Book launch: Mandisa Mbali’s ‘South African AIDS Activism and Global Health Politics’

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Richard BallardIn this post, we share Prof Richard Ballard’s comments on Dr Mandisa Mbali’s new book, ‘South African AIDS Activism and Global Health Politics’. Richard gave this review speech at the launch of the book in Durban last month.  In addition to providing a commentary on Mandisa’s work, Richard provides some insightful reflections on the study of social movements, which have a wider relevance in South Africa and beyond. Richard Ballard is Professor in the Department of Population Studies and Development Studies at the University of KwaZulu Natal. Mandisa Mbali  is Lecturer in the Department of Sociology and Social Anthropology at the University of. Stellenbosch.

Thanks very much for asking me to speak on this occasion. My job here this evening is an easy one because Mandisa has produced a wonderful book for us. It is impressive, firstly, because of its scope. One expects it to be a story of the Treatment Action Campaign but in fact the TAC is located within a much greater universe of doctors, scientists, gay activists, gender activists, international activists, multilateral organisations, and politicians that precede and exceed the TAC. The book represents the subject in something approaching its multifaceted entirety rather than privileging some actors’ roles.

Second is the depth of the research. Mandisa has poured through a great many newspaper articles and documents and she cites around 70 interviews. Since she is a historian, her first priority is to be empirically exacting and this gives the book an overriding sense of accuracy. But all this research has also produced the nuggets which make the story interesting. I was amused by the World Bank report which concocts a fictional African country called ‘Muzumbuka’ to refer euphemistically to a real country which couldn’t afford ARVs, or the Sunday Times article in 1993 which insisted, without any irony, that black people lacked political correctness.

Third the tremendous complexity of the subject is organized according to relatively bite-sized thematic and historical episodes which make it possible to understand the variety of parallel stories that constitute AIDS activism. Although the effect is of an elegant whole, each of these chapters could also be read on its own. The prose is clear, direct, efficient, and yet unhurried.

Fourth, her historian’s method is able to overcome the reductionism that sometimes characterizes writing on social movements. Scholars sometimes reify social movements into singular blocky forces rather than networks of real people. Activists in this story come from a variety of standpoints: gay/straight; black/white; activists in the global South and activists in the North; women/men; middle class and poor; professionals and grassroots activists. While the struggle for HIV related healthcare does provide the platform for unifying interactions between these diverse groups there are also accusations of imperialism by those in the south of those from the north, or the marginalization of women by men. Mandisa sensitively engages accusations of sexual harassment within the TAC itself.

Fifth, her historian’s method is also able to counter the idealism that saturates a great deal of writing about social movements and activism. At a conference in 2004 I heard Mark Heyward say that social movements were a figment of the left’s imagination. Given that he was a key figure in the TAC, this seems paradoxical. What he was saying of course was that he didn’t recognise himself and his organization in the kinds of descriptions he was hearing. Leftist scholars sometimes project their own political desires onto reality with the result that movements are romanticized as worthy subalterns if they accord with the scholar’s politics, or condemned as reformist if they fail to live up to the scholar’s revolutionary expectations. But solid empirical accounts of social movements such as Mandisa’s show that activists do not abstractly choose their politics as if from a menu. Social movements are often quite reactive things, taking real actions in response to the contexts around them. Ideology is retrospectively identified just as often as it is the stimulus of cause of activism in the first place.

Similarly, adversaries are also idealized in a great deal of writing on social movements:  they are generally constructed as some variation of evil neoliberals doing satan’s work on earth. Some of those who blocked progress in the progressive management of HIV are certainly hateworthy, motivated by greed, or racist, sexist and homophobic contempt of those who needed help. But blockages also originated from those who thought of themselves as progressive and anti-imperialist. Furthermore, important breakthroughs in opening the taps of international aid came not from our hero activists but from less expected quarters, such as conservative Christian Republicans. Accounts of activism that start with empirical reality are able to transcend the Manichean simplicities that keep some accounts of social movements in the realm of wishful thinking.

That said, the book is principled and driven by a clear sense of justice. Even though we all lived through the media coverage of big pharma’s greed, the development industry’s insistence that treatment was not cost effective, and the defiant contrarianism of the Mbeki presidency, these outrages still caused me to gasp in amazement and turn the page to see what happened next. It was thrilling to read again of Mandela’s visit to Zackie Achmat and his decision to pull on an HIV positive T Shirt, and of the judiciary’s various rulings in favour of treatment. And it was humbling to read of ordinary people who fought for recognition and treatment at sometimes great personal cost.

This book allows us to reflect on one of the fundamental themes that any of us can think about: namely how governments come to establish mechanisms to enable those who have little to have greater life possibilities. Since the late 1990s, Social Policy has enjoyed something of a renaissance in the Global South fuelled in no small part by the crushing effects of austerity since the early 80s. Few are going so far as to say that we are in a post-neoliberal era, most governments still look to market led growth as their vehicles of development. But alongside this enduring market faith, there has been a renewed interest in the ability of governments to put in place distributional systems that channel life sustaining flows to people on the margins. One of the major innovations is that around 45 countries in the global south have now put in place cash transfer schemes, such as the child support grant in this country and the Bolsa Familia in Brazil, which in some contexts have been shown to reduce poverty and inequality.

Struggles for mechanisms that address social ills are useful in drawing attention to the ways in which some lives seem to authorities less worth saving than others. No doubt many of the actors involved would recognize the limits of single mechanisms in confronting the profoundly complex effects of uneven development and poverty. But single mechanisms alone can make a profound difference and cannot be taken for granted once they have become normalised. As the last part of Mandisa’s book shows, the gains which have been made on HIV have been fragile indeed. As a result of recession, the Global Fund has not been receiving money pledged to it and this has thrown into doubt many treatment programmes in poorer countries. The role of civil society in bringing about and sustaining important life sustaining mechanisms is abundantly evident in this account and it is a role that is as urgent as it ever was.

Mandisa has produced a masterful book and we should all congratulate her for her wonderful achievement.

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