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This resource is hosted by the Nelson Mandela Foundation, but was compiled and authored by Padraig O’Malley. It is the product of almost two decades of research and includes analyses, chronologies, historical documents, and interviews from the apartheid and post-apartheid eras.

08 Sep 2000: Makgoba, William Malegapuru

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MWM. Is it a chapter of a book?

POM. I've now done 18,000 hours of interviews since 1989 and just if I ran it off to see how many pages, it would be a quarter of a million pages so I've a real problem. I'm in fact now doing two books. I owe the publisher one and that will be about  a 700 page book and then for the second one I will take all the interviews with all the people and either by person or by year, the University Press will publish them, maybe two volumes a year over five years.

. Naturally one of the issues that it would be impossible not to become involved in is the whole AIDS issue. Frankly I am astonished. I talk to government ministers and we have these tortological discussions about what's the priority, there are many priorities, it's one of many challenges, whereas I am saying if you look at the figures you're not going to have a country in 15 years. I found more expression I was at the conference on racism last week - more of a spirit of we must tackle this, we must do something about it, than I have when I've talked to anybody about AIDS. Why? Why isn't AIDS prioritised as the problem facing the country that demands massive mobilisation of resources and that in comparison to it all other problems pale? I'm not saying they should be ignored but unless you get on top of this one, the freedom everybody fought for, there will be nobody around to enjoy it.

MWM. I  think there's massive denial, there is denial in the country and this denial I think has characterised Africa, has characterised, I think, the response to AIDS in Africa. When it first arrived in Uganda it was first denied. When it first arrived in Zimbabwe it was first denied and in Zambia it was first denied. Everybody has always thought that it is my neighbour's problem, not my problem, and I think it has hit SA at that level where I think there is just general denial of the problem at the highest levels and I think that is hampering the response. They are trying to find all kinds of excuses as to why it is not a problem rather than it is a problem.

POM. From the medical community, the medical community I assume would say let's stop just debating about whether HIV and AIDS are theorising, intellectualising about it - we have a problem, this thing kills.

MWM. I think the medical profession has gone beyond the intellectual debates about the virus and its cause to AIDS. What we have to accept is that whether we call it a monkey or a baboon or a tree it is giving us problems. We see it as a problem that we have to deal with and deal with it in a focused and massive way but I don't think that the political leadership in the country recognises that. They recognise it at a superficial level, not at a deeper level. As I say the deeper level is associated with all kinds of mechanisms of denial that you can find.

POM. I suppose that's what I don't I hear you but I don't understand why if one laid out the data and said to the government, to the President, these are the facts, this is how it's going to look in ten years time.

MWM. Because they refuse the facts. Part of denial is to refuse the facts, just like there are people who don't believe that there is a virus or the virus causes a disease because they refuse to see the facts. You can show them the facts but they refuse them, just like there are some people who still believe that the earth is flat. It doesn't matter what facts you show them they refuse to see them. If they look at them they will piece them in one way or another such that it alleviates the reality of having to confront the epidemic.

POM. What do you think, for example, about the whole question of the provision of anti-retroviral drugs to pregnant women? The drug companies have come out and said they will supply free medicine for five years.

MWM. It doesn't matter. If somebody denies that there is a virus that causes a disease why should you then prescribe anti-retrovirals? It's a contradiction, so the best way is to simply deny it and find an escape route and say, well it's because of the toxicity. There are many toxic drugs that were used in the medical profession to treat various leukemias, various lymphomas, various cancers but nobody ever argues about their toxicity because you think you are improving the quality of the life of an individual without which, if they don't have the drug, the quality of that person's life is even worse. Nobody is saying that all these anti-retrovirals are just good things like aspirins that you can take and be hurrah about them. We know that as the medical profession but the tradition of this profession is to improve on that, is to monitor things, is to be honest when there are side effects and report them, is to gather information so that you can improve from where you are. But here the information that is gathered is used as an excuse not to engage the treatment. Then you have to deal with dying babies, you have to deal with looking after orphans, it's even much more costly. As I say that is part of a denial syndrome. It takes all kinds of forms, either you distort the facts, you refuse them, you don't want to see them or you request another commission to look into them because you don't want to actually take an action and deal with it.

POM. Would there be any analogy in terms of denial, say, with whites during apartheid?

MWM. Well whites are denying today that they are racist. It is the same kind of thing.

POM. They never heard of

MWM. We never heard of it, we never voted for them, I never liked apartheid. I've got my brother-in-law who is black and all kinds of things but to face the fact that you actually grew up in a racially dominated society that socialised you that way. The denial mechanism, as I say, either the definition is wrong or the facts are not right and you find all kinds of mechanisms to do anything but face the fact that, yes, I think you may be racist.

POM. I talked last week with Pallo Jordan, in fact it was during the Racism Conference, but we got onto talking of policy on AIDS. He said that within the government there were two blocks, there were those who would say we should deal with it on an incremental kind of a way, and those who think you ought to go full bang, and that those who wanted to nudge ahead were in the majority at the moment.

MWM. I'm not privy to that kind of discussion but what you are experiencing being the end user is that really I think the vacillation and the mixed messages are not helpful in trying to deal with the massive problem that we have.

POM. Aren't there massive moral considerations here?

MWM. I think morality is not one of the strengths of the South African society. Morality? If you look at this society it is not one of its strengths. It's an amoral society this. They may see the moral consequences but if they are not moral themselves how do they deal with it?

POM. I thought that was one of the things I mean you'd see the ANC conference and immediately after the

MWM. Well I'm talking about South African society on the whole. It doesn't really have very strong morals.

POM. But they talk about building a new man, new values, new leadership, new this, new that.

MWM. Have they shown you one of them that they've built already?

POM. No.

MWM. So I just know this may be an imaginary man.

POM. What is the importance of taboo in this?

MWM. Taboo in simple English is part of denial. If something is tabooed for too long, it's not spoken about because it's taboo I think it reinforces denial mechanisms. There is really not too much taboo except that I suppose South African society is both simple and complex. I think the complexity of the AIDS epidemic is that as it happens it affects the majority of SA people who happen to be black, who happen to have fought for the struggle and with all the racial connotations that come with this whole thing it gets back again to the issue of race. So there are these kinds of complexities that are in the past. Also you must remember something else that may not be very clear, that the increase in the incidence of HIV in SA also parallels the unbanning of the ANC. If you look at the figures before we had the return of the exiles in SA when it was isolated from the rest of the world, the incidence of HIV here in 1990 was I think .74%. It has increased almost twenty-fold. It was that low. Some people would argue that that increase parallels the ANC's return because most people who were in exile lived in these African countries where the epidemic was already rife so when they came back and people were excited about having their brothers and sisters back either as girlfriends and boyfriends and the whole thing was seeding itself in the process. There is part of it that has got a certain taste in relation to the liberation struggle. There are many factors that may be playing around in relation to this whole denial syndrome. So it's a question of race, a question of the liberation struggle, it's a question of the fact that it's black people in the country and the stigmatisation that goes with that. There are many factors that may be playing to produce this almost un-understandable level of denial.

POM. I thought it odd being at the AIDS conference for one week that the only silence that wasn't broken was the silence around race. It never figured.

MWM. Where? AIDS?

POM. In Durban, race and HIV, they never came up. At the Racism Conference I won't say they never came up but HIV and

MWM. They are seen as separate issues, yes. But actually I think there can be a connection if you look slightly deeper and be more analytical about it. I think there is an element in this country that if you look at the figures you will find that it's black people and in SA once one race becomes involved it's much easier to have a race label come very easily and it becomes stigmatised in a very different way that is also racial and so forth. But as you say it may be that some people are trying to inhibit that, I don't  really know.

POM. What would you see as the way forward? I'm sure you have given advice to many panels, experts, government agencies and whatever.

MWM. My view is that AIDS is a major problem in SA. It is the greatest threat to the African Renaissance because it may not be there, it may not be the Africa that we think we fought for and we want to live in. I think the sooner we accept simpler theories that have proven, that have got experimental data to prove them, the better we are to deal with this epidemic and also there's no need to reinvent the wheel. We just need to look at how Britain, how Uganda, how the Ivory Coast, how Thailand dealt with this epidemic. The solution is not something that is extra-terrestrial and outside the ability of mankind to grasp. It's a highly preventable disease but I think if there is enough commitment, enough focus it should be easy to reduce the current burden of the disease in any country. But you have to speak with clarity, with one voice and commit your resources to it. You can't on the one hand say something and then at another place say something very different. Political leadership in Africa is very important because politicians are the salvation of African oppression and African discrimination. So when you are a politician you occupy a much more important position than a scientist and so if you have the right political message I think it becomes very important. At the moment in SA we don't have that. The politicians are fighting each other and the population is exposed to this mixed signalling and that just reinforces denial.

. There has to be a general acceptance of the epidemic, there has to be a general recognition that it's a major problem and there has to be a general recognition that we can only do it by acting together in a concerted manner that is sustainable, not do it today and tomorrow forget or something like that. We have to look at clear examples of success and have to also involve ourselves in those processes and procedures that have been tried and are known to work. Everybody knows that if you give anti-retrovirals to pregnant mothers you reduce the level of transmission.

POM. You don't need to be a rocket scientist.

MWM. You don't need to be any scientist at all, you just need to have seen patients like that.  Anybody will tell you they know people who have been given anti-retrovirals who were on their way out who are now working and they are leading productive lives. We need to take those kinds of lessons and incorporate them. There's no point in thinking that we're going to discover something new that is very different. We may do it but it will be within the mainstream of what is already known to be successful. I would counsel that we simply take those very simple lessons and experiences of other nations and do the things that we know work well and implement them within our own context, within our own obviously budget, within our own financial ability.

POM. Again going back to the question of political commitment. The President is a bright man.

MWM. Yes.

POM. And the people around him, these are bright people.

MWM. I'm not sure about that.

POM. Not sure? OK. Maybe that's the problem right there. What is the quality of the leadership that can create the will that's needed to bring a population out of denial into acceptance and to move from there?

MWM. Yes, you know this, I have to say this. All bright people have their blind spots. Hitler was a very bright man. What did he do? So I don't necessarily think of brightness in terms of good intentions and good consequences. There is also a very sinister side to every bright person. Michael Jackson is a real bright guy and look what he did to small boys. One has to not simply associate brightness with a good deliverance and when brightness occurs in the absence of maybe good advice it can also be very dangerous. So if you're bright and you surround yourself with sycophants then you do silly things and you do inappropriate things, you don't get the advice that you are supposed to get and people don't tell you to stop. So I think there are all kinds of permutations about brightness that I think people need to be aware of and I think, my definition of a bright man is a bright person who also knows how to be bright to be responsible because you can be bright and be quite irresponsible. People will still recognise that.

POM. In a way I began my research with the demise, the beginning of the demise of apartheid and I'm finishing it with

MWM. The demise of the continent.

POM. That's right!

MWM. I think this epidemic poses the greatest challenge to whatever Africa wants to do. This is the defining epidemic. In the future people will look into their leaders and ask: is this the man who's going to get us out of this problem or not? If not they're not going to vote for them because this epidemic is going to be here with us to stay. It's not going to come in and disappear. It's here with us to stay and the more it spreads around the more people become aware of it and the more people participate in its solution and its understanding and fairly soon I think the masses will rise against the political leadership.

POM. You say a certain critical mass have to be reached before people say they've had enough.

MWM. We're tired of this intellectual academic debate that you're all going through.  I think you need to act and we must see by the action because we know that so-and-so acted and these are the consequences. We know that Museveni acted and he has reduced the incidence from about 40% to 10% in some areas. We know that the Thai people acted and they have reduced their incidence rate. We know that people in the Ivory Coast acted and they have produced some results. We know the Americans have acted but slightly in a different way because they've got a good drug market and they have reduced the disease. The British have done it. So there will be those kinds of things.

POM. Do you see signs of that critical mass being there?

MWM. I think every day when you listen to some of the debates in SA you can see people getting frustrated with the current messages.

POM. If there were one single thing within your power to do to get a grip on this, what is the most decisive step that can be taken at this point in time from a policy perspective?

MWM. I would ask the President of this country to stay out of this matter. I would ask the President of my country to stay out of this matter.

POM. I remember at the conference that you were in it's two years ago now, what I did was I taped the entire conference I have it all transcribed. By the time I have it transcribed the book will have come out. So!

MWM. No, I would advise

POM. It was the African Renaissance.

MWM. I think he can do himself a lot of good by staying out of this current controversy and it will facilitate other people who have different messages to come up and in the end by staying out of it he will add a lot of value and benefit to many people because by staying in the controversy I think he has perpetuated being part of the denial. He has perpetuated in creating a climate of uncertainty, an environment in which many scientists are very terrified and unhappy. So it's not simply affecting the people with the disease but it's also affecting the professionals who are practising. That was not the case until he entered the debate and every day when you read about it you can see that it has not been constructive.

POM. This past weekend the Minister of Health sending out the chapter from the illuminatae or whatever, it just adds to

MWM. That's what I'm saying but I just think there are little things like those that you don't need to get yourself involved in. Every time they come up or they get leaks or something like that they add a negative image, they add negative messages to people and we don't deserve that.

POM. Do you get that feeling when you go abroad now, or do they say, "What the hell is happening in your country?"

MWM. No, no, I don't even get that message. I think as a country we have lost credibility.  Finished. We have lost credibility. Nobody wants to come here any more, come and do business with us. That's what I hear because they may not get their returns on their investments. We are not committed to treating one of the most easily understood diseases so why should people come and invest here?

POM. Absolutely.

MWM. And the future of our relationship with the world is going to be defined by this epidemic. At the moment we are not doing that, we are just painting ourselves into corners, we are just destroying all the good reputation that Mr Mandela built for this country. And we are destroying it in a manner that also does not have very high integrity.

POM. I'll leave it at that. I don't want to take too much of your time, you're very busy and you're tired.

MWM. This epidemic is unfortunately a defining epidemic for many people in different ways.

POM. George Soros is interested in funding a project on HIV in SA.

MWM. You can tell him to give the MRC money.

POM. He could put money in. I know this through Van Zyl Slabbert who is his man in this country. Soros is coming here in December and he has already indicated to him that he would like to see a range of projects that he could fund. I'll drop you a note about it.

MWM. That would be useful.

POM. It might be something that could be a social experiment, like if you took a village where there's a high incidence you could say -

MWM. You need those kind of examples.

POM. - and you can study.

MWM. I must give you a paper that I wrote about politics and science. It might give you an impression of what I really think.

POM. In another part of my life I edit something called the New England Journal of Public Policy and I do special issues. I'm doing a special issue on the social and economic impact of AIDS in Southern Africa. I've reduced it down to South Africa because there just are no studies done. You would think economists would have gone out there and made models and I went to ask somebody, a high ranking politician, opposition politician, I said, "Do you know when Trevor Manuel prepares budget estimates what variables he uses to take into account the impact of AIDS when he makes his projections in the short term and medium term?" He said "I haven't the faintest idea."

MWM. There are all sorts of things. You know at the second panel, the President's Advisory Panel, there was some data presented on the mortality of how people are dying, the pattern of mortality, and I presented the data and there was a massive campaign to actually deny that, that the pattern of death has changed. People are no more dying in their sixties and seventies, they are dying in their thirties and forties. What is worse is that we have in SA what no country has, no member of the animal kingdom has, is that in SA the females are dying earlier than the males. Now snakes, lions, tigers, baboons, monkeys, you name them, in all biological systems the women tend to outlive the male species because the male species is always involved in high risk activities, fighting for females, killing each other for sex and so forth, but in SA we have reversed that pattern that is so characteristic of biological systems, that women, young women are dying earlier than men. And that is denied. People say it is due to violence and they are looking for other reasons why they may be dying. But we also have the figures that show you that young women get infected with this disease five years earlier than the men and the age at which they're dying is about the age of 30 or so. If you make the simple calculations that most people start becoming sexually active around the ages of 15 and 20 you can understand why between the ages of 25 and 30 you would have that peak if the disease at least has a lifespan of about eight to ten years. But no, people are looking for why these young people are dying but they are not actually surprised at this, it's a violation of a biological principle that never existed maybe ten years ago. They are looking for every other reason except AIDS.

POM. OK. Give me the paper and then I will drop you a note on the Soros thing.

This resource is hosted by the Nelson Mandela Foundation, but was compiled and authored by Padraig O’Malley. Return to theThis resource is hosted by the site.