farrakhan simultaneously advocated scepticism regarding the accepted treatments of HIV/Aids, while also promoting a supposed “African” cure for the disease. The reason why the quack cure promoted by Farrakhan a product cammed “Kemron”, received such overwhelming uptake from the African-American community, was because of a resonance from within a particular social and cultural position of “primary marginalisation” caused by the array of disadvantage which that group suffered under and experiencing on a day to day basis. But by both mobilising against medical science on the one hand, and then aggressively promoting a quack remedy in its place, Farrakhan contributed significantly towards the “secondary marginalisation” of the same group.

A similar trajectory took place in the South African context. In an extraordinary and frightening reminder of the madness of it all, Nattrass gives us some detail on the way in which Mbeki appeared simply incapable of accepting the science of HIV. When Mbeki succeeded Mandela as President in 1999, almost one in five South Africans were already infected with the disease. (It needs to be mentioned, because Natrass appears not to in any detail, that the Mandela government was also fairly lily-livered about dealing with the disease. I know this from my own experience, where extremely successful and viable projects, such as the Progressive Primary Healthcare Network AIDS programme – with community roots in significant numbers of communities, was shut down for reasons which I could only identify as the need for the new government to brook no rivals, as far as Health delivery was concerned.

But the Mbeki government was something else entirely. A cabinet member at the time described it to me as being similar to the President having some kind of “gogga” in his head, which wouldn’t allow him to see reason. Instead of basing government policy on scientific consensus on the issue, Mbeki deliberately chose to take seriously – more than that, he chose to elevate – the views of “dissidents” within the scope of HIV/Aids analysis. The belief of these “dissidents” ranged from the belief that antiretrovirals were toxic, to beliefs that HIV and Aids did not exist at all. So mad were some of these people that they would even allow their own children to suffer and die from the disease, when treatments were readily available.
Mbeki convened an Aids Advisory panel, consisting of half the members from within the scientific community and the other half from this “dissident” community. Manto Tshabalala-Msimang went further, to reject credible and scientifically based reports from the medicines Control Council, that antireterovirals were safe and effective – and described them instead as “poison”.

Nattrass has helpfully identified four types of Aids denialist in this book. Firstly, what she calls the “hero scientist” – those who, because of science in their background, lend a sense of scientific credibility to the dissident movement. These individuals, as I said, have science in their background. It is not necessarily appropriate science. Secondly, she identifies the “cultropreneur” – therapists who operate in that nether world of “alternative healing”. These are they who actively exploit the conspiracy as a serious market opportunity. Then there are the “living icons” – people who claim to be living proof of the legitimacy of Aids denialism. And lastly, there is the “praise-singer”. These are journalists who promote the message of the Aids denialists to the public.

Mbeki and Tshabalala-Msimang employed the full suite while in power. From hero scientists such as Peter Duesberg, a virologist who believes that while HIV does exist, it is nonetheless harmless. Others, such as Eleni Papadopulos-Eleopulos, a medical technician, who does not believe that HIV exists at all – despite a fully described genome to the contrary. And again, because of my particular background, I could not but see the “religio-cultural” similarities between what Nattrass was describing and the way in which Aids denialism appears to operate (indeed she explores this herself). Essentially, it becomes a kind of “faith” and it operates in the same way. It has its high priests. It has its preachers and witnesses. It has its orthodoxy. And in the end, it has a very economic root for its sustenance.

The danger, of course, is when the scientists start behaving in exactly the same way – pitting scoff against scoff and dismissal against dismissal. The danger is arrogance – and that, beyond everything else, was Mbeki’s Achilles heel.

I will not spoil the centrepiece of the book for you, where Nattrass explores the psycho-social, historical and scientific environment in which the Mbeki/Tshabalala- Msimang duo (together with a largely silent cabinet and government structures) preached their Gospel of garlic and beetroot cures. Suffice to say, there were elements of the gospel they preached which were obvious and undoubtedly true. HIV and Aids does thrive in poorer environments. It does thrive where nutrition is poor. It does thrive where facilities and hygiene are inadequate. But it is one thing to say that and quite another altogether to find a causal relationship between the two. The assertions are undoubtedly true. You can’t effectively deal with HIV and Aids if you don’t also deal with the conditions in which it thrives. But the madness is to then feel so emboldened as to claim that therefore the drugs used to combat it are toxic and should be avoided.

Nattrass explores the entire and extraordinary enigma of Mbeki’s questioning of the science. Was it because this formed part of a political struggle which was being waged with civil society? Was it because he saw the environment as fatally corrupted by industrial interests? Was it because of his anticolonial, Africanist ideology? Was it sheer narcissism? What was it that caused him to take the kind of stand he did – even when it threatened his own political existence?

The religious, messianic theme is explored fully. Because, says Nattrass, “AIDS denialism is not simply about intellectual beliefs, it is about identity”. And more than that even, it is not simply intellectual conversion, it is about group adherence. And it is this group identity which Nattrass examines so fully and so well. There are the common features of any religious sect, those of the insiders and the outsiders; the elect few speaking truth to power; pushing the boundaries of knowledge and received doctrine. Aids denialism is, according to one analyst, a “kind of cult” replete with its own sense of persecution, spiritual enlightenment and even mystical powers. It starts to function like many bogus religious sects – to the extent of simply not admitting, for instance, that one of its foremost “living icons” had died, when she did, on her web page.

To end, she argues, (readably, I am glad to say) for the primacy of the scientific method. For rigourous peer review. For evidence based medicine. For “Health” rather than the paradigm slide into “Wellness”. The HIV/Aids terrain is contested territory. It remains true that there are reasons for public suspicion and many of these reasons are based on the belief that profit is the motive for the production of drugs. The battle is often extremely fierce, but there really can be no capitulation, because the consequences are so extreme.

“Defending science”, she says, “is a quintessentially enlightenment project”. One of the most contested terrains for this project, remains the Internet. The challenge for pro-science advocacy work there, is to ensure an abiding and credible presence within that space.

The AIDS conspiracy: Science fights back is a readable and, in places, utterly riveting study of the confluences which occur between the rational and the irrational; the rigourous and the half-baked; the lunatic fringe and the scientific establishment. It will be fascinating to anyone who has a need to understand the world in which we live. But if you don’t have that need – if you find yourself more comfortable in a world of rumour and conspiracy, you would probably be too arrogant to engage with the science of HIV, in the first place.

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