AIDS and the scientific governance of medicine in post-apartheid South Africa

AIDS policy in post-apartheid South Africa has been shaped by persistent antipathy towards antiretroviral drugs (ARVs). This hostility was framed initially by President Mbeki's questioning of AIDS science and subsequently by direct resistance to implementing prevention and treatment programmes using ARVs. Once that battle was lost in the courts and in the political arena, the Health Minister, Tshabalala-Msimang, continued to portray ARVs as 'poison' and to support alternative untested therapies. Demographic modelling suggests that if the national government had used ARVs for prevention and treatment at the same rate as the Western Cape (which defied national policy on ARVs), then about 171,000 HIV infections and 343,000 deaths could have been prevented between 1999 and 2007. Two key scientific bodies, the Medicines Control Council (MCC) and the Medical Research Council (MRC) fall under the ambit of the national Department of Health. Although notionally independent, both have experienced political interference as a consequence of their scientific approach towards AIDS. AIDS policy improved after the Deputy President was given responsibility for coordinating AIDS policy in 2006. However, the undermining of the scientific governance of medicine is a legacy that still needs to be addressed.