In an exceedingly provocative piece, Pablo looks at the politics of AIDS, covering the number game and the political agenda. Dr. Pablo Idahosa is a professor in the Division of Social Science, York University, where he also direct the African Studies Programme. He teaches African and development Studies. Author of the Populist Dimension to African Political Thought, Co-editor of Development Displacements, he has written variously on development ethics, African popular culture, ethnicity, and he is co-writing a book on African modernities.
I said that I would put in a modest proposal after the break. However, what with the outbreak, if you pardon the pun, of the latest scandal and furor, for there have been many, about the bogus, toxic nevirapine trials for/on pregnant, supposedly HIV-positive women in Uganda, I have decided to propose something. However, to start with, the piece No. 164 is in fact over a year old, but it's a part of a huge literature, some popular like this piece, and others very, very technical, often known as the dissident literature on HIV and AIDS. This literature first came to prominence, or infamy, depending on how you view things, back in 2000 when Mbeki invited a number of them to the Durban AIDS conference. Although I never made it to Durban that year, I am one of those dissents, and have been for nearly fifteen years now. The literature is intimidating, and for most people a plenty long way from what they know-- or at least think they do. Even for people with a medical background, it demands some understanding of microbiology, nuclear medicine, and of course virology and epidemiology, pharmacology and toxicology-- not to say, one also needs some more than elementary understanding of statistics and demography and gender. By its nature, discussions of HIV and AIDS are multidisciplinary, and should be inter-disciplinary, but often is not, because of the multiple, and complex demands of social science and medical sciences. This is one of the reasons that many people are bamboozled by it all. Try getting past a few sentences in an academic journal dealing with AIDS, and you will see what I mean, especially after your eyes glaze over. This turning way from the difficulties, however, lends itself to becoming a latest axis upon which western domination of local sciences is linked to development prescriptions from outside, and is one of the foundations of one of my two skeletal proposals below.
Let me begin, however, with my own self-admonition and admission. I first got into this nearly ten years ago when teaching one of my development classes about culture and development, and about population change in relation to so-called "traditional" family structures-- an embedded assumption of many students-- and of course AIDS came up. The usual suspects were arrayed: the sexual practices of African men, their controlling impositions upon women, and their irresponsible surrogate polygamy (multiple sexual partners); their serial migrancy as truck drivers, miners etc.; and the inevitability of not just infection by prostitution, but the returning infection to individual or multiple partners at home. At this time, of course, most of the corridor of death was confined to east and central Africa, and by then we all knew of some high profile person/s who had died of the disease, the most famous perhaps being the great Congolese guitarist, Franco. Later would come, among others, Kaunda's son and Fela, of course.
I decided to set the students, or those for a presentation, with an easy simulation The available data, such as it was, could be found via WHO and the fledgling UNAIDS, while UNDP's HDR and the World Bank Development Report would provide the broader social and economic indices. Most of the other information was, to say the least episodic and impressionistic, but it was all we had, and as Nigerians might say, as I wasn't there, what would I know. People were dying; that much was indubitably true, and it was of the ravages of AIDS, or so we were being told by those who were telling us-- many of them NGOs from the West, and those collecting and controlling the data.
Two remediations at this stage were thought of. One was behavior modification, sexual practices had to be changed-- most especially condom use-- and the other was that also a magic bullet had to be found; one that Africans could take and which could be distributed cheaply. Along came Nevirapine (viraimune) which was thought to be less toxic, and ultimately cheaper than the AIDS cocktail AZT, and would at least, stall the transmission of pregnant mother to infant infection of HIV. Who could be against that? In any event, I asked my students to engage in a simulation, which crudely went as follows. If the population growth remains constant, and population change is at x growth per year, with the incidence of death from yAIDS what would the population of Uganda be in four years time, assuming no change in the incidence of AIDS? Now, without going into multiple other variables that one could have added to the simulation to make it more complex and more "real", but which I did not believe possible in the absence of an anthropology or family studies, or understandings or projections about fertility--e.g.. total fertility, vs. rate medium-variant fertility rates/maternal mortality ratios. etc.-- that we know what we would be asked for in a more serious exercise. But no matter; it was a simple student exercise. The fact is that the figure they came up with as of 1990 for 2000 would be a population of Uganda that would be just under 1/3 of what Uganda's population was in 1985! Yet, all evidence pointed to the fact that it had been growing at an average rate of 2.5 percent per annum, increasing from 12.6 million people in 1985 to 22.2 million in 2000 (and is now, by the way, 23.4 million by the end of 2002, and is projected to be at 39.4 million in ten years from now in 2015). I was both alarmed and perplexed by all of this. Could one do similar simulations with other countries? Indeed we did, and we came up with similar numbers for other AIDS countries-- Tanzania and Congo, for example). it would be interesting to do the same for Southern Africa, the current epicentre of AIDS.
Subsequently, of course, the revised figures for Uganda would be put down to good education and sound sexual practices; that Museveni had realized with realist prescience what other reluctant, in denial leaders elsewhere in Africa would not That this all coincided with SAPS and stabilization, and that Uganda became a golden boy of swallowing bitter pills of non-ideological market forces, seemed not to matter. If so much did add up, other things did not. My response set off a whole set of other questions. These questions were sharpened upon reading a piece by Charles Geshekter (then a professor of economic history at Cal State, and a specialist on Somali history), in Transitions, and which was met by deafening silence by our academic colleagues). There were additional and numerous other coincidental and circumstantial evidence around data gathering (too many neat figures), definitions of HIV and AIDS, a series of errors of simple statistical computing (incidence verses prevalence, compound rates, etc.), along with my visceral reactions to putative African male sexual practices being screamed about by zealous missionaries of epidemiological humanitarian interventionism with as much medical training as myself. All of this made me stop, balk, and ask a few questions. These questions, and the answers, can wait for another time. Suffice it is to say, that I did not believe the figures about mortality rates bandied around; I did not believe that the awful toxicity of the drugs that were being used on people with poor nutritional quotients would prove useful; and I was angry that Africa would be used as a laboratory for testing the efficacy of drugs that had barely been approved in the West as dangerous, and, as it turns, out were useless.
There are so many issues here: evidentiary, ethical, economic and political, not to say developmental. That a country like Uganda, which became the beachhead of legitimacy for the South African trials (and which, contrary to the slavish propaganda, have not had the success rates claimed) should be the impoverished guinea pig and site of these cover ups, speaks volumes about the impotence of African Social science and Science to speak for and act for itself and for those in need.
More to the point, it shows what powerful sectors, institutions and individuals can do when they want something, irrespective of the well being of those whom they speak on behalf of. It's a miserable metaphor for Africa's multiple dependencies and supplication before powers who distribute dangerous nostrums, as well as dangerous drugs, and whose ultimate concern is with profit not the well being of Africans.
So here's the proposal. While I would prefer African states distribute welfare, they cannot or will not. Let's put our money where our books and articles do not go: to help people in need. Why do we have to rely upon the multitude of sometimes well-meaning, but often instrumental organizations, the multitude of modern missionaries and multilateral banks and producers of knowledge? At my university we are asked to contribute a small amount of our income, which gets taken out of our salary at the end of each month (it's like a dental plan; and, yes, for those who like these things, it's tax deductible) for scholarships to needy students coming to the University. Could there not be some such fund for all of those who are doing work on health and diseases, but that is dedicated to non-attached researchers and people in the continent who are not beholden to drug companies, who are not under the sway of privatizing medicine and not under the duress of so much poverty to take anything that comes there way?
If the devil is in the details, I will ask that others become her/his advocate, and that we at the very least begin the process of establishing a medium and an institution through which this can become a reality. Yes, its idealistic, but I'm tired of others thwarting my own idealism through the paternalistic cynicism of manipulation.