The Rhetoric of AIDS Policy in South Africa by Marcus Paroske B.A. in Political Science and Philosophy, Regis University 1997 M.A. in Speech Communication, Colorado State University 1999 M.A. in Philosophy, University of Pittsburgh 2005 Submitted to the Graduate Faculty of Arts and Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2006 UNIVERSITY OF PITTSBURGH FACULTY OF ARTS AND SCIENCES This dissertation was presented by Marcus Paroske It was defended on December 9, 2005 and approved by Lester Olson, PhD, Professor Gordon Mitchell, PhD, Associate Professor Lisa S. Parker, PhD, Associate Professor Dissertation Director: John Lyne, PhD, Professor ii Copyright by Marcus Paroske 2006 iii The Rhetoric of AIDS Policy in South Africa Marcus Paroske, PhD University of Pittsburgh, 2005 This dissertation examines the rhetorical dynamics of South African AIDS policy under President Thabo Mbeki. From 1999-2004, Mbeki bucked global consensus surrounding the etiology and treatment of AIDS and prohibited government distribution of anti-retroviral drug treatments. In defense of these policies, the President offered scientific arguments founded on the theories of Western “AIDS dissenters.” He also made the case that South Africa’s unique experiences under apartheid demanded a strong tolerance of dissent and debate. The international condemnation of these views was striking. Over the course of the controversy, rhetoric played a central role in shaping the views of both sides. Advocates marshaled public arguments in response to the exigencies of the controversy. Contextual constraints also forced the rhetors to adapt their messages. Each chapter of this dissertation examines a different rhetorical element of the controversy. They include the cultural context of South Africa’s transition to democracy, the development of AIDS dissent in the Mbeki administration, the early development of AIDS dissent in the West, the technical clash of scientific arguments in Mbeki’s Presidential AIDS Advisory Panel, and indigenous social movement resistance to the government’s policies. iv TABLE OF CONTENTS PREFACE …………………………………….…………………………………….viii 1.0 CHAPTER ONE …………………………………………………………..……..1 1.1 JUSTIFICATION FOR THE STUDY …………………….……..………3 1.2 HISTORY OF THE CONTROVERSY …………………………...……..7 1.3 REVIEW OF THE LITERATURE ……………………………….……..9 1.4 DISSERTATION PREVIEW ……………………..……………………11 1.5 CRITICAL PERSPECTIVE …………………….….…………...….…..13 1.5.1 Post-Colonialism ……………………….….…………...……..13 1.5.2 Afrocentrism ……………………………….……..…….…….15 1.5.3 Rhetoric of Science ……………………….………...…….…..17 1.6 THEORIZING THE CONTEXT …………………...……………….….19 1.6.1 Post-Apartheid South Africa ………………..……….….…….19 1.6.2 The Impact of an Epidemic ………………….…………..……22 1.6.3 Mbeki’s Background ………………………….………..……..25 2.0 CHAPTER TWO …………………………………………….………….……...33 2.1 THE QUICK FIX OF VIRODENE …………………………….………36 2.2 MBEKI AS DEFENDER OF AIDS DRUGS ………………….……….39 2.3 THE TRIPS CONTROVERSY ……………………………….….……..42 2.4 AIDS DISSENT COMES TO SOUTH AFRICA …………….………...46 v 2.5 MBEKI THE DISSIDENT ………………………………...…………….51 2.6 THE LETTER ……………………………………………...…………….53 2.7 THE LETTER’S RECEPTION ………………….………..……………..60 2.8 ANALYSIS OF THE LETTER ………………….....……..……………..62 2.9 THE REJOINDERS ……………………...……..….…….………………68 2.10 THE DURBAN CONFERENCE ………...…..…………….…………..73 3.0 CHAPTER THREE ………………………………..………………….…………77 3.1 THE SCIENCE OF AIDS DISSENT ………..…………….…………….79 3.1.1 The Advocates ………………………..………….…………….79 3.1.2 Virology ……………………………..…………….…………...81 3.1.3 Anti-Retroviral Drugs ……………......…………….…………..83 3.1.4 Epidemiology ………………………..…………..……………..84 3.1.5 HIV Testing …………………………..…………..…………….86 3.2 AIDS DISSENT GOES PUBLIC ………………...……….……………..88 3.3 THE DUESBERG PHENOMENON ………….…..……..………………90 3.4 CHRISTINE MAGGIORE …………………….…..………..……………94 3.5 THE CULTURE OF AN EPIDEMIC …………….……………………..100 3.6 THE SCIENCE POLICY FORUM DEBATE …….…………………….106 4.0 CHAPTER FOUR ………………………………………….……………………116 4.1 THE PRESIDENTIAL AIDS ADVISORY PANEL .………...…………117 4.2 THE RHETORIC OF SCIENCE POLICY ………….…………………..125 4.3 THE SCIENCE OF THE REPORT ……………………………………..129 4.3.1 Etiology …………………………………….………………….129 vi 4.3.2 Epidemiology ………………………………………………….135 4.3.3 Policy Prescriptions …………………………………………...140 4.4 RHETORIC IN THE PANEL’S DELIBERATIONS …………………..143 4.4.1 Ethics of Uncertainty ………………………………………….143 4.4.2 Political Standards of Proof …………………………………..146 4.5 CONCLUSION OF THE REPORT ………………….…………………153 5.0 CHAPTER FIVE ………………………………………………….…………….156 5.1 STUDYING SOCIAL MOVEMENTS …………………………………157 5.2 THE TREATMENT ACTION CAMPAIGN …………………………..159 5.3 MORALITY AND ACCESS TO AIDS DRUGS ……………………....161 5.4 DEMOCRATIZATION AND THE POLITICAL PROCESS ……….....166 5.5 RISK ……………………………………………………………………..171 5.6 THE TAC TAKES MBEKI TO COURT ……………………………….173 5.7 MBEKI RECANTS ……………………………………………………...180 5.8 POSTSCRIPT: NEVIRAPINE AND THE NIH ………………………...185 6.0 CHAPTER SIX ……………………………………………………………….....191 6.1 DISSERTATION REVIEW ……………………………………………..191 6.2 ASSESSING THE RHETORIC OF BOTH SIDES ……………………..196 6.3 THE DISSERTATION WITHIN THE RHETORIC OF SCIENCE …....199 6.4 INTERCULTURAL RHETORIC OF SCIENCE ………………………..203 6.5 CALL FOR FURTHER CASE STUDIES ……………………………….205 APPENDIX. THABO MBEKI’S LETTER TO WORLD LEADERS ………………210 BIBLIOGRAPHY ……………………………………………………………………214 vii PREFACE I would like to recognize the many individuals who have helped this project come to fruition. The arguments developed here were forged in numerous conversations with colleagues and mentors throughout my education. Rather than risk omissions, I will thank collectively the students from the 11th floor of the Cathedral of Learning for years of comments. In particular, though, I am indebted to Omri Ceren and Eli Brennan for their long hours of dialogue about my work. Lisa Keranen has been both mentor and cherished friend. Ron von Burg and Alessandra Beasley have been not just my most frequent sounding boards over the years, but my best friends as well. Faculty at the University of Pittsburgh have also been instrumental in this work and my education overall. Jonathan Sterne and Henry Krips have helped hone my craft through several seminars. Gordon Mitchell has provided scholarly opportunities and encouragement that were instrumental in my development. Lisa Parker has selflessly gone beyond the call of duty as outside member, especially in the preparation of this document. John Lyne has been an intellectual example throughout my entire academic career. His stewardship as advisor of this project has helped tremendously. One typically saves the most important acknowledgement for last. No exception here. Michelle Silva has added more to my life than anyone or anything else. Everything I will ever accomplish is dedicated to her. viii 1.0 CHAPTER ONE One of the most powerful stories of freedom in history unfolded during the waning years of the twentieth century. South Africa, long the symbol of colonial oppression, had shed the manacles of apartheid after decades of struggle. From the inevitability of repression under minority rule, the county began its transition into an uncertain new life. While the moral legitimacy of the new regime was assured by the presence of Nelson Mandela at its helm, the policy challenges that would face the fledgling democracy were daunting. As it so happened, a plague lay dormant, known only to a prescient few. The Acquired Immunodeficiency Syndrome (AIDS) would strike South Africa, most cruelly, right after the moment of its greatest triumph. And AIDS itself was also an enigma. The science of the disease, retrovirology, was new and uncertain. Important scientific factors such as the disease’s etiology, methods of transmission and treatment were speculative. A debate in the Western world about AIDS that had been quietly, occasionally raucously, taking place challenged the entire received view of the disease. Nevertheless, the Western world had come to the conclusion that the science of AIDS was certain enough to justify aggressive health policies to fight the disease. But a handful of dissenters remained, and their texts proliferated on the Internet. Even with all of the disagreement about AIDS, at least one thing was incontrovertible. Something was killing hundreds of thousands of Africans, South Africans most especially, and all signs pointed toward pandemic death tolls in the coming decades on the continent. 1 In 1999, one further enigmatic element was added to the puzzle. Replacing South Africa’s beloved Mandela as President was Thabo Mbeki. His credentials as a freedom fighter were uncontested, but his skills as a policy maker were not generally known. Questions about his leadership style quickly transformed into derision when, several months after his inauguration, President Mbeki shocked the world by embracing the seemingly discredited AIDS dissenters and refusing to distribute anti-retroviral (ARV) drugs to his people. Transitioning from apartheid to multi-racial democracy, invaded by a deadly disease that little was know about, and ruled by a man who by all accounts was intelligent and capable and yet held a view on AIDS that seemed preposterous to most, South Africa and its health policy faced an uncertain future. And from uncertainty rhetoric is born. The several years following Mbeki’s controversial articulation of AIDS dissent saw a number of important instances of scientific rhetoric emerge. Criticisms of the President from leading scientists, the use of science by social movements