Adam Sitze

Denialism
Peihaps the nost coheient expiession ol Piesi-
dent Thalo Mlekis position on the ielation-
ship letween HIV, AIDS, and antiietioviial
(ARV) theiapy is set loith in a docunent
entitled Castio Hlongwane, Caiavans, Cats,
Geese, Foot and Mouth Statistics: HIV[AIDS
and the Stiuggle loi the Hunanisation ol the
Aliican. The text was distiiluted thioughout
the Aliican National Congiess (ANC) National
Executive in Maich zooz, and is iunoied to
have leen authoied ly Petei Mokala, whose
sulsequent death on ]une , zooz, at age
loity-thiee ol acute pneunonia linked to a ies-
piiatoiy piollen gave iise to speculations that
he died ol AIDS. It is not a docunent to le
wiitten o, even though this is how its ciitics
have tieated it.
1
On the contiaiy, whethei one
inteipiets it as Mokalas ollique, extended sui-
cide note (explaining why he would not take
ARVs even though he could aoid then) oi
as Mlekis unwilling political last will and tes-
tanent (allowing a nane to le given to his
disavowal ol a deadly conditions given nane),
it nust le iead as a distinctly neciopolitical
text. In it we nd the stiongest sustained aigu-
nent in suppoit ol the Mleki adninistiations
The Scutn At|untic Quurtcr|y o:q, Fall zooq.
Copyiight _ zooq ly Duke Univeisity Piess.
770 Adun Sitzc
decisionto delay the piovisionol ARVs to SouthAliicans letweenand
zoo. This aigunent nay le sunnaiized as lollows: HIV is not the only
cause ol the nany innune deciencies weakening the South Aliican lody
politic, poveity also causes the acquisition ol innune deciencies, the sci-
ence giounding HIVs existence and tieatnent is not only questionalle lut
iacist, ARVs can neithei pievent noi tieat the acquisition ol poveity-lased
innune deciencies, ARVs aie linkedto the inteiests ol nultinational capi-
tal, ARVs aie not even a cuie loi HIV and aie toxic lesides.
2
Whatevei the
neiits ol these clains aie on theii own teins (the iacisn ol HIV[AIDS
epideniology ceitainly has leen well docunented), Castio Hlongwane
adds then up, ly a kind ol kettle logic, to ieach what seens to have leen a
piesupposed conclusion: the Ministiy ol Health need not iush to include
ARV tieatnents as a pait ol the ght against HIV[AIDS in South Aliica.
The Tieatnent Action Canpaign (TAC) estinates that this conclusion has
led to the unnecessaiy deaths ol thousands ol pooi people.
It is tenpting to iead Castio Hlongwane as a neie eect ol a noie
lundanental econonic logic, such that the Mleki adninistiations hesita-
tion to piovide ARVs could le explained lecause they aie too expensive, oi
lecause pioviding geneiic ARVs would sonehow scaie o loieign diiect
investnent. But the distuiling piolalility is that the Mleki adninistia-
tions theoiies alout HIV and AIDS opeiate with a high degiee ol iela-
tive autonony. Pioviding ARVs loi HIV-positive South Aliicans is not only
econonically possille loi the Mleki adninistiation, lut nay le its nost
cost-eective policy option.
3
The decision not to piovide ARVs cannot then
le consideied a decision nade ol econonic necessity. As Mandisa Mlali
aigues, the veiy opposite is tiue: theie is eveiy indicationthat the theoiy that
HIV is not the exclusive cause ol AIDS is the exclusive cause ol the Mleki
adninistiations deadly delay ol ARVS.
4
Castio Hlongwane, as the single
nost coheient loinulation ol this theoiy, nust le iead loi the peiloinative
loice ol its death sentences.
The doninant accounts ol the Mleki adninistiations denialisn tend to
liane the question as a vaiiation on the tiadition ol hunanistic and social-
scientic thought Mahnood Mandani has called South Aliican exception-
alisn.
5
Giasped within this liane, Mlekis theoiies would le unique to
South Aliica, intelligille as only anothei intiiguing tuin in the histoiy ol a
paiticulaily lascinating nation, the politics and cultuie ol which aie unlike
any othei. The coiollaiy ol this appioach would le the ieduction ol denial-
Dcniu|isn 771
isn to an exceptionalisn ol a second soit. As the only leadei in contenpo-
iaiy woild politics to pullicly question accepted scientic opinion on the
question ol HIV[AIDS, Mleki would appeai puiely and sinply iiiational.
He would eneige as the enlodinent ol eveiy postulate ol Enlightennent
iacisn.
Aside lion its capitulation to the eteinal inpeiialist suspicion ol post-
colonial sell-goveinnent, the piollen with the exceptionalist appioach is
that it would olscuie a noie geneial econony ol denialisn, a denialisnwrit
|urgc. By this, I nean the denialisn piogianned into not only the ciicuits
and institutions ol glolalizing capital, lut also the U.S. nass nedias apoca-
lyptic accounts ol AIDS in Aliica that have ciiculated since at least 86.
6
Discussing these accounts in 88, Susan Sontag olected to the piolil-
eiation ol iepoits oi pioections ol unieal (that is, ungiaspalle) doons-
day eventualities, aiguing that the naiiative ol inevitalility stiuctuiing the
lattei is lound to pioduce a vaiiety ol ieality-denying iesponses.
7
On Son-
tags iead, theie is a denialist keinel lodged in the veiy discouise ol enei-
gency that has lianed the noithein appioach to the pandenic lion the
leginning. To the extent that Aliica alieady signied nihilisn (death, sick-
ness, nothingness, despaii) in and loi the Euio-Aneiican social inaginaiy,
8
it cannot cone as a suipiise that the sulects ol the sane would pielei
neiely to shuddei at the thought ol Aliicans lack ol access to essential
nedicines (loi HIV[AIDS oi loi nalaiia oi tuleiculosis). In South Aliica,
neanwhile, the eailiest accounts ol the epidenic eneiged in 8.
9
In the
next eight yeais, noie than lty studies would le pullished in South Aliica
in the elds ol actuaiial science, epideniology, lusiness nanagenent,
denogiaphy, and pullic health.
10
These studies, nany ol which weie con-
ducted in the ninistiies ol the apaitheid state, the lals, liliaiies, and
aichives ol white-only univeisities, and the oces ol white-owned capitals,
openly calculated and speculated on the eect ol HIV on South Aliicas
llack population.
11
By 8, the sane apaitheid ninisteis who, in 8, had
ielukeda sensationalist nedia loi llowing the epidenic out ol piopoition
12
weie nusing pullicly alout the diseases destiuctive powei.
13
Between
o and , hundieds noie studies ol HIV[AIDS in South Aliica
eneiged.
14
The nethodologies, disciplinaiy status, institutional suppoits,
and prcb|cnutiquc ol these studies weie noie oi less the sane as the studies
ol the late 8os, lut they weie now naiked ly one ciitical dieience. By
the late 8os to nid-os, the discouise on HIV[AIDS, in South Aliica
as elsewheie,
15
had leen alteied ly the eneigence ol niiacle diugs. Altei
the FDA appioved Zidovudine (AZT) in 8;, it was cleai that the nedi-
772 Adun Sitzc
cation, while toxic and ly no neans a cuie loi HIV[AIDS, could signi-
cantly inhilit the ieplication ol HIV, and that people with low white llood
cell counts couldlike Lazaius, it was saidietuin lion the giave.
16
By
eaily q, luithei studies estallished that AZT could ieduce nothei-to-
child-tiansnission (MTCT) ol HIV to as low as 8. peicent.
17
A second
HIV[AIDS diug, Didanosine (ddI), would le appioved ly the FDA in Octo-
lei , while Neviiapine, which the FDA appioved in Septenlei 6,
was shown in to le o peicent noie poweilul than AZT in ieducing
intiapaitun MCTC.
What this neans is that even piioi to the eneigence letween q and
6ol nonnucleoside ieveise tiansciiptase inhilitois, piotease inhilitois,
and poweilul tiiple theiapies, knowledge alout the hoiiille scope ol the
pandenic hadleennultipliedly a decisive coecient. Foi at least a decade,
it has leen possille to llock the ieplication ol the viius with antiietio-
viial tieatnent. In Foucauldian teins, lionedical technologies like AZT
and ddI liought a new diagian ol powei[knowledge into eect.
18
Because
ARVs ieduced AIDS-ielated noitality ly ; peicent, an HIV-positive diag-
nosis could le ieclassied as a chionic condition iathei than a death sen-
tence. This iiieveisilly changed the peicepts that enalle us to see and speak
alout the viius. The new diagian intioduced a set ol uigent political ques-
tions ielated to the powei ielations ol ucccss. Now that lile with HIV[AIDS
could le extended with iegulai doses ol ARVs, coipoiate entities enteied
into diiect ielations ol liopolitical iegulation ol the lodies ol people with
HIV[AIDS. Even as people with HIV[AIDS acquiied a new loin ol lile,
the laws ol the deiegulated naiket acquiied a new powei to live and let
die. In 8, an eneigent AIDS Coalition to Unleash Powei (ACT UP),
which was laigely iesponsille loi constituting the new diagian in the ist
place,
19
placed political econonic questions iegaiding the cost and distii-
lution ol ARVs at the veiy centei ol the stiuggle against the pandenic.
20
The naoi phainaceutical coipoiations acknowledged as nuch ly entei-
taining questions ol the glolal aoidalility ol ARVs in a set ol neetings
hosted ly the Woild Health Oiganization (WHO) letween and .
21
Claining to le at the neicy ol the sane laws ol capital they neicilessly
enloiced, these coipoiations iaised those questions in convoluted teins
that peinitted then to le innediately diopped. And so, noie than ten
yeais altei AZT was appioved ly the FDA as a tieatnent loi HIV[AIDS,
ieseaicheis in Geneva could still iepoit, wiiting in an evasive passive voice,
that unloitunately, the lionedical advance denonstiating the dianatic
Dcniu|isn 773
ieduction ol nothei-to-child tiansnission ol HIV with Zidovudine (ZDV)
tieatnent has yet to le tianslated into widespiead use ol antiviial tieatnent
to help pievent HIV inlection in inlants.
22
Indeed, to inquiie into denialisn today is to ask how only a liaction ol
those in need weie ieceiving antiietioviial tieatnent at the end ol zooz
alout 8oo,ooo people woildwide, oo,ooo ol whon live in high-incone
countiies. In sul-Sahaian Aliica, wheie z.q nillion died ol AIDS in zooz,
only alout o,ooo people weie ieceiving tieatnent.
23
It is inpossille to
iespond to this questionwithout ist chaiting the ways that a ceitaindenial-
isn has inloined not only noithein discouises on the pandenic, lut also
the decisions ol the doninant institutions ol glolalizing capital, which have
acted piecisely to ieluse the liopowei called into leing ly the newlionedi-
cal technologies on the lasis ol a lundanentally iacist appioach to glolal
populations.
24
In the sane yeai that apaitheid loinally ended in Pietoiia,
the gioundwoik loi what sone have called glolal apaitheid was nalized
in Washington, D.C.
25
In q, the yeai that studies denitively estallished
the powei ol peiinatal AZTtieatnent, the lest availalle pioections wained
that the pandenic could soondoulle insize inthe woilds pooiest iegions.
26
Yet in that sane yeai, the United States not only enteied into a loui-yeai
peiiod ol stagnant inteinational HIV[AIDS lunding,
27
lut also acceleiated
its distinctly inpeiial econonic policy ly concluding the Uiuguay iound
ol the Geneial Agieenent on Taiis and Tiade (GATT).
28
The Final Act ol
GATT estallished the Woild Tiade Oiganization (WTO) and codied a set
ol highly contested clauses peitaining to Tiade-Related Aspects ol Intel-
lectual Piopeity Rights (TRIPs).
29
The TRIPs clauses, loinulated in laige
pait ly nultinational phainaceutical coipoiations,
30
gave the sane coi-
poiations signicant poweis to secuie theii intellectual piopeity patents,
and thus theii nonopolies, on essential nedications.
31
At a nonent when
eective HIV[AIDS tieatnents had leen availalle loi yeais, and when the
scope ol the pandenic was plainly known to all decision nakeis, the United
States and Big Phaina acted not to suppoit people with HIV[AIDS in theii
stiuggle against the viius, lut to piotect patents lion the clains ol people
with HIV[AIDS. Not to le outdone wheie ciuel nisnanagenent is con-
ceined, the Woild Bank and the Inteinational Monetaiy Fund (IMF), acting
with theii signatuie inconpetence,
32
iesponded to HIV[AIDS not only ly
adding luel to the ie, lut also, duiing the late os, ly accusing Alii-
774 Adun Sitzc
cans ol aison. As scoies ol analysts have shown, it is no accident that the
states which inplenented stiuctuial adustnent plans in the 8os weie
the sane ones that lound thenselves nost unalle to iespond eectively to
the spiead ol HIV[AIDS in the os.
33
Foiced to cut social spending and
even uiged to chaige loi health caie seivices in IMF-designed plans to sta-
lilize cuiiencies and lacilitate WB delt iepaynent, these states and theii
dininished health caie systens weie incapalle ol addiessing the nani-
lold nedical needs ol people living with HIV[AIDS.
34
It was thus adding
insult to inuiy when, altei yeais ol cieating this incapacity as a ieality, the
Woild Bank issued a 6 study iegietlully conining the unaoidalility
ol HIV[AIDS tieatnent in sul-Sahaian Aliica on the lasis ol a iealistic
estinate ol the iegions low total health expendituie iates.
35
The cost-lenet analyses ly which these institutions aiiived at theii deci-
sions aie, as David Fidlei has aigued, intelligille as a nix ol vicious iacisn
and cynical Rcu|pc|itik.
36
But what Fidleis dialectic nisses is the univei-
sal equivalent that iendeis the heat ol the one connensuialle with the
coldness ol the othei. It is neithei hypeilole noi catachiesis lut aiithnetic
to heai in these institutions nuinuied solipsistic calculations so nany
hissed whispeis ol Maixs llunt woid on the late ol lile alandoned ly the
ieplication ol suiplus value: The suiplus populations would have to die.
37
It is oui view that the inpact ol AIDS viu these nechanisns [laloi supply
shoitages and signicant ieductions in aggiegate denand (via ieductions
in total consunption)| has leen exaggeiated in loth cases. As we aigued
eailiei, in the piesence ol high unenploynent, even the laige nunleis
ol deaths lion AIDS that oui nodel pioects aie likely to iesult in ten-
poiaiy laloui supply lottlenecks and liictional ieplacenent costs, iathei
than sulstantial and lasting laloui supply shoitages.
38
In the piesence
ol laige-scale unenploynent, it is likely that a signicant piopoition ol
those disalled ly, oi dying lion, HIV[AIDS will le ieplaced. The [indiiect
costs| nodel [ol the hunan capital appioach, which takes lost eainings as
a pioxy loi lost pioduction attiilutalle to the disease| thus adusts esti-
nates ol total pioduction downwaids to account loi the ieplacenent ol a
piopoition ol lost woikeis in these sectois. Note that non-naiketed pio-
duction (such as household woik) has not leen included in the calculation
ol lost pioduction costs.
39
Ovei the shoit tein at the nacio level, and to
sone extent deteinined ly the natuie ol the econonic gioups aected [ly
HIV[AIDS|, the indicatois suggest that the econony as a whole nay lene-
t, even while a iange ol households aie loiced evei luithei into a state
Dcniu|isn 775
ol unsustainalility and poveity.
40
Il the only eect ol the AIDS epidenic
weie to ieduce the populationgiowth iate, it would inciease the giowth iate
ol pcr cupitu incone in any plausille econonic nodel.
41
Dean ]anison ol
the Woild Bank intioduced the concept ol a disalility-adusted lile yeai, oi
DALY, to neasuie the nunlei ol pioductive yeais lost to illness oi death.
By his calculus, loi exanple, a countiy that spent s,ooo a yeai to save the
lile ol soneone eaining soo a yeai would suei a net econonic loss.
42
It
is helplul, even ciucial, to calculate the cost ol disease and the iesultant loss
ol eainings. Health is cleaily a lactoi in developnent. Bisnaick knew that
in the late th centuiy. He was the ist to peisuade nanagenent to cie-
ate a nutual health insuiance systen loi woikeis so the lactoiies could go
on iunning. But it is naive to think that lusiness people will le peisuaded
to invest in healthcaie in a glolalised laloi naiket.
43
I think to piovide
tieatnent to the lulk ol the people is ust not leasille. I think to piovide
tieatnent loi instance to qualied woikeis actually saves noney loi con-
panies. . . . I think [ol | the cost ol pioviding actual tieatnent to eveiyone at
the piesent. I dont think its iealistic. Its not achievalle.
44
Because capital is constiained only evei to le alle to appioach ARV tieat-
nents, not to nention people with HIV[AIDS, on the lasis ol an M-C-M
ciicuit,
45
the degiee to which a chenical conpound oi a living leing cannot
geneiate suiplus value loi capital is the degiee to which it lecones supei-
uous in and to a capitalist econony. Though the HIV[AIDS pandenic is
haidly ieducille to the old laws ol capital, capitals contiadictions neveithe-
less deteinine its shape and scope. As ol zooo, z peicent ol the woild
population have to nake do with only 8 peicent ol total expendituie [on
ARVtieatnents|.
46
The dizzying inteiconnections ol glolalisns paiochial
ows thus coiielate with a stiiation ol soleiing glolal piopoitions: the loca-
tions ol the naikets wheie the nost HIV[AIDS tieatnents aie sold aie
alnost nutually exclusive with the places wheie nost people with HIV[
AIDS live. Despite appeaiances, this is not so nuch a naiket lailuie
47
as a distinctly neolileial oveiextension ol the law ol the naiket itsell.
48
By
insisting that it deiive a suiplus lion the pioduction ol ARV tieatnents,
capital pievents the intiinsic capacities ol the chenical conpounds in those
tieatnents lion doing what they can do in the lodies ol people living with
HIV[AIDS. To the extent that essential nedicines cannot geneiate capital,
capital iendeis then inessential, withholding then lion the vast naoiity
ol the people they aie designed to tieat. Conveisely, ly ielusing to connit
to the health ol people living with HIV[AIDS unless those people satisly
776 Adun Sitzc
a condition extianeous to health (the capacity to pioduce suiplus value),
capital sepaiates people with HIV[AIDS lionwhat they could do with ARV
tieatnents. Inshoit, ly intioducing into a piollenol glolal healththe con-
pletely extiinsic ciiteiia ol suiplus value, capital sepaiates individuals lion
the inoiganic natuie they cannot live without.
49
Yet lecause the chenical conpounds in ARV tieatnents aie one ol the
loins thiough which people cieate a lile on the lody-without-oigans, those
conpounds aie not and cannot le the piivate piopeity ol this oi that coipo-
iation, lut aie and nust ienainthe pioducts ol what Maix calls the geneial
intellect.
50
The connon notion that ucccss tc csscntiu| ncdicincs is ccnstitu-
tivc cj u |ijc expiesses ontologically what activist intellectuals expiess politi-
cally whenthey aigue that essential diugs nust le consideied a glolal pul-
lic good.
51
Moie so than a call to ietuin to the violated innocence ol the
connons (which, despite its attiactions, has its own piollens
52
), a con-
non notion ol this type opens up the piactical geneiality, which is not to say
univeisality, adequate loi ieiegulating, il not also dechaiteiing, the coipoia-
tions that aie the woist enenies ol the intiinsically geneiic conpounds they
connodily. Patiick Bond is coiiect to call the stiuggle against HIV[AIDS a
conliontationwithcapital-in-geneial,
53
as was Leslie Doyal whenshe aigued
that the denand loi health is in itsell a ievolutionaiy denand,
54
and the
late ]onathan Mann, who pioposed that the stiuggle against HIV[AIDS is
ly denition ievolutionaiy.
55
Loss ol lile lionHIV[AIDS is less a stiuctuial
asynptote leyond which capital accunulation cannot occui
56
than a synp-
ton ol a glolalisn alieady ieady to alsoil ust such a loss.
57
The conpul-
sionto deny essential nedicines to the pooi is piogianned into the ciicuits
ly which glolalizing capital attenpts to iepioduce its own constant iate ol
giowth. Multiplying capital cannot lut nultiply the viius.
How, il at all, does this help us iead Castio Hlongwane? No doult the
texts aigunents alout poveity would not le so nisleading weie they lin-
ited to the clain that the spiead ol HIV[AIDS cannot le undeistood apait
lionthe conditions ol extiene poveity that aie one ol the legacies ol apait-
heid. This clain is all too tiue, and Zackie Achnat, chaiipeison ol the
TAC, nakes it liequently.
58
All the sane, it is pointless to diaw on the tia-
ditional teins ol philosophical logic to ciitique the sophistiy ol Castio
Hlongwane. Even locusing on its conlused sulstitution ol the pandenics
necessaiy condition (poveity) loi its sucient condition (HIV) distiacts
Dcniu|isn 777
lion the lundanental piollen. Moie than the naikets lailuie to ensuie
the pooi access to ARVs, denialisn writ |urgc desciiles a condition dened
ly the innanence ol HIV[AIDS and capital. In the geneial econony we aie
chaiting, the ieplication ol deiegulated capital and the unllocked ieplica-
tion ol the viius aie so tightly linked that, in eect, they constitute a single
doulle helix.
59
Wheie capital nds that it can extiact suiplus value lion a
lody oi nolecule, theie ARVs will llock the ieveise tiansciiption ol HIV
RNA in the DNA ol T-cells. But wheie capital nds no connodities to con-
veit to suiplus value, theie the nucleic acid ol the viius copies itsell without
linit in the living cells ol the lody. Undei conditions ol capitalist political
econony, the inteivals ol one iepeat thenselves indiiect inveise piopoition
to the inteivals ol the othei. Whats noie, as two ol the nost lundanental
loices dening the diagian that today goes ly the nane g|cbu|izuticn, and
as loices that aie ly denition neithei dead noi alive, HIV[AIDS and glolal-
izing capital geneiate a situation in which the ontological linit letween
lile and death lecones noie dicult than evei to x. Maix estallished
long ago that capital is, as dead laloi tine, a nonliving yet undead loice
that iequiies laloiing leings loi its own iepioduction.
60
Medical ieseaich-
eis, neanwhile, appioach the HIVviius as a conplex noleculai (inoiganic)
stiuctuie the only specically oiganic chaiacteiistic ol whichiepioduc-
tionit loiiows paiasitically lion the enzynes, eneigy, and iilosones ol
its host cells.
61
Given the stiuctuial sinilaiity letween these two ciicuits,
ought we considei the ielation letween then a neie nattei ol honology?
Oi does theii ielation indicate that they exist on the sane plane ol consis-
tency and puisue a single glolal piogian? Il so, how aie we to undeistand
that plane, given that the stiiated disciplines that today ienain in chaige
ol the study ol the viius (nacioecononics, epideniology, and viiology, not
to nention actuaiial science, lusiness nanagenent, and denogiaphy) aie
incapalle ol posing the question ol theii innanence? Il loth ciicuits detei-
nine the shape, extent, and quality ol what we call glolalization, wont they
each also intensily the otheis iendeiing indistinct ol the linit letween lile
and death? Il so, how night that indistinction iequiie us to iethink the
seiies ol political, legal, noial, and epistenological concepts lounded on
that linit?
62
Beloie iesponding to these questions, let ne considei the stiongest
counteiaigunent against the innanence ol HIV[AIDS and glolal capital,
nanely, that the lattei is suciently elastic to allowthe loinei to disappeai
without also alteiing its ownlundanental stiuctuie. Foi the stiongest piool
778 Adun Sitzc
that deiegulated capital cannot help lut not help pooi people with HIV[
AIDS, we unloitunately need look no luithei than capitals own attenpts at
laigesse. Piioi to the eneigence ol Bushs Eneigency Plan loi AIDS Reliel
(PEPFAR), capitals lest eoit to addiess the pandenic on its own teins
cane in the loin ol a seiies ol piice cuts.
The nost inpoitant agieenent ol iecent yeais to ieduce the cost ol
antiietioviials in developing countiies, the acceleiating access initia-
tive, has nade it possille to cut the annual cost pei patient lion
sz,ooo in zooo to sqzo in zoo. It was launched in May zooo ly
UNAIDS, in paitneiship with seveial UN agencies and ve diug con-
panies (Boehiingei Ingelhein, Biistol-Meyeis Squill, GlaxoSnith-
Kline, Meick &Co., andHonann-La Roche), lut theie is little to show
loi it. Ovei thiee yeais, 8o countiies expiessed inteiest, have devel-
oped actionplans, lut less thanhall have nally concluded agieenents
with the conpanies, and undei % ol the patients in those countiies
aie ieceiving antiietioviial tieatnents: a total ol z;,ooo people lenet
in Aliica wheie o nillion people aie HIV+.
63
Even though these piice cuts had, as an unintended side-eect, loonei-
anging calls loi lowei diug piices in G8 states,
64
they neveitheless lailed as
an attenpt to lieak with capitals laws ol iestiicted econony. Like the chaii-
talle donations ol naoi philanthiopists, they aiiived wiapped in iestiic-
tions and lound with conditionalities.
65
Hence Di. Mohanned Aldul-
lahs (chaii ol Kenyas AIDS Contiol Council) iiposte to the UNAIDS oei:
Il the inteinational naathe diug conpaniesieally nean lusiness,
they should waive theii patent iights and let developing countiies nake the
diugs thenselves undei theii supeivision. Kenya alieady has the capacity
to nake nost ol these diugs. It is the lig ve who aie stopping us.
66
Bushs
PEPFAR, which, like the Glolal Fund to Fight AIDS, Tuleiculosis, and
Malaiia (GFATM),
67
was loiced into existence ly the tiieless eoits ol AIDS
activists, neveitheless does not lieak with this systen ol cynical sulsidies
lut, on the contiaiy, institutionalizes it.
68
Even though Bushs speechwiit-
eis included in his zoo State ol the Union addiess an unusually candid
ienaik iegaiding the innense possilility oeied ly geneiic HIV[AIDS
tieatnents, PEPFARs only notalle achievenent since then has leen how
quickly it has thiown the innense poweis ol the U.S. executive lianch
lehind Big Phainas suppiession ol that veiy possilility.
69
Neolileialisns alandonnent ol sul-Sahaian Aliica is all the noie an-
Dcniu|isn 779
geiing lecause ol the signicant gains against HIV[AIDS acconplished ly
the lew states that have leen alle to deconnodily HIV[AIDS tieatnents.
In 6, diawing on a long histoiy ol opposition to diug patents,
70
Biazil
passed its Patent Piopeity Law, which allowed the Biazilian Health Minis-
tiy to conline pievention eoits with univeisal and liee access to locally
pioduced geneiic ARVs. The iesults weie good. The viiuss tiansnission
iate was ieduced, Biazils AIDS-ielated deaths weie halved, and the gen-
eial state ol pullic health inpioved.
71
Pnurnuccuticu| Eccutivc nagazine
dutilully wained its ieadeis.
72
And so, even though Biazils law was con-
sistent with TRIPs,
73
which lully allows loi conpulsoiy licensing, lecause
ol what one legal scholai geneiously calls ianpant conlusion ovei TRIPs
in the Oce ol the U.S. Tiade Repiesentative (USTR),
74
which has consis-
tently and aggiessively nisinteipieted TRIPs as a neiely nininun stan-
daid loi patent conpliance,
75
Biazils tiade law was opposed ist ly the
Clinton adninistiation, which led loinal conplaints against the lawwith
the WTO on ]anuaiy , zoo, and then ly the Bush adninistiation, which
ieled the sane conplaint two weeks latei.
76
But even with the thieat ol U.S. tiade sanctions added into the equa-
tion, Biazils exanple denonstiatedthe possilility anddesiialility ol lieak-
ing patents in oidei to inplenent a cooidinated piogian ol ARV tieat-
nent and pievention. It was to enulate the successes ol the Biaziliannodel
that the Mandela adninistiation dialted the Medicines and Related Sul-
stances Contiol Anendnent Act, Nunlei o, ol ;. The lill gave the
South Aliican goveinnent the powei to elininate patent piotections loi
phainaceuticals in oidei to ieduce the piice ol nedicines vital to pul-
lic health.
77
Its section (c) vested the executive lianch, viu the ninistei
ol health, with the powei to conpulsoiily license HIV[AIDS nedications
and[oi to paiallel inpoit the sane.
78
Yet even though this quite nild
law (as ]onathan King iightly chaiacteiized it
79
) was conpletely TRIPs-
conpliant, the United States thieatened South Aliica ust as it had thieat-
ened not only Biazil lut also, eailiei, Thailand.
80
The United States placed
South Aliica on its Special o watch list in 8 and again in . It ini-
tiated what the USTR explicitly called a lull couit piess, even deploying
the peisonal chains ol then vice piesident Al Goie to stiike down the law.
81
This nassive lullying eoit, as Roleit Weissnan aptly ienaned it, net
in Apiil with sustained iesistance oiganized and led ly ACT UP activ-
ists like Paul Davis, Asia Russell, and Shaionann Lynch, suppoited ly pul-
lic ielations eoits lion Mdecins Sans Fiontiies (MSF) and inloined
780 Adun Sitzc
ly ieseaich lion the Consunei Pioect on Technology.
82
Though nany
u|tcrncndiu|istcs cite Seattle as the ist signicant victoiy ovei the osten-
silly anonynous and alstiact loices ol nultinational capital, we nust not
loiget that, two nonths eailiei, seven hundied notivated and highly oiga-
nized people loiced the USTR to announce, against a supposedly invin-
cille Big Phaina lolly, that the tiade dispute was iesolved and that the
U.S. goveinnent would cease piessuiing South Aliica on the issues ol con-
pulsoiy licensing and paiallel inpoits.
83
This victoiy olviously woiiied
PhRMA, which, lesides leing inpatient with the inpotence ol the U.S.
executive lianch, was neivous alout the conlination ol intensilying tieat-
nent access activisn in South Aliica and the oei ol inexpensive geneiic
ARVs ly a nunlei ol Thai and Indian phainaceuticals.
84
Along with its
twinoiganizationinSouthAliica (the SouthAliicanPhainaceutical Manu-
lactuieis Association [PMA|), PhRMA led suit against the South Aliican
goveinnent in, naning Mandela as a delendant inanattenpt to stiike
section (c) lion the looks. What happened next is dicult to loiget, il
only lecause its loice as an event is still iesonating today. On Apiil , zoo,
thiity-nine ol the iichest phainaceutical conpanies, acting as a caitel ol
the single-nost piotalle sectoi ol nultinational capital in the woild, with-
diew theii case against South Aliica, having leen outnaneuveied in and
out ol couit ly the South Aliican goveinnent, the TAC, and the liight-ied
piotest ol the glolal nultitude.
What this cuisoiy chait indicates is that what today goes ly the nane dcniu|-
isnis not and cannot le linited eithei to Mleki oi even to a text like Castio
Hlongwane. On the contiaiy, altei tuining a cold haid staie towaid the
piollen ol HIV[AIDS in sul-Sahaian Aliica in the late 8os and eaily
os, the doninant institutions ol inteinational nance, nultinational
capital, glolal goveinance, and developed states, up to and including the
U.S. executive lianch, ielused sul-Sahaian Aliica access to the potent con-
lination ol geneiic nedicines and capital necessaiy to stall the epidenic.
The eneigence ol this geneial econony ol denialisn is loth dutub|c and
dcncnstrub|c. It is dutub|c lecause the potentialities it suppiessed eneiged
at a veiy specic conunctuie dened ly the eneigence ol ARV theiapies.
It is dcncnstrub|c lecause it is lased on an easily ieconstiucted set ol cost-
lenet calculations that continue to le shanelessly conputed in pullic
today. And it is gcncru| lecause it naiked an alyssal consensus ieached ly
Dcniu|isn 781
glolalisns leading institutions. Because glolal capital would not suei the
expendituie necessaiy to halt the ieplication ol the viius, the ieplication ol
the viius could not le halted. People with HIV[AIDS would ust have to
suei.
85
To piopose the existence ol a denialisn writ |urgc oi a geneial econ-
ony ol denialisn is neithei neiely to ietuin the insult noi to exoneiate the
Mleki adninistiation. It is to suggest that a quotient ol the loice enalling
the scoinlul ciitique ol the Mleki adninistiation in noithein nass nedia
deiives lion a condensation and displacenent ol denialisn writ |urgc onto
Mlekis guie. Readeis ol Tinc and Ncwswcck can sleep well at night know-
ing that iiiational Aliican leadeis (and not the nultinationals whose advei-
tisenents cianthose sane nagazines pages) aie iesponsille loi withhold-
ing HIV[AIDS tieatnents lion the pooi. Oui noninalisn iequiies us to
undeistand this denialisnol the ist oidei. But that sane piinciple olliges
us to acknowledge that denial is noie than a neie ielusal ol ieality. In addi-
tion to naning a psychic synpton and an epistenological eiioi, the tein
also indicates a veiy specic ielation ol powei. When we ciitique the way
a goveinnent denies a peison his oi hei iights, we inply that it ieluses a
peison what is alieady essentially constitutive ol his oi hei veiy leing: the
iight to have iights.
86
It is this doxa that is at issue when, in the ist volune
ol Tnc !istcry cj Scuu|ity, Foucault suggested that the exeicise ol conten-
poiaiy soveieign powei was no longei a powei to tukc lile oi |ct live lut
a powei to nukc live oi to cust cut into death [dc ieetei duns |u ncrt|.
87
Huileys tianslation ol rcjctcr as disallow olscuies the sense in which the
soveieign powei to let die nanilests itsell piecisely as a kind ol iepudia-
tion. Undei political conditions that place the sulects existence as a living
leing in question,
88
soveieign powei is what it was loi Sade: a powei to
iepudiate zcc itsell.
89
Whatevei is ielused in denial is innanent to the lile
ol the denied.
This ielation to institutions ol soveieign powei suggests that denialisn
is not so nuch synpton oi eiioi as glolal dispcsitij.
90
Undeistood in this
nannei, denialisns conponent paits denitely include a way ol not see-
ing oi not speaking alout the potentialities ol HIV[AIDS tieatnent (which
we nay ust as well call disavowal). But leyond that, it consists ol the sov-
eieign powei to ieluse to the living the loins-ol-lile without which a lile
cannot le alive, and also, alove all, ol the ielations ol econonic and political
loice that enalle disavowal to lecone a soveieignpowei capalle ol actualiz-
ing the potential supeiuity ol pooi people living with HIV[AIDS. Denial-
782 Adun Sitzc
isn will have leen in eect wheievei a disavowal ol the possililities ol lile
with HIV[AIDS nds institutional suppoit in the soveieign powei to alan-
don naked lile. Nuneious enlodinents ol the U.S. executive lianch,
91
il
not also the executives ol nuneious Aliican states,
92
the vaiious institu-
tions ol the Washington Consensus, and the naoi phainaceutical capitals
exeicise a denialisn ol this type. A denialist institution is one whose lio-
political clain on lile iequiies it constantly to attenpt to iegistei the colos-
sal ieality ol the HIV[AIDS pandenic (thiough ceaseless studies, shock-
ing estinates, giave pullic statenents, expeit panels, sustained pullic
ielations canpaigns, naudlin chaiity lalls, hall-heaited aid piogians,
stiange donation schenes) yet whose inplication within ciicuits ol capi-
tal spui it to disavow that sane ieality (nainly ly classilying it as an ethi-
cal piollen, which, as Alain Badiou has aigued, has the eect ol ceding
to the naiket a nonopoly ovei the ontological attiilute ol necessity: such
classication alieady invites the active and passive suppiession ol exist-
ing lut unecononical possililities loi slowing the viius ieplication
93
). The
nost poweilul eect ol such institutions is that those living within theii
uiisdictions nd thenselves inteinally excluded ly the suileit ol oveilap-
ping soveieign poweis claining to ensuie theii su|us.
94
Denialisns ciown-
ing achievenent is an alsuid lut not unlaniliai geopolitical condition in
which the leading institutions ol glolalizing capital daily ieiteiate theii
connitnent to the ght against HIV[AIDSa geopolitical condition, then,
wheie people with HIV[AIDS have nevei attiacted noie conpassionate
spokespeople, chaiitalle oiganizations, conceined onlookeis, piolessional
nouineis, pitying philanthiopists, and iock-stai advocatesand yet wheie,
lteen yeais altei ARVs eneiged as a distinct lionedical possilility, they
aie availalle to only o,ooo to ;,ooo ol the q. nillion in sul-Sahaian
Aliica who will die without innediate access to then.
A peiplexing contiguity links the geneial econony ol denialisn to its spe-
cic nanilestation in the Mleki adninistiation. Appioached in this liane,
Mlekis denialisnis still, inManphela Ranpheles woids, iiiesponsilility
loideiing on ciininality.
95
Even leloie the South Aliican goveinnents
and the TACs iesounding Apiil zoo couit victoiy ovei the phainaceutical
caitel, the Ministiy ol Health indicated that it would not declaie the situa-
tion a national eneigency oi extiene uigency that, undei Aiticle
ol TRIPs would le the suiest way to open an exception to patent enloice-
Dcniu|isn 783
nent and enalle the paiallel inpoits the couit victoiy had nade possille.
96
Instead, Mleki legan posing, noie insistently and pullicly than evei, ques-
tions he had asked since at least iegaiding the ielationship letween
HIV and AIDS, the validity ol HIV[AIDS tests, the iacist piesuppositions
ol epideniological studies ol HIV, and the ostensilly intoleialle toxicity ol
ARVs.
97
Why?
When the TAC calls the Mleki adninistiations logic denialisn, oi
when Pietei-Diik Uys paiodies Mleki ly playing MacBeki, they inply
that Mlekis position is inloined ly a ceitain nadness.
98
Disavowal (Vcr-
|cugnung) is ceitainly, loi Fieud, constituted ly a sinultaneous denial and
iecognition ol a tiaunatic ieality that is so consistent it eventually splits
the ego into the two autononous egos ol the psychotic. But the textual
opeiation at woik when Castio Hlongwane ieects the ielation letween
HIV and AIDS thiough a senantic analysis ol the signiei AIDS itsell,
99
to the point wheie it aigues that to call the illnesses sweeping thiough
South Aliica AIDS would itsell le genocide,
100
suggests that, il theie weie
an opeiation ol psychosis in Castio Hlongwane, it would not le intelli-
gille in Fieudian teins. Because the text seens to encountei A!DS as an
inassinilalle signiei, and lecause its niiacle cuie loi AIDS consists in
nothing noie than a ielusal ol its signied, the nadness ol the text would
seen to consist less in disavowal than in what Lacan, diawing on a uiidi-
cal tein, calls loieclosuie.
101
Foi Lacan, loieclosuie takes place when the
sulects ielusal, ieection, oi iepudiation ol |c ncn du pcrc ieaches a point
wheie the pateinal signiei is cast outside ol the synlolic altogethei. The
paiadox ol loieclosuie is that the signiei which conleis oidei, identity,
and law upon the synlolic is loiced outside ol the sane synlolic oidei it
giounds.
102
It is loi this ieason that loieclosuie nanilests itsell in a ceitain
kind ol niiaculous synlolic cieativity.
103
The hallucinations ol the psy-
chotic, Lacan suggests, aie specically neological in chaiactei, naiked ly
autonyns, new conpound woids, puiely honophonic equivalences, and a
stiuggle against the onnipotent woids ol God.
104
On this iead, il theie weie
in Castio Hlongwane a ceitain opeiation ol psychosis, it would nanilest
itsell at the point wheie the text ienanes the acionynAIDS and intioduces
its node ol tiuth pioduction as a niiacle akin to a soveieign peiloinative
(let theie le light).
105
Like Piesident Schieleis autoliogiaphy, the validity
ol the texts statenents would deiive lion its attenpt to occupy the gap in
the synlolic lelt open ly the loieclosed-upon ncn du pcrc. But, keeping
in nind that loi Achille Mlenle, as loi Cail Schnitt, the categoiy ol the
784 Adun Sitzc
niiacle is linked to the paiadox ol the soveieign exception, wheie the sovei-
eign is legally exenpted lion the sane iule ol law he giounds, peihaps we
ought to considei a less psycholiogiaphical appioach to the inteipietation
ol Castio Hlongwane.
106
Fion the angle ol a ceitain concept ol political
soveieignty, the texts theoiies, which ly its own account do lattle with the
signieis ol an onnipotent appaiatus, would le what Mlenle would call a
lantasn ol powei. Issued lion the oigan ol soveieign powei, they would
le wiitten with the tip ol Gods phallus.
107
In this event, it would le inpos-
sille to iead Castio Hlongwane without situating its theoiies in the non-
discuisive suppoits that endow then with the capacity to ienain in loice
while also signilying nothing.
108
Whatevei its etiology, Mlekis naddening intiansigence loiced the TAC
into action against the sane post-apaitheid goveinnent that nany TAC ac-
tivists had lought to liing into existence.
109
In August zoo, the TAC led
suit in the Tiansvaal High Couit against the South Aliican Ministiy ol
Health and against each ol the piovincial Executive Councils ol Health,
denanding that Neviiapine le nade availalle to HIV-positive piegnant
wonen giving liith in pullic health institutions, and that the goveinnent
inplenent an eective national piogian to pievent MTCT ol HIV. The
TAC won the case in Decenlei zoo, with the high couit iuling that the
state lanonNeviiapine outside pilot sites was unustialle,
110
only to lace
an innediate appeal ly the Ministiy ol Health. At issue in the Ministiys
appeal was a questionconceining the lalance ol poweis undei the newCon-
stitution: ly iequiiing the goveinnent to pievent MTCT, was the Constitu-
tional Couit cieating health policy (that is, oveistepping its constitutional
linits) oi neiely enloicing the Bill ol Rights?
111
It is woith dwelling on this
question loi a nonent. Given the ease with which the teinupurtncid lends
itsell to netonyny, it is no suipiise that the social antagonisns aiound
tieatnent access would quickly lecone naiiated as a stiuggle against a new
apaitheid. Though iecouise to the tein is ly no neans inappiopiiate, the
tioulle with applying it stiaightloiwaidly to the ANC-led goveinnent is
that the ihetoiical plus ol a dianatic dialectical ieveisal does not oset the
logical ninuses ol occluding the teins contested histoiiogiaphy, olscui-
ing the caie with which the TAC positions itsell ielative to the ANC and
to South Aliicas 6 Constitution, and olluscating the conciete way in
which the political legacy ol apaitheid is diiectly at stake in the political
techniques ly which the TAC stiuggled loi access. A noie nuanced vei-
sion ol the sane aigunent would suggest that the TACs stiuggle against
Dcniu|isn 785
the Mleki adninistiation is less ieducille to a stiuggle against the ANC
pei se, than against the enduiing poweis ol the executive lianch in paiticu-
lai.
112
In , Bainey Pityana olseived that, undei apaitheid, the piinciple
ol pailianentaiy soveieignty had iesulted in the eiosion ol the powei and
inuence ol the udiciaiy inlavoui ol the executive.
113
The udiciaiys inpo-
tence undei the Westninstei systen ielegated it to the neie enloicenent
ol iacist laws it could not and, inany case, oltenwould not contest. Giventhe
extent to which ninoiity white supienacist iule depended on unchecked
executive powei, it nakes sense that Pityana would conclude his aigunent
ly suggesting that, anong othei things, those who will woik on a newcon-
stitution need to ensuie that theie is a genuine sepaiation ol poweis and
that the powei ol the executive is linited.
114
In post-apaitheid South Aliica, the stiuggle to naintain the indepen-
dence ol the udiciaiy has taken on a contiadictoiy loin, since, despite sig-
nicant piogiess, the couits ienain all lut inaccessille to the poois, and
continue to le conposed ol nany ol the sane white udges who piesided
so lecklessly undei apaitheid.
115
South Aliicas Constitutional Couit, which
cane into leing on Feliuaiy , , was designed to iespond to, il not
also iesolve, this contiadiction. Moie than any othei uiidical-political insti-
tution cieated ly the new Constitution, it was to seive as the loundation
loi the Bill ol Rights and the sepaiation ol poweis that weie to have dened
the post-apaitheid Rccntsstuut.
116
The Couits poweis weie to ensuie that the
seat ol soveieign powei in post-apaitheid South Aliica would le concen-
tiated noie in the Constitution and in the udiciaiy than in the legislatuie
oi executive. The stiong aigunent onlehall ol this appioachis that it would
le alle to piovide a uiidical-political lianewoik capalle ol lawlully disnan-
tling apaitheids white supienacist legacy. Because the new Constitutions
Bill ol Rights included usticialle socioecononic iights, and lecause the
executive lianch ienained iesponsille loi the scal consequences ol any
given national social and econonic policy, the new Constitutions sepaia-
tion ol poweis positioned the Constitutional Couit to lecone a site wheie
the socioecononic legacy ol apaitheid could le contested, as it weie, at the
expense ol the executive.
117
Yet, ly that sane token, the intioduction ol the
newConstitution was less a hannei llowthan a heait tiansplant: it did not
shattei apaitheid in a single stioke lut intioduced an oigan that, il success-
lul, would le capalle eventually ol ciiculating noniacialisn in the capillai-
ies ol the lody politic. But heiein lies one ol the signatuie linits to the con-
stitutionalist appioach to political tiansition. The tioulle is not only that,
786 Adun Sitzc
as Heinz Klug aigues, to date theie have leen veiy lewconstitutional chal-
lenges to the lasic inequalities which aie pait ol apaitheids legacy, lut also
that, when it cones to the lasic inequalities that aie the legacy ol apaitheid,
it is not cleai what a constitution can do.
118
The TACs legal challenges against the executive lianch aie one ol the
ist signicant tests ol the socioecononic iights set loith in the Consti-
tution, as well as one ol the ist signicant tests ol the lalance ol poweis
letween the executive and the udiciaiy.
119
As such, the TACs case is less
a ienewal, sequel, oi analog ol the stiuggle to constitute a post-apaitheid
South Aliican state than a conciete and diiect extension ol that stiuggle.
Appioached lionthis angle, wheie the sepaiation ol poweis lecones intel-
ligille as a site loi contestation ovei the political tiace ol apaitheid, one ol
the noie distuiling aspects ol Mlekis denialisneneiges. As it piolonged
its denialisneven altei losing its Constitutional Couit appeal in ]uly zooz,
the Mleki adninistiation tuined one ol the loundational institutions ol
the post-apaitheid Constitution into a point wheie the sane Constitution
loundeis. Altei the MTCT case, it seened that the Mleki adninistiation
would legin to clinl down lionits denialisn(not least lecause, that sane
nonth, the Mleki adninistiation announced that it would also nake ARVs
availalle to iape suivivois). But it was piecisely at that point that Castio
Hlongwane was leaked. Even the TACs couit victoiies, which suggested
that usticialle socioecononic iights aie indeed piacticalle,
120
weie not sul-
cient to liing into existence the MTCT piogians legitinated in then.
Denialisn had leen oveiiuled in the Constitutional Couit, lut it was still
in eect liopolitically. In Decenlei zooz, the executives delays loiced the
TACto lodge a conplaint with South Aliicas HunanRights Council.
121
The
conplaint called loi an investigation ol contenpt ol couit ly the Mpuna-
langa MEC loi Health, since the MTCT piogian suppoited ly the highest
level ol the South Aliican udiciaiy had still not leen inplenented. In ]anu-
aiy zoo, Tshalala-Msinang again aigued that gailic, lenon, olive, and
Aliican potatoes could le used in place ol ARVs to stiengthen innune
systens, while also llocking a Glolal Fund disluisenent ol s;z nillion
intended to puichase ARVs inKwaZulu-Natal. InMaichzoo, liustiated ly
the executives piolonged ielusal, the TAC intioduced anothei civil disole-
dience canpaign. When, altei loui yeais ol patient civil iights oiganizing,
the TAC laid chaiges ol nuidei and culpalle honicide against nenleis ol
the ANCgoveinnent, oi whenit inteiiupted the ninistei ol healths speech
Dcniu|isn 787
to call hei a nuideiei, theii tactics weie haidly, as sone have chaiged, out
ol oidei than peihaps long oveidue.
122
Besides suggesting that the poweis ol cccutcriu pctcstus have nanaged to
peisist in post-apaitheid South Aliica, Mlekis denialisn has thus denon-
stiated the liagility ol even an extienely stiong Rccntsstuut. When the lasic
iight at issue is the iight loi access to health caie seivices, and when the
seivice in question consists ol access to a chenical conpound capalle ol
llocking HIVs ieplication, the essence ol a iight is not, as connonsensi-
cal discouises ol iight piesuppose, piedicated ol space (wheie the decisive
questions concein inclusion oi exclusion, leing inside oi outside iights
donain, staying within oi stiaying leyond its linits). Wheie the exeicise ol
iights is dened ly an expiiation date, it is tine that is ol the essence. The
Mleki adninistiations exeicise ol executive powei lollowing, and aigu-
ally even piioi to, the MTCT case opened a liotenpoial exception to iights
withinthe space ol iights itsell.
123
Denialisnis anexeicise ol political powei
in which the executive lianch exeicised a powei to let die without also, at
the sane tine, ievoking oi suspending the constitutional piovisions that
guaiantee a iight to lile.
Uliike Kistnei thus has a peisuasive case when she applies to Mlekis
denialisnAganlens analysis ol the soveieign powei and naked lile.
124
But,
ly that sane token, Kistneis stiaightloiwaid application ol Aganlen also
olscuies the way that denialisn thiows the doninant ieading ol Aganlen
into question. The Mleki adninistiations lile-denying exeicise ol sovei-
eignpowei consisted not ina declaiationol a state ol eneigency, lut, onthe
contiaiy, in a stalwait ielusal to issue such a declaiation.
125
By not declaiing
the health eneigency that only the executive lianch, thiough the Ministiy
ol Health, could declaie, Mleki delayed tiiggeiing the TRIPs clause that
would have activated key piovisions ol Aiticle ol the TRIPs agieenent
and enalled the conpulsoiy licensing ol inexpensive veisions ol HIV[AIDS
theiapies.
126
Alandoned within the inteival ol these delays, those clain-
ing theii iight to lile in an exenplaiy wayin a way that sciupulously and
explicitly ained the lasic iights set loith in the new Constitutionweie
neveitheless unalle to liing those iights to lile. Beloie leing alle to see
the liuits ol theii laloi in the TACs August zoo victoiy, TAC activists
Queenie Qiza, Edwaid Malunda, Chiistophei Moiaka, and Chailene Wil-
788 Adun Sitzc
son, to nane ust a lew, succunled to AIDS and died. Theii deaths weie
loieseealle, and could have leenpievented had they had access to the theia-
pies they weie lully within theii iights to ieceive. But theii iight to lile was
denied ly the Mleki adninistiations soveieign ielusal to exeicise its own
soveieign powei.
It does not lollow lion this that those who died piotesting theii iight to
lile weie victins ol lalse consciousness, oi that the TAC was duped ly the
Constitution into liniting itsell to neiely legal tactics (the veiy opposite is
tiue), oi that iights aie not woith ghting loi, oi that the states denial ol
the lasic iight to lile in this instance sonehow cancels out the neiits ol
iights pei se. The tioulling inplication ol denialisn is iathei that necio-
political alandonnent can take place even in a iolust Rccntsstuut. Denial-
isns coiollaiy, in this iespect, is the uigency ol posing liopolitical ques-
tions not neiely in constitutionalist teins, wheie the possession ol a iight
is itsell takenas a loinol political powei, lut, noie lundanentally, inteins
ol the innanent nodes ol existence ol people piovided with iights. Wheie
the possession ol iight is neithei coextensive with noi even deteininant ol
political powei ielations, the latteis ielation to lile will lecone lelicitous
oi salutaiy less thiough the iecitation ol vaiious lacis iights than thiough
ieleience to the twist oi toision that is loth piioi to and inconnensuialle
with the loundation ol the constitution itsell.
127
In these teins, the specically political philosophical question posed ly
denialisn is not why Mleki says what he says, whethei he peisonally
lelieves in his own utteiances oi not, whethei he ieally is nad oi not, and
so on. It is how the post-apaitheid state acquiied the powei to deny lile and
to pieseive iights in one and the sane gestuie. Heie it is woith iecalling
that the olscuie and olten lizaiie wiitings ol David Rasnick, Petei Dues-
leig, Roleit Root-Beinstein, and otheis did not lecone |ijc-denying until
theii iteiations enteied into ielation with the nondiscuisive loice specic to
the institution ol pctcstus cccutcriu.
128
Mlekis iiiesponsilility loideiing
on ciininality is insepaialle lion the ciininality ol soveieignty itsell.
129
Yet il theie is theieloie no denialisnwithout the soveieign powei to let die,
so too is theie no soveieign powei to let die without its own scandalous
genealogy.
130
What the contenpoiaiy ciitique ol the Mleki adninistiation
too olten nisses is that a ceitain denialisn dened the apaitheid states
ielation to HIV[AIDS lion the veiy leginning. In the eaily os, a nun-
lei ol nedical woikeis legan aiguing that the iapid spiead ol the epidenic
thiough vaiious llack populations was ielated to a datalle and denon-
Dcniu|isn 789
stialle pattein ol inaction on the pait ol the apaitheid goveinnent since
8.
131
This inaction was especially egiegious given the goveinnents loie-
knowledge ol the possilility ol epidenic.
132
In as eaily as 8, the Depait-
nent ol National Health and Population Developnent estallished an AIDS
Advisoiy Gioup.
133
Foi ieasons ol iacisn and honopholia,
134
the lew edu-
cational initiatives it did oiganize weie linited to alnost exclusively white
populations.
135
Only in z, altei conleiiing with the Health Secietaiiat
ol the newly unlanned ANC,
136
did the Depaitnent ol Health estallish a
national AIDS piogian.
137
Wiiting in that yeai, Alan Flening shaiply coi-
iected the lanent that South Aliica had alieady lost the lattle to pievent
AIDS. I disagiee: lattle was nevei oined.
138
A yeai latei, Wilson Caiswell
issued a danning ciitique outlining the delileiate natuie ol this inaction.
SouthAliica has the inliastiuctuie and healthlunding needed to check
AIDS, lut lailed to take action. The cential health ninistiy did not
iespond to the epidenic until o with the estallishnent ol an AIDS
unit, secondaiy school AIDS pievention piogians and packages in
8 languages, a neutial national inloination canpaign, woikshops to
inciease awaieness, and lunding to oiganizations taigeting haid-to-
ieach gioups. The AIDS unit was soon neiged into a health piono-
tion section and the units head ied, with all the pievention initia-
tives teininated except the continued availalility ol panphlets in only
English and Aliikaans. An ocial conplaint has leen nade to no avail
against the health depaitnent ocial who closed the AIDS canpaign.
Meanwhile, the goveinnent contends that it holds no iesponsilility
loi educating its population in the pievention ol AIDS. These iecent
actions suggest that the goveinnent is connitting genocide ly allow-
ing excess noitality lion AIDS to decinate Black heteiosexuals dui-
ing the inpending peiiod ol inteiin iule and political tiansition.
139
Caiswells aigunent is haidly a conspiiacy theoiy. Wiiting in 88, Susan
Sontag cited then loieign ninistei Roelol Pik Bothas oninous waining
that the teiioiists aie now coning to us with a weapon noie teiiille than
Maixisn: AIDS.
140
That the apaitheid goveinnent ieacted to HIV[AIDS
piinaiily as a tactic ol wailaie is cleai lion othei souices as well. In ,
two loinei apaitheid agents applied to the Tiuth and Reconciliation Con-
nission loi annesty loi enploying HIV-positive ex-PAC and ANC nen-
leis in o to spiead HIV[AIDs in llack liothels.
141
Yet even as unthink-
alle as this act is, it is not an aleiiation lion the ciine that is apaitheid
790 Adun Sitzc
itsell. Apaitheid puisued genocide not only thiough the polices weapon-
ization ol people with HIV[AIDS, lut also thiough the shansoveieignty ol
the tiilal honelands. Pietei-Diik Uys nisses the naik when he suggests
that in the past the South Aliican goveinnent killed people, now we
ust let then diel
142
One need only ieview the last hall centuiys llack
inlant noitality iates to see that Biko was not exaggeiating when he aigued
that the tiilal cocoons called honelands aie nothing else lut sophisti-
cated concentiation canps wheie llack people aie allowed to suei peace-
lully.
143
The soveieign powei to let die was always integial to the necio-
politics ol the apaitheid state. That this powei was not suciently dissolved
with the tianslei ol powei in q is cleai lion the inplenentation ol
the AIDS Plan the ANC developed in conceit with the Depaitnent ol
Health altei its unlanning. Though the plan was piogiessive in nany
iespects, nal political authoiity loi its cooidination iested with the execu-
tive lianch, wheie, despite consideialle luieauciatic conlusion in the
inteivening yeais, is wheie it ienains today.
144
Il, as Helen Schneidei,
]oanne Stein, and Mandisa Mlali can aigue, the ieal piollen undeilying
AIDS inplenentation lailuie in South Aliica is the authoiitaiian style ol
the political leadeis cooidinating that inplenentation, it is lecause ol an
inconplete tiansloination ol the soveieign poweis that dened the woist
ol apaitheid.
145
Denialisn is less a question ol Mlekis utteiances oi
Mokalas psyche than nattei ol the nondiscuisive loices specic to institu-
tions ol cccutcriu pctcstus. In the last analysis, it is against the ienanence ol
these loices that the TAC stiuggles. The lundanental political philosophi-
cal question posed ly denialisnis howa soveieign powei to alandon naked
lile to unceienonial death was alle to suivive South Aliicas tiansition to
denociacy.
Posing the piollen in this nannei sinultaneously opens a way to think
alout the loins ol iesistance to denialisn. In zoo, the leading institu-
tions ol glolal nass nedia locused consideialle attention on TAC chaii-
peison Zackie Achnats pledge not to take ARVs leloie they lecane avail-
alle in the South Aliican pullic health caie systen.
146
Piecisely lecause
ol the hagiogiaphic quality ol this attention, which olscuies the chaiactei
ol the TAC as a lioad giass-ioots novenent, it is has lecone necessaiy
to iethink Achnats inteiventions on the lasis ol his own wiiting. By the
lattei, I nean to the texts Achnat has pullished on sex, politics, and iep-
Dcniu|isn 791
iesentation aiound the sane tine he lounded the National Coalition loi
Gay and Leslian Equality. Even as the veiy lest ol the iecent hagiogiaphies
take pains to include nentions ol Achnats six nonths as a nale piostitute,
they loi sone ieason tieat as unspeakalle his tine as a ciitical theoiist.
147
The inplication ol this loieclosuie is that one cannot loth bc a naityi (as
the hagiogiaphies assune Achnat is) and ccr u criticu| tnccry cj naityi-
don (as Achnat has done in his wiiting), as il the auia and authenticity ol
political saciice would le sonehow conuied away ly explicit account ol
the nechanisns ly which such eects aie pioduced.
In an odd way, this inplication is entiiely consistent with the aigunents
ol the ielused texts thenselves. In his q O the Contiol Tiack: Powei,
Resistance, and Repiesentation in South Aliican Docunentaiies, Achnat
oeis a theoiization and ciitique ol ideas which invoke sueiing, saciice,
and death as necessaiy loi lileiation.
148
He locuses, in paiticulai, on the
natiices ol powei and knowledge that, piioi to any puie souice ol populai
nenoiy, nake possille the docunentaiy lnic naiiation ol the antiapait-
heid stiuggle as an unained people piepaied to conliont the nightiest
nilitaiy loice on the Aliican continent with the powei ol tncir cwn dcutn.
149
His ciitique ol this natiix is that, ly conguiing death as saciice, it iecu-
peiates liondeath a suiplus value, inthe loinol the signiei ol the naityi,
that docunentaiy lnessentially enoys andexploits. The innanent powei
ol these signieis, Achnat suggests, is theii capacity to hauntto possess
the sulect that witnesses then.
150
At the close ol Achnats essaywhich, like his My Childhood as an
Adult Molestei, ends with an explicit enphasis on leginning
151
his text
takes a netaciitical tuin. As il the essay had leen diiected, all along, against
the Gieco-Ronan-Chiistian netaphysic that tianslates naityidon into
witnessing, sulstitutes testinony loi witnessing, and deiives piotest lion
testinony, Achnats ciitique ol the content ol anti-apaitheid docunen-
taiies enteis into a ietheoiization ol the way that naityidonis insciiled in
the testanentaiy loin ol piotest docunentaiy itsell. Acknowledging that
the ninetic appioxination to tiuth that denes the docunentaiy loin
is deiived lion the expeiience ol sueiing, iepiession, and death, Ach-
nat suggests that this nineticisn is itsc|j gcncrutivc cj the saciicial cycle
ol violence it clains neiely to iepiesent. The docunentaiy enphasis on
naityidon, he aigues, nay in lact le the constant ieinvention ol the oiigi-
naiy tiauna ol colonial wais and conquest, iacial donination, gendei and
class inequalities, pioected onto naityied lodies.
152
Quite unlike Ren
792 Adun Sitzc
Giiaid, lion whose analytic ol nineticisn Achnat naintains a studied
distance, Achnat aigues that insolai as docunentaiy lndeiives its powei
ol tiuth lion what he calls the powei ol ones own death, the coiielation
ol attestation and conscience that denes its node ol tiuth pioduction will
necessaiily rcquirc death, in the loin ol the iepioduction ol the naityis
on whose lehall it then clains to leai witness. Achnat suggests that this
deiivation ol tiuth and politics lion death lecones especially intoleialle,
undei conditions wheie inpeiialist lantasies ol Aliican nihilisn nd theii
ihyne in the Aliican states exeicise ol a ceitain denialisn.
Living in Aliica on a continent which signies death and destiuction
in the inpeiialist inaginaiy, it is inpeiative to uncouple saciice lion
iesistance. Faced with the denial ol state iesponsilility loi the lasic
conditions ol lile in villages, towns, and cities acioss the continent we
cannot indulge the genocidal lantasies ol saciice. Hence, it is distuil-
ing to iead lnnakeis who insist upon valoiising saciice and toituie
as a necessity loi the pastoial ieinvention ol Aliica.
153
To oppose the pleasuie piinciple insciiled indocunentaiy attestation, Ach-
nat tuins to Foucaults aigunent, in the nal chaptei ol the ist volune
ol Tnc !istcry cj Scuu|ity, that death is poweis linit. His ieading ol Fou-
cault is piecise and sultle, and I would like to iead ovei Achnats shouldei
in oidei to diaw out what I leel aie its inplications. In the chaptei to which
Achnat tuins, Foucault legins ly discussing putriu pctcstus.
154
Without
going any luithei, it is alieady woith noting that, in the political philoso-
phies ol Kant and Hegel, the notionol testanent ieceives its intelligilility
lion the sane Ronan laws ol patiiaichal inheiitance that give iise to the
nodein concept ol state soveieignty.
155
The codes ol putriu pctcstus that give
the lathei the iight to decide on the lile oi death ol the son also stipulate the
conditions undei which the will ol the lathei can suivive his death. Testa-
nents aie designed to guaiantee piinogenituie (the institution so opposed
ly the eaily Maix): the tcstis in tcstuncnt piesupposes the tcstcs ol the putriu
pctcstus.
The stakes ol Achnats ciitique ol docunentaiy attestation lecone
cleaiei once iead alongside Foucaults inquiiy into the linits ol putriu pc-
tcstus. His ciitique lecones intelligille as a challenge to docunentaiy ln
to think leyond its capitulation to the nihilisn insciiled in the patiiaichal
concept ol testanent. To liane inages ol death as signieis ol naityidon
is not only to locate the tiuth, test, oi touchstone ol political stiuggle in
Dcniu|isn 793
death. It is also to cone into possession ol the inages ol the dead as il they
weie nothing noie than piopeities invested with a ceitain political value
as il the dead have neiely lelt lehind theii inages in a last will and tes-
tanent the validity ol which it then lalls to docunentaiy ln to execute
as a kind ol estate. But ly placing this kind ol value on death, Achnat
seens to aigue, docunentaiy lnalso unwittingly tuins death itsell into a
value. It exoicises the powei innanent to the inages ol the dead (the powei
to possess the living) even as it teaches the unhaunted living to value lile
as nothing noie than a potential political death. Docunentaiy ln would
thus ienain undei the sway ol putriu pctcstus to the extent that its ethics ol
attestation deiives its undeistanding ol death liona piopeity-lased notion
ol inheiitance. Resistance to putriu pctcstus would, in tuin, iequiie a depai-
tuie lion docunentaiy lns capitulation to and iecapitulation ol the tes-
tanentaiy poetics giounded in this undeistanding.
Why else night Achnat le ieading Tnc !istcry cj Scuu|ity in qa
nonent ol political tiansition that also naiked a unctuie wheie conles-
sion and testinony weie leconing the doninant iegines ol intelligilility
loi the naiiation ol apaitheid. Whethei in the nanaged spectacles ol the
Tiuth and Reconciliation Connission oi in the spate ol liogiaphies and
autoliogiaphies that eneiged in the os, discouises on the tiansition
lionapaitheid lecane goveined ly the iegine ol tiuth Foucault has called
ccnc|cgcsis. Though ccnc|cgcsis can le ioughly tianslated as iecognition
ol lact, Foucault tieats it as a technology ol the sell designed to puiily the
soul lionsinthiougha sell-ievelation(pub|icutic sui) that is sinultaneously
a sell-ienunciation (the extiene loin ol which is naityidon). Like any
technology ol the sell, exonologesis is a distinctly collective act, whethei in
its nedical oi uiidical loin, it unlolds as a dianatic iitual ol penitence that
ieconcites the penitent with the connunity and the connunity to itsell.
Foucaults inquiiy into ccnc|cgcsis, which advances his discussion ol con-
lession in the ist volune ol Tnc !istcry cj Scuu|ity, appioaches it as a spe-
cically pastoial powei, a node ol sulectivation that linds the sulect to
itsell thiough vaiious piactices ol sell-knowledge: pullicly disclosing ones
wounds in oidei to le cuied, leaiing witness against and ielusing onesell
in oidei to nake a lieak with ones past, and ieaining the lact ol ones
delity to the piinciple ol salvation thiough tiuth.
156
Retuining to Foucaults connents on ccnc|cgcsis helps us ieiead the
opening ol Achnats My Childhood as an Adult Molestei, which ien-
deis testinony decidedly indistinct lion the nost uncensoied lantasy.
157
794 Adun Sitzc
This pieleience not to delivei stiaight testinony naiks a depaituie lion
the disciplines ol sell-ievelation that otheiwise doninated the pioduction
ol discouise alout apaitheid in the nid-os. Achnat instead locates the
tiuth ol politics, and the politics ol tiuth, in a oylul nilitancy that ains
even death itsellthough in a veiy cautious way. Reading Foucaults ie-
naiks on the natuie ol contenpoiaiy soveieign powei, Achnat suggests
that while death is the linit ol powei, saciice liings a dieient powei
ielation to leai on the synlolisn ol death. The piivate nonents ol death
lecone tineless pullic inages ol saciice. Against ccnc|cgcsiss ielent-
less inpeiative to conless and testily pullicly, Achnat concludes his essay
ly calling loi loins ol docunentaiy lnthat ensuie that death once again
lecones the linit point ol powei and an eteinal nonent ol piivacy. This
nay seen like an odd point with which to conclude an ending that is sup-
posed to doulle as a leginning. But iead alongside Foucaults aigunent
in Tnc !istcry cj Scuu|ity, the ainative keinel enciypted in it lecones
cleaiei. Il we keep in nind that, loi Foucault, death is the linit not to powei
pei se, lut the linit to political soveieignty vested with a powei to nukc live
oi to cust cut into death, we can lollow the way in which Achnats aina-
tion ol a piivate death is a line ol ight lion the soveieign powei to decide
lile and death.
This lecones vitally inpoitant when we considei the utteiance
that, in its vaiious iteiations ovei the last loui yeais, has lecone glolally
known as Achnats pledge. I will not take expensive tieatnent until all
oidinaiy South Aliicans can get it on the pullic-health systen. That piol-
ally neans that I will die a hoiiille death, even though nedical science
has nade it unnecessaiy.
158
As we know, the loice ol Achnats peiloina-
tive culninated lelicitously in his ingestion ol ARVs in eaily August zoo,
days altei the Mleki adninistiation caved to the TAC and announced that
the goveinnent would soon ioll out a univeisal AIDS plan. But in naking
and keeping his pledge even thoughespecially whilehis lile hung in
the lalance, didnt Achnat contiadict eveiything he wiote in q? As his
own lile and possille death lecane the olect ol nuneious docunentaiies,
didnt he suiiendei to the veiy netaphysic ol naityidon, piotest, and tes-
tinony against which he eailiei wiote so passionately? Didnt Achnats
ielusal to take ARVs iequiie hin to sulect hinsell to the veiy soveieign
powei against which he piotested, nanely, the powei to let die?
The hagiogiaphies inply exactly this. But to ieadAchnats qand
texts is to gain a newangle lionwhich to undeistand his pledge. The lattei,
Dcniu|isn 795
like the loinei, consists ol a depaituie lion the entiie catalog ol tianscen-
dental and essentially nihilistic poweis collected undei the iuliic ol putriu
pctcstus. Up to and including naityidon. Though Achnat nade a pledge
ieleiiing to the possilility ol his own death, it would le a nistake to pie-
sune this pledge expiesses a desiie to piotest oi leai witness thiough oi to
the powei ol ones own death. Recalling that Achnat is a dedicated ieadei
ol Bataille, and a wiitei loi whon lile, sex, and politics aie inextiicalle, let
ne conclude ly dwelling on the singulai politics ol his pledge. To do so
is to wondei whethei, piioi to its utteiance, peihaps even as its condition
ol possilility and as the souice ol its powei, it was sultended ly a seciet,
cautious pact with the viius itsell. A pact ol what kind? In , Alexan-
dei Gaica Duttnann aigued that the anxiety ol living with HIV[AIDS is,
in pait, that the viius undeinines the ontological distinction letween lile
and death. One no longei lives and has not yet died, lecause one has died
alieady and neveitheless lives on, lecause lile and death neige leyond iec-
ognition.
159
Undei political conditions wheie death naiks poweis linit,
wouldnt this indistinction anount to un cdgc? Wouldnt it yield a powei
to piotest soveieign powei lion ust leyond, oi ust leloie, the linit that
denes its uiisdiction? Supposing it weie even possille loi a viius to sign a
pact, that is to say, to keepits pionise, wouldnt one ol the eects ol that pact
le a chance to take pait in a conlat against soveieign powei without also
having anything to do with the linits it insciiles in lile? Signing a seciet
pact with the viius would not heie le a nattei ol using the powei ol ones
own death as an instiunent ol political leveiage. It would le a nattei ol
cautiously opening a ielation to death that neveitheless did not deiive its
political powei lion death. Pait ol the powei ol such a pact would deiive
liongiving onesell ovei to the viius, suiiendeiing to its ieplication, lut on
one ciitical condition: that one gain lionthat ieplication a newpowei. This
powei would le neithei a powei ol ones own death noi a powei to iepie-
sent death. It would instead le a paiadoxical powei that deiives its specic
nodality lionthe ontological indeteininacy ol the viius itsell: liona viius
that is neithei dead noi alive, the powei to live without dying on the teins
ol soveieign powei.
Pledging to ienain without ARVs until the pooiest have access to then
would then le a way ol intioducing a pionise, and theieloie the political
itsell, into the ielations letween people living with HIV lut without ARVs.
Letting his lody enlody a wiong that itsell calls loi ustice would le a way
ol aining the sane HIV-positive political connunity his pledge posits.
796 Adun Sitzc
Putting his lile on the line would le neithei stoicisn noi sutyugrunu,
160
lut
a way ol diawing on the viius to iedene the line letween lile and death
itsell: to ie-cieate the diagnosis positive in and as a nane loi the aina-
tion ol lile with HIV. The pledge would not, then, le a pact ol the soit that
linds one to onesell in solipsistic noial consistency (pionise-keeping).
161
It would le a piocess ol individuation dened ly a piotest ol the condition
ol the dead and the living dead.
162
To iteiate the viiuss own potency in and
as the powei ol that pledge would le to tiansciile the veiy powei ol the
viius into a powei ol tiuth the nost poweilul eect ol whichtieatnent
would anount to the viiuss iecession. It would le to entei into a cautious
ensenlle with the viius that was at the sane tine a conlat against it. It
would le to tuin the viius lack on itsell, to nake it woik on itsell, to tuin
the viiuss own powei into a potential loi the viius to le naintained in pii-
vationto live, with it.
Who knows whethei this pact, inlact, exists. Peihaps I have ust inagined
it. But what is cleai enough is that, giasped hagiogiaphically, the tiuth-loice
ol Achnats pledge cannot lut le nisiecognized as the naityidon lion
which Achnat, in q, uiged ight. On these teins, it would ienain intel-
ligille neiely as a paiticulaily lold and loicelully instiunentalist loin ol
dissent, olection, oi conplaint. But othei visions ol piotest aie possille.
Fion Zackie Achnat one can leain that prctcst also signies prcnisc and
urnuticn, and that to piotest and to live aie undenially the sane.
Notes
The authoi would like to thank Ciystal Baitolovich, Sanay Basu, Susan Ednunds, Bol Gates,
Michael Goode, Rogei Hallas, Any Kapczynski, Mandisa Mlali, and Maiy Stiunk loi theii
connents and ciitiques on dialts ol this essay.
See Phillipe Riviie, In Denial alout a Deadly Futuie: South Aliicas AIDS Apaitheid,
tians. Malcoln Gieenwood, Lc Mcndc Dip|cnutiquc (August zooz), http:[[nondediplo
.con[zooz[o8[oqaids (accessed Apiil q, zooq). This essay will instead take up the line
ol inquiiy opened ly Mandisa Mlali, who suggests that denialisn is a new -isn in
South Aliica, and Uliike Kistnei, who aigues that it is a newway ol exeicising political
powei in natteis ol lile and death. See Mandisa Mlali, HIV[AIDS Policy-Making in
Post-Apaitheid South Aliica, inStutc cj tnc Nuticn. Scutn Ajricu .cc.cc, ed. ]. Daniel,
A. Halil, and R. Southall (Cape Town: Hunan Sciences Reseaich Council Piess, zoo),
z;n , Uliike Kistnei, The Constitutional Right to Live, and the Political Powei to Let
Die, Dcbutc 8 (Septenlei zooz): 6.
z See also Thalo Mleki, Lettei lion Thalo Mleki to Bill Clinton, Wusningtcn Pcst,
Apiil 8, zooo, Baiton Gellnan, South Aliican Piesident Escalates AIDS Feud, Wusn-
ingtcn Pcst, Apiil , zooo, Thalo Mleki, Speech ol the Piesident ol South Aliica at the
Dcniu|isn 797
Opening Session ol the Conleience (speech given at the Thiiteenth Inteinational AIDS
Conleience, Duilan, SouthAliica, ]uly , zooo), ]on]etei, Political Resistance inSouth
Aliica Blocks Wide Use ol HIV Diugs, Leadeis Anlivalent alout Distiilution ol Anti-
ietioviials, Wusningtcn Pcst, Octolei , zoo, ]aspieet Kindia and Diew Foiiest, ANC
Closes Ranks, Goveinnent Ocials Reluse to Dely Piesident Thalo Mleki on the Issue
ol AIDS Tieatnent, Mui| und Guurdiun, Feliuaiy zz, zooz, Feiial Haaee, Questions
and Answeis with Petei Mokala, No Antiietioviials, Please, Finunciu| Mui|, Maich ,
zooz, Rachel Swains, AnAIDSSkeptic inSouthAliica Feeds Sinneiing Doults (Intei-
view with Petei Mokala), Ncw Ycrk Tincs, Maich , zooz, Thalo Mleki, Health,
Hunan Dignity, and Paitneis loi Poveity Reduction, ANC Tcduy, Apiil , zooz.
Richaid Pithouse aigues that Mlekis lailuie to seize the oppoitunity piovided ly the
deleat ol the phainaceutical conpanies cannot le explained ly a desiie to put the nai-
ket leloie peoples health. Even naiket lundanentalists agiee that it is cost eective
to piovide the nedicines that can pievent new inlections and tieat existing inlections
iathei than enduie the cost ol nass ill health and eaily death. Mlekis inaction can
only le explained ly the lact that he genuinely takes the denialist view, suppoited ly
a tiny gioup ol iight-wing Aneiicans, that the HI viius doesnt cause AIDS and that
AIDS nedicines aie toxic (AIDS Activists Take ANC Goveinnent to Couit, Grccn
Lcjt Wcck|y, Decenlei z, zoo, conpaie Richaid Pithouse, Mlekis AIDS Stance
Slanned, Grccn Lcjt Wcck|y, ]uly z6, zooo, ).
q See Mandisa Mlali, Mlekis Bizaiie AIDS Theoiies, Mui| und Guurdiun, Maich z,
zooz.
Mahnood Mandani, Citizcn und Subjcct (Piinceton: Piinceton Univeisity Piess,
6), z;.
6 See Rod Noidland, Aliica in the Plague Yeais, Ncwswcck, Novenlei zq, 86, qq,
Michael Seiiill, Inthe Giip ol the Scouige, Tinc, Feliuaiy 6, 8;, 8, MaiilynChase,
AIDS Has Spiead Alnost Eveiywheie in Aliica, Zaiie Doctoi Tells Pailey, Wu|| Strcct
]curnu|, ]une zq, 86, Maiilyn Chase, Giowing AIDS Peiil in Aliica Is Seen, Huge
Medical, Educational Push Asked, Wu|| Strcct ]curnu|, Novenlei q, 86, Renee Sala-
tiei, Maitin Foienan, ]on Tinkei, and Maity Radlett, A!DS und tnc Tnird Wcr|d (London:
Panos Institute, 8).
; Susan Sontag, A!DS und !ts Mctupncrs (NewYoik: Faiiai, Stiaus, and Giioux, 88), .
8 See Achille Mlenle, On tnc Pcstcc|cny (Beikeley: Univeisity ol Caliloinia Piess, zoo),
q, SinonWatney, Missionaiy Positions: AIDS, Aliica, and Race, in Pructiccs cj Frcc-
dcn. Sc|cctcd Writings cn !!VA!DS (Duihan: Duke Univeisity Piess, q), ozo,
lut conpaie Ato Quayson, Olveise Denoninations: Aliica? Pub|ic Cu|turc q. (Fall
zooz): 8;.
See E. B. Gouws and B. G. Willians, Science and HIV[AIDS in South Aliica: A Review
ol the Liteiatuie, Scutn Ajricun ]curnu| cj Scicncc 6 (]une zooo): z;q, Louis Giund-
lingh, HIV[AIDS inSouthAliica: ACase ol Failed Reponses Because ol Stignatization,
Disciinination, and Moiality, 8q, Ncw Ccntrcc q6 (Novenlei ): 8,
Louis Giundlingh, Goveinnent Reponses to HIV[AIDS in South Aliica as Repoited
in the Media, 8q, Scutn Ajricun !istcricu| ]curnu| q (Novenlei zoo): z
, R. Shei, Acquiied Innune Deciency Syndione (AIDS) in the RSA(Supplenent),
Scutn Ajricun Mcdicu| ]curnu| (Octolei 86): zz6, W. Beckei, HTLV-III Inlection in
798 Adun Sitzc
the RSA (Supplenent), Scutn Ajricun Mcdicu| ]curnu| (Octolei 86): z6z;, conpaie
R. Shei, HIV Inlection in South Aliica, 8z88A Review, Scutn Ajricun Mcdicu|
]curnu| ;6.; (Octolei 8): q8.
o See ]. A. van dei Meiwe, AIDS (unpullished papei, Sud Aliikaanse Nasionale Tiust
en Assuiansie Maatskappi Bepeik [SANLAM|, 88), G. M. Oppenheinei and R. A.
Padgug, AIDS: The Risks to Insuieis, the Thieat to Equity, !ustings Ccntcr Rcpcrt 6.
(Octolei 86): 8zz, W. A. van Niekeik, Inloination on HIV[AIDS (iepoit ieleased
ly the Repullic ol South Aliica, Depaitnent ol National Health and Population Devel-
opnent, Novenlei 88), B. D. Schoul et al., Epideniological Consideiations ol the
Piesent Status and Futuie Giowth ol the Acquiied Innunodeciency Syndione Epi-
denic in South Aliica, Scutn Ajricun Mcdicu| ]curnu| ;o.q (August zo, 88): ;,
P. G. du Plessis, The Potential Inuence ol AIDS on the South Aliican Investnent
Milieu (paitial lulllnent ol MBA, Depaitnent ol Business Managenent, Univeisity
ol Stellenlosch, ), R. Schall, Statistical Analysis ol HIV Pievalence, Scutn Ajricun
Mcdicu| ]curnu| ;;. (]anuaiy o): z, E. Osloin, Foiwaid Pioection ol HIV Pieva-
lence, Scutn Ajricun Mcdicu| ]curnu| ;8.6 (Septenlei o): ;, C. ]. van Geldeien,
Insuiance and Conpensation in the Event ol HIV Inlection, Scutn Ajricun Mcdicu|
]curnu| 8.6 (Maich z): .
See G. N. Padayachee and R. Schall, Shoit-teinPiedictions ol the Pievalence ol Hunan
Innunodeciency Viius Inlection anong the Black Population in South Aliica, Scutn
Ajricun Mcdicu| ]curnu| ;;.; (Apiil o): z, R. Schall, On the Maxinun Size ol
the AIDS Epidenic anong the Heteiosexual Black Population in South Aliica, Scutn
Ajricun Mcdicu| ]curnu| ;8. (Novenlei o): o;.
z See Giundlingh, Goveinnent Responses to HIV[AIDS, q.
In 8, Ministei ol Health and Population Developnent Di. Willie van Niekeik stated
that AIDS possessed destiuctive potential stietching leyond hunan concept. It has the
potential to lead to chaos in Aliica and South Aliica, not only destioying the social and
political stiuctuies lut to lead [sic| to econonic chaos (cited in Giundlingh, Govein-
nent Responses to HIV[AIDS, z;).
q See Gouws and Willians, Science and HIV[AIDS, z;q;.
See Giundlingh, Goveinnent Responses to HIV[AIDS, .
6 See Rogei Ricklels, Living with AIDS: Thanks to New Diugs, Patients Aie Suiviving
and Woiking LongeiThey Aie a Gieatei Piesence in the Woikplace Today, Enployeis
Aie AdaptingThe Costs ol Chionic Illness, Wu|| Strcct ]curnu|, Septenlei z, 88.
; See E. M. Connoi et al., Reduction ol Mateinal-Inlant Tiansnission ol Hunan Innu-
nodeciency Viius Type with Zidovudine Tieatnent, NcwEng|und ]curnu| cj Mcdicinc
.8 (q): ;8o, conpaie Enoiy Thonas ]i., AZT Is Found to Slash the Tians-
nission ol HIV lion Motheis to Theii Inlants, Wu|| Strcct ]curnu|, Feliuaiy zz, q.
8 See Gilles Deleuze, Fcucuu|t, tians. Sean Hand (Minneapolis: Univeisity ol Minnesota
Piess, 88), qqq.
See Gilleit Ellaz, Beyond Angei: The Activist Constiuction ol the AIDS Ciisis, Scciu|
]usticc zz.q (Decenlei ): q, Paula Tieichlei, !cw tc !uvc Tnccry in un Epidcnic.
Cu|turu| Cnrcnic|cs cj A!DS (Duihan: Duke Univeisity Piess, ), z;8q.
zo See Maiilyn Chase, Piicing Battle: Buiioughs Wellcone Reaps Piots, Outiage lion
Dcniu|isn 799
Its AIDS Diug, Wu|| Strcct ]curnu|, Septenlei , 8, Maiilyn Chase, Buiioughs-
Wellcone Cuts Piice ol AZT undei Piessuie lion AIDS Activists, Wu|| Strcct ]curnu|,
Septenlei , 8, Naoni Fieundlich, Now That AIDS Is Tieatalle, Wholl Pay the
Ciushing Cost? Busincss Wcck, Septenlei , 8, , Steve Taiavella, AIDS Diug
Biings Piovideis Challenge ol Distiilution, Mcdcrn !cu|tncurc (Septenlei 8):
, The Costs ol Cuies (editoiial), Wu|| Strcct ]curnu|, Octolei q, 8, ]acol Snith
Yang, ;o Piotest Bush, Guy Ccnnunity Ncws, Octolei z, , z, Buiioughs-
Wellcone Hit ovei High AIDS Diug Piots, Cncnicu| Murkcting Rcpcrtcr zq.z6 (]une
): ;.
z Baiton Gellnan, An Unequal Calculus ol Lile and Death, As Millions Peiished in Pan-
denic, Fiins Delated Access to Diugs, Wusningtcn Pcst, Decenlei z;, zooo.
zz See Monitoiing the AIDS Pandenic (MAP), The Status and Tiends ol the HIV[AIDS
Epidenics in the Woild, Pielininaiy Repoit (]une z6, 8), . The ist study to con-
clude on the unaoidalility ol ARVs in sul-Sahaian Aliica was Manseigh et al., Cost-
Eectiveness ol Shoit-Couise Zidovudine to Pievent Peiinatal HIV Type Inlection in
Sul-Sahaian Aliican Developing Countiy Setting, ]curnu| cj tnc Ancricun Mcdicu| Assc-
ciuticn z;6.z (]uly 6): q. Latei studies codied this conclusion without also
questioning the political econonic conditions ol possilility loi the diug piices they took
as theii point ol depaituie. See Katheiine Floyd and Chailes Gilks, Cost and Financ-
ing ol Pioviding Anti-Retioviial Theiapy: A Backgiound Papei, Woild Health Oigan-
ization (Apiil ;), www.woildlank.oig[aids-econ[aiv[oyd[whoaiv.pdl (accessed
Apiil q, zooq), which concludes that ARV theiapy does not appeai to le eithei cost-
saving oi cost-eective in a developing countiy context, and this is tiue loi piophylaxis
to piegnant wonen as well as noie geneial piovision to HIV-inlected individuals ().
z See UNAIDS Fact Sheet, Access to HIV Tieatnent and Caie, Septenlei zoo, www
.unaids.oig[en[nedia[lact+sheets.asp (accessed Apiil q, zooq).
zq See Achille Mlenle, Neciopolitics, tians. Lilly Meintes, Pub|ic Cu|turc . (zoo): ;.
z See Biyan Rostion, The New Apaitheid? Mui| und Guurdiun, Feliuaiy z, zooz, ,
Maik Gevissei, AIDS: The NewApaitheid, Tnc Nuticn, May q, zoo, 6, SalihBookei
and WillianMintei, Glolal Apaitheid, Tnc Nuticn, ]uly , zoo, ;, Maitine Bulaid,
Apaitheid ol Phainacology, Lc Mcndc Dip|cnutiquc, tians. MalcolnGieenwood (]anu-
aiy zooo), http:[[nondediplo.con[zooo[o[zlulaid? [accessed Apiil q, zooq|). See,
noie geneially, Titus Alexandei, Unruvc|ing G|cbu| Apurtncid. An Ovcrvicw cj Wcr|d Pc|i-
tics (Canliidge, UK: Polity Piess, 6), Patiick Bond, Aguinst G|cbu| Apurtncid. Scutn
Ajricu Mccts tnc Wcr|d Bunk, !MF, und !ntcrnuticnu| Finuncc (Cape Town: Univeisity ol
Cape Town Piess, zoo).
z6 In , the WHO estinated that duiing q ovei . nillion people had leen in-
lected with HIV, and estinated that qo nillion could le inlected ly zooo (The Cui-
ient Glolal Situation ol the HIV[AIDS Pandenic, W!O Rcpcrt []anuaiy , |).
These weie the sane nunleis the WHO piovided to Big Phaina on May z, , and
that the CIA nade availalle to Piesident Geoige H. W. Bush that sane yeai in Intei-
agency Intelligence Menoiandun -ooo. See Gellnan, Unequal Calculus, David
Fidlei, Racisn oi Rcu|pc|itik? U.S. Foieign Policy and the HIV[AIDS Catastiophe in
Sul-Sahaian Aliica, Tnc ]curnu| cj Gcndcr, Rucc, und ]usticc ; (zoo): o.
800 Adun Sitzc
z; See Fidlei, Racisn oi Rcu|pc|itik? o.
z8 See Ennanuel Todd, Ajtcr tnc Enpirc. Tnc Brcukdcwn cj tnc Ancricun Ordcr, tians. C. ]on
Delogu (New Yoik: Colunlia Univeisity Piess, zoo), ;;6.
z See Intellectual Piopeity . . . Is Thelt, Tnc Eccncnist, ]anuaiy zz, q, ;z.
o See Roleit Weissnan, A Long Stiange TRIPs: The Phainaceutical Industiy Diive to
Hainonize Glolal Intellectual Piopeity Rules, and the Renaining WTO Legal Alteina-
tives Availalle to Thiid Woild Countiies, Univcrsity cj Pcnnsy|vuniu ]curnu| cj Eccncnic
Luw ; (6): o6z, esp. o;.
Which, as Sanay Basu has enphasized, include lut aie not linited to HIV[AIDS theia-
pies. See The Dangeious Deiadicalization ol AIDS Discouise, ZNct Ccnncntury
(Octolei z, zoo), www.znag.oig[content[showaiticle.cln?SectionID=q&ItenID=
q8 (accessed Apiil q, zooq).
z By its own estinates, the lailuie iate ol Woild Bank pioects in the pooiest iegions ol
the woild is 6 to ;o peicent. See Bond, Aguinst G|cbu| Apurtncid, zo. Even the Woild
Banks own attenpts to iediess the delt ciises caused ly its policies have, ly its own
adnission, lailed. See Fantu Cheiu, Delt Reliel and Social Investnent: Linking the
HIPC Initiative to the HIV[AIDS Epidenic in Aliica: The Case ol Zanlia, Rcvicw cj
Ajricun Pc|iticu| Eccncny 86 (zooo): zozz.
See Alison Maishall with Ton Piavda, The Vicious Ciicle: AIDS and Thiid Woild
Delt, iepoit ly the Woild Developnent Movenent loi the UNSpecial Session on HIV[
AIDS, ]une z, zoo, www.wdn.oig.uk[canliiels[delt[viciicle.pdl (accessed Maich,
zooq), L. Squiie, Conlionting AIDS, Finuncc und Dcvc|cpncnt (Maich 8): ;,
Nana Poku, Aliicas AIDS Ciisis in Context: How the Pooi Aie Dying, Tnird Wcr|d
Quurtcr|y zz.z (zoo): zoo, Caiolyn Baylies, Inteinational Paitneiship in the Fight
against AIDS: Addiessing Need and Rediessing Inustice? Rcvicw cj Ajricun Pc|iticu|
Eccncny 8 (): , Caiol Baikei and Meiedeth Tuishen, AIDS in Aliica, Rcvicw
cj Ajricun Pc|iticu| Eccncny .6 (Sunnei 86): q, Meiedeth Tuishen, US Aid to
AIDS in Aliica, Rcvicw cj Ajricun Pc|iticu| Eccncny . (Sunnei 86): 8.
q This is not to suggest, howevei, that an advanced health inliastiuctuie is necessaiy
leloie ARVs can legin to le adninisteied successlully. On the contiaiy, iecent studies
have shown that the poois in Cape Town adheie noie stiictly to piesciiled ARV iegi-
nens than do people in the United Kingdon, thus putting the lie to the aigunent that
pooi Aliicans, nany ol whon lack watches and liteiacy, would lieak the stiict iegine
ol taking ceitain pills at ceitain tines, iisking the eneigence ol a diug-iesistant stiain
ol HIV (Roiy Caiioll, Aids Oiphans Suivival Oeis Aliica Hope, Giound-Bieaking
Tieatnent Delunks Diug Fiin Myths in Cape Town, Tnc Obscrvcr, May z, zoo, ,
see C. Oiiell, D. R. Bangsleig, M. Badii, R. Wood Adheience Is Not a Baiiiei to Suc-
cesslul Antiietioviial Theiapy in South Aliica A!DS ;. []une zoo|: 6;).
See Floyd and Gilks, Cost and Financing Aspects ol Pioviding Anti-Retioviial Theiapy.
Nicholas Piescott aigues, neanwhile, loi the leasilility ol AZT peiinatal tieatnent, lut
without inquiiing into the conditions ol possilility loi the iealistic ludget constiaints
he cites. See Setting Piioiities loi Goveinnent Involvenent with Antiietioviials, in
Tnc !np|icuticns cj Antirctrcviru| Trcutncnts. !njcrnu| Ccnsu|tuticn, ed. Eiic van Piaag,
Susan Feinyak, and Alison Maitin Katz (Geneva: WHO in collaloiation with UNAIDS,
;), ;6z.
Dcniu|isn 801
6 Fidlei, Racisn oi Rcu|pc|itik? 8, qq6.
; Kail Maix, Econonic and Philosophic Manusciipts, in Eur|y Writings, tians. R. Living-
stone and Giegoi Benton (New Yoik: Vintage Books, ;), z86, conpaie Kail Maix,
Grundrissc. Fcunduticns cj tnc Critiquc cj Pc|iticu| Eccncny (Rcugn Drujt), tians. M. Nico-
laus (NewYoik: Penguin Books, in association with Ncw Lcjt Rcvicw, ;), ;o6. On the
point ol suiplus populations, the piedoninantly anthiopological and phenonenologi-
cal teins ol Mlenles analysis ol violence leadhis discussionol geneializedsoveieignty
astiay. Inthe case ol HIV[AIDS, geneialized soveieigntys destiuctionol hunanlodies
and populations is not, as Mlenle suggests, linked to the geneialized instiunental-
ization ol hunan existence (Neciopolitics, ). On the contiaiy, the people alandoned
ly capitals ieplication ol suiplus value aie not instiunentalized at all, which is why
capital alandons then. The violence ol this alandonnent is neithei phenonenological
noi anthiopological lut innanent to the ciicuits ol capital itsell.
8 This estinate is lased on a study that is, in tuin, the iesult ol a hypothetical nodel ol
the costs ol a package ol caie likely to le ieceived ly those people with HIV oi AIDS
who gain access to health caie seivices. This excludes the veiy signicant piopoition ol
people who, we lelieve, will not gain access to health seivices at all (6). See AIDS in
South Aliica: The Denogiaphic and Econonic Inplications (a papei piepaied ly the
Centie loi Health Policy, Depaitnent ol Connunity Health Medical School, Univeisity
ol Witwateisiand, ]ohannesluig, no. z, Septenlei , 6).
]onathan Bioonleig, Malcoln Steinleig, Patiick Masole, and Giane Behi, The Eco-
nonic Inpact ol the AIDS Epidenic in South Aliica, in Fucing Up tc A!DS. Tnc Sccic-
Eccncnic !npuct in Scutncrn Ajricu, ed. Sholto Cioss and Alan Whiteside (NewYoik: St.
Maitins Piess, ), 6.
qo Sholto Cioss, A Socio-Econonic Analysis ol the Long-Run Eects ol AIDS in South
Aliica, in Cioss and Whiteside, Fucing Up tc A!DS, . Cioss goes on to aigue that in
the South Aliican case, theie is veiy stiong evidence loi the neo-Malthusian position:
olscuied as the situation has leen ly the social engineeiing policies ol apaitheid, nevei-
theless the intiinsically low levels ol enploynent and the high iepioduction iates
in association with a piinaiy-iesouice lased econony with no olvious possililities
loi iuial involutionnean that theie is a stiong coiielation letween high population
giowth iates and the entiapnent in poveity ol the naoiity. To the extent that AIDS will
liing alout an oveiall ieduction in population giowth iates, theie is thus a prinu jucic
case that the eect on econonic giowthand ol couise on pcr cupitu incone, although
this in itsell is no veiy satislactoiy indicatoiwill lion one point ol view le positive
(qoq).
q Fion the z Woild Bank Population and Hunan Resouices iepoit, cited in Baiton
Gellnan, The Belated Glolal Response to AIDS in Aliica: Woild Shunned Signs ol the
Coning Plague, Wusningtcn Pcst, ]uly , zooo.
qz Gellnan, Unequal Calculus.
q Anonynous lankei, quoted in ]ean-Loup Motchane, WHOs Responsille? Lc Mcndc
Dip|cnutiquc tians. Luke Sanloid (]uly zooz), http:[[nondediplo.con[zooz[o;[;who?
(accessed Apiil q, zooq).
qq Geoige Soios, quoted in Patiick Bond, Saciicing AIDS Victins loi Coipoiate Piots,
Grccn Lcjt Wcck|y, ]uly , zooz, 8.
802 Adun Sitzc
q See Kail Maix, Cupitu|. ACritiquc cj Pc|iticu| Eccncny, Vc|unc r, tians. Ben Fowkes (New
Yoik: Vintage Books, ;;), zq;;.
q6 See Bulaid, Apaitheid ol Phainacology.
q; Though it ceitainly is that. See Andy Giay and ]enni Snit, Inpioving Access to HIV-
Related Diugs in South Aliica: A Case ol Colliding Inteiests, Rcvicw cj Ajricun Pc|iticu|
Eccncny z;.86 (Decenlei zooo): 86.
q8 See Thonas Lenke, The Biithol Bio-politics, Michel Foucaults Lectuie at the Collge
de Fiance on Neo-Lileial Goveinnentality, Eccncny und Sccicty o.z (May zoo): ;.
q Maix, Econonic and Philosophical Manusciipts, z8.
o See Gioigio Aganlen, Mcuns witncut Ends. Essuys cn Pc|itics, tians. C. Casaiino and
V. Binetti (Minneapolis: Univeisity ol Minnesota Piess, zooz), , 6. I an giatelul to
Any Kapczynski loi loinulating this piollen.
Geinan Velasquez, Unhealthy Piots, tians. ]. Stokei, Lc Mcndc Dip|cnutiquc (]uly
zoo), http:[[nondediplo.con[zoo[o;[ovelasquez? (accessed Apiil q, zooq). See also
Phillipe Quau, Who Owns Knowledge? tians. Malcoln Gieenwood, Lc Mcndc Dip|c-
nutiquc (]anuaiy zooo), http:[[nondediplo.con[zooo[o[queau? (accessed Apiil q,
zooq), Inge Kaul, Biens pullics glolaux: un concept ivolutionnaiie, Lc Mcndc Dip|c-
nutiquc (]une zooo): zzz, Maik Heywood, Lile-Sustaining Medicines Aie a Basic
Need, Mui| und Guurdiun, Maich z, zoo.
z The concept ol the connons has lecone one ol the key giounds loi u|tcrncndiu|istc
stiuggle, up to and including the stiuggle loi tieatnent access. Thus, ol the vaiious
gioups engaged in such stiuggles, Naoni Klein could aigue, the spiiit they shaie is
a iadical ieclaining ol the connons (Reclaining the Connons, Ncw Lcjt Rcvicw
[May]une zoo|: 8z, conpaie A|tcrnutivcs tc Eccncnic G|cbu|izuticn. A Bcttcr Wcr|d
!s Pcssib|c, A Rcpcrt cj tnc !ntcrnuticnu| Fcrun cn G|cbu|izuticn [San Fiancisco: Beiiett-
Koehlei, zooz|, ;oq, esp. 86). But as conpelling and coiiect as this chaiacteiization
nay le, the connons is olten naiiated in the genie ol a kind ol pastoial heteiotopia,
inplying that nodels loi late nodein glolal anticapitalisn can le deiived lion ante-
capitalist Euiope. The piollen with this is not only its nostalgia, lut also the ielation
ol its ihetoiic ol ciisis to the Malthusian prcb|cnutiquc that has goveined sone ol the
noie pioninent late nodein ietuins to the notion ol the connons. That the lattei is
also a iesponse to the piollenol oveipopulation is evident lionGaiiett Haidins The
Tiagedy ol the Connons, which concludes ly aiguing that it is the iole ol education
to ieveal to all the necessity ol alandoning the lieedon to lieed. Only so, can we put
an end to this [populational| aspect ol the tiagedy ol the connons (Scicncc 6z [68|:
zq8). It ienains an open question whethei Negiis theoiization ol the inneasuialle
opening ol the connon, which tacitly cites Ranciies ieieading ol Plato, depaits lion
this prcb|cnutiquc (Tinc jcr Rcvc|uticn, tians. Mateo Mandaiini [New Yoik: Continuun
Books, zoo|, 8).
See Bond, Saciicing AIDS Victins, 8.
q Doyal quoted in Giay and Snit, Inpioving Access, 88.
]onathan Mann, AIDS: Why It Isnt Being Deleated, Grccn Lcjt Wcck|y, Apiil z8, .
6 See Innanuel Walleistein, Tnc Dcc|inc cj Ancricun Pcwcr (NewYoik: NewPiess, zoo),
zo.
; See Sanay Basu, AIDS, Enpiie, and Pullic Health Behaviouiisn, Znct Ccnncn-
Dcniu|isn 803
tury (August z, zoo), www.znag.oig[content[showaiticle.cln?SectionID=z&ItenID
=88 (accessed Apiil q, zooq).
8 See Zackie Achnat, Living Noniacialisn, Mui| und Guurdiun, May z, zoo. See also
Nicoli Nattiass, We Need to Fight AIDS und Poveity, Mui| und Guurdiun, Maich z,
zoo.
Which is an innanentist ieloinulation ol the aigunent that (as Paul Fainei puts
it in his zoo delense ol Mleki) inequality is the naoi co-lactoi in this epidenic
(AIDS Heietic, Ncw !ntcrnuticnu|ist []anuaiyFeliuaiy zoo|: 6) oi that AIDS
and econonics aie conpletely entwined (Misundeistanding Mleki, statenent pie-
paied ly the Institute loi Health and Social ]ustice at the Depaitnent ol Social Medi-
cine, Haivaid Medical School, www.znag.oig[nisundeistanding nleki.htn[accessed
Apiil q, zooq|).
6o See Kail Maix, Cupitu|, :qz.
6 See Maiy Catheiine Bateson and Richaid Goldsly, Tninking A!DS (NewYoik: Addison-
Wesley, 88), 8.
6z See Mlenle, Neciopolitics, 6.
6 Velasquez, Unhealthy Piots.
6q See Gaidinei Haiiis and Michael Waldholz, AIDS Diug Plan Spuis Call to Cut Piices
Elsewheie, Wu|| Strcct ]curnu|, May z, zooo.
6 See Baylies, Oveiview: HIV[AIDS in Aliica, Rcvicw cj Ajricun Pc|iticu| Eccncny 86
(zooo): q. Zackie Achnat explains that in Botswana, loi eveiy dollai Meick gives,
the Gates Foundation gives a dollai, which cones lack to the conpany when they luy
Meick diugs at wholesale piice, which can le added to Meicks tax deduction on the
donation (Roleit Weissnan and Zackie Achnat, Delying the Diug Caitel: The South
Aliican Canpaign loi Access to Essential Medicines, Mu|tinuticnu| Mcnitcr []anuaiy
Feliuaiy zoo|: z). Sinilaily, a one-lillion-dollai loan announced ly Clinton in zooo
caiiied the condition that the diugs nust le lought lion Aneiican phainaceutical
ins (Cheiu, Delt Reliel and Social Investnent, z;, Gellnan Unequal Calculus,
Gellnan, Woild Shunned Signs). None ol this, ol couise, pievented capital lion pat-
ting itsell onthe lack loi a olwell done. See Michael Waldholz, AZTPiice Cut loi Thiid
Woild Motheis-to-Be, Wu|| Strcct ]curnu|, Maich , 8, Michael Waldholz, AIDS
Medicine Will Cost Less in Pooi Nations, Wu|| Strcct ]curnu|, ]une z, 8.
66 Quoted in ]anes Still, Slashed Diug Costs Will Not Touch Kenyas Aids Ciisis, Tnc
Guurdiun, Novenlei ;, zooo. Foi his pait, Achnat endoises local pioduction ol nedi-
cines in loth the piivate and pullic sectois. See Weissnan and Achnat, Delying the
Diug Caitel, .
6; See Roleit Weissnan, The AIDS Fund Fight, Tnc Nuticn, ]uly , zoo, q, AllynTayloi,
Pullic-Piivate Paitneiships loi Health: The United Nations Glolal Fund on AIDS and
Health, Tnc ]cnn Mursnu|| LuwRcvicw (zooz): qoq, Fidlei, Racisnoi Rcu|pc|itik?
6q6.
68 See Naoni Klein, Bushs Aids Gilt Has BeenSeized ly Industiy Giants, Tnc Guurdiun,
Octolei , zoo, www.guaidian.co.uk[wto[aiticle[o,z;6,o6;86,oo.htnl (accessed
Apiil q, zooq).
6 In his ciitique ol PEPFAR, ]anes Love olseives that Bush, like Piesident Bill Clinton
leloie hin, has noisily conlated geneiic diugs in inteinational loiuns, even though,
804 Adun Sitzc
to quote Bush, theii lowei cost places an innense possilility within oui giasp (Pie-
sciiption loi Pain, Lc Mcndc Dip|cnutiquc [Maich zoo|, http:[[nondediplo.con[zoo[
o[zgeneiics? [accessed Apiil q, zooq|).
;o See Nancy Dunne, U.S. Wains Biazil on Piotection loi Diug Patents, Finunciu| Tincs,
]uly z, 88, .
; See Stephen Buckley, Biazil Becones Model in Fight against AIDS, Wusningtcn Pcst,
Septenlei ;, zooo, Tina Rosenleig, Look at Biazil, Ncw Ycrk Tincs, ]anuaiy z8,
zoo. ]ohn Culhane has noted, howevei, that in Biazil as in the United States, the suc-
cess ol ARV theiapy has leen linited along lines ol iace and gendei. In Biazil, signi-
cantly noie wonen than nen aie inlected, and in the United States, Aliican-Aneiican
wonen account loi two-thiids ol all newinlections. See Recuiiing Nightnaie: Baiiieis
to Eective Tieatnent ol HIV in the United States and Inteinationally, ]cnn Mursnu||
Luw Rcvicw (zooz): 8z.
;z See L. ]. Selleis, Success Stoiy, Pnurnuccuticu| Eccutivc z. (Maich zoo): o.
; See Policy Position ol Biazil at the TRIPs Council on Access to Medicines (]une zo,
zoo), www.cptech.oig[ip[wto[tc[liazil.htnl (accessed Apiil q, zooq).
;q Saia Foid, Conpulsoiy Licensing Piovisions undei the TRIPs Agieenent: Balancing
Pills and Patents, Ancricun Univcrsity !ntcrnuticnu| Luw Rcvicw (zooo): q, Roleit
Weissnan, Fiee Tiade and Medicines in the Aneiicas, Fcrcign Pc|icy in Fccus 6.
(Apiil zoo): .
; The United States aggiessive asseition ol patent iights, even in cases wheie its own
national secuiity inteiests seen to dictate otheiwise (witness the delates aiound Cipio
in Octolei zoo), has ultinately undeinined even the hegenony ol its own institu-
tions ol neolileial econonics. The attenpts ly the United States in Decenlei zooz and
August zoo to dilute paiagiaph6ol theWTOs Novenlei zoo Doha Ministeiial Decla-
iationheialded, il not also concietely piepaied the way loi, the collapse ol theWTOtiade
talks in Cancun in Septenlei zoo. See The Right Fix? Tnc Eccncnist, August z8,
zoo, . The United States asseition ol such iights is not, ol couise, a newdevelopnent.
See Sana Siwolop, Reagan Tuins Up the Heat on Patent-Pilleiing Countiies, Busincss
Wcck, Apiil z, 86, q;.
;6 Kevin Watkins, A Haish Canpaign to Pievent Aoidalle AIDS Tieatnent, !ntcrnu-
ticnu| !cru|d Tribunc, Feliuaiy z, zoo.
;; Foid, Conpulsoiy Licensing Piovisions, z.
;8 See Patiick Bond, Glolalization, Phainaceutical Piicing, and South Aliican Health
Policy: Managing Conliontation with U.S. Fiins and Politicians, !ntcrnuticnu| ]curnu|
cj !cu|tn Scrviccs z.q (): ;68.
; ]onathan King, Connentaiy: Lile Patents and AIDS Diug Access, GcncWutcn q.
(Septenlei zoo): .
8o See Bond, Glolalization, Phainaceutical Piicing, and South Aliican Health Policy,
;;.
8 See Roleit Weissnan, AIDS Diugs loi Aliica, Mu|tinuticnu| Mcnitcr (Septenlei
): o, Michelle Neiozzi, The Battle ovei Lile-Saving Phainaceuticals: Aie De-
veloping Countiies Being TRIPped ly Developed Countiies? Vi||uncvu Luw Rcvicw q;
(zooz): 6o;, Cheiu, Delt Reliel and Social Investnent, z;z8.
Dcniu|isn 805
8z See Weissnan, AIDS Diugs loi Aliica, , Richaid Kin, ACT UP Goes Glolal, Tnc
Nuticn, ]uly , zoo, ;.
8 Weissnan, AIDS Diugs loi Aliica, . Klein suggests that u|tcrncndiu|istc stiuggles
legin with the Zapatista upiising ol ]anuaiy , q (Reclaining the Connons, 8).
8q At the tine, a geneiic veision ol Fluconazole cost USso.o in Thailand, undei patent
in South Aliica and Kenya, the sane nedicine cost USs.oo and USs8.oo, iespec-
tively (Poku, Aliicas AIDS Ciisis, zoz, Mdecins Sans Fiontiies, Untangling the
Wel ol Piice Reductions: A Piicing Guide loi the Puichase ol ARVs loi Developing
Countiies []uly , zooz|, www.accessned-nsl.oig[docunents[puiplez.pdl [accessed
Apiil q, zooq|). In Maich zooo, the TAC challenged Pzei to ieduce the piice ol Flu-
conazole to USso.o pei zoo nilligian. In the sane nonth, Cipla oeied Neviiapine
loi iupees pei tal, noie than hall Boehiingei Ingelheins piice ol qq iupees loi the
liand-nane veision ol the sane. In Octolei zooo, the TAC announced the Chiisto-
phei Moiaka Deance Canpaign against patent aluse, and legan illegally inpoiting
Fluconazole lion Thailand. In ]anuaiy zoo, the ist illegal shipnent ol Fluconazole
aiiived.
8 It was not until that the Woild Bank could liing itsell to pullicly aiticulate this
consensus: Nowheie is the eoit lig enough, oi well-iesouiced enough to tuin the epi-
denic lack (Woild Bank, !ntcnsijying Acticn uguinst !!VA!DS in Ajricu, Rcspcnding
tc u Dcvc|cpncnt Crisis, (Washington, DC: The Inteinational Bank loi Reconstiuction
and Developnent, Aliica Region, ). The latest eoits ienain goveined ly the sane
consensus. Even though 6 nillion people with AIDS will le in innediate clinical need
ol ARVs ly zoo, and . nillion ly zoo8, the WHOs goal is to tieat only nillion ly
zoo, andPEPFARs only znillionly zoo8. The nassively undeilundedGFATM, nean-
while, is at this point capalle ol pioviding ARVs to only q,ooo people with HIV[AIDS
ly zoo8 (HealthGAP, Tieat the PeopleConnit to Tieat Those in Innediate Clinical
Need, [May , zoo|, on le with authoi).
86 See Claude Leloit, Dcnccrucy und Pc|iticu| Tnccry, tians. D. Macey (Minneapolis: Uni-
veisity ol Minnesota Piess, 88), ;, qo. See also Wole Soyinka, Tnc Burdcn cj Mcncry,
tnc Musc cj Fcrgivcncss (New Yoik: Oxloid Univeisity Piess, ), ;o;z.
8; See Michel Foucault, Tnc !istcry cj Scuu|ity, vol. : An !ntrcducticn, tians. R. Huiley
(New Yoik: Vintage Books, o), 8, enphasis in oiiginal, conpaie Sccicty Must Bc
Dcjcndcd. Lccturcs ut tnc Cc||cgc dc Fruncc, r,,6, tians. D. Macey (NewYoik: Picadoi,
zoo), zq, zq;.
88 See Foucault, Tnc !istcry cj Scuu|ity, :q.
8 Wiiting in 6, seven yeais altei Lacan used rcjus as one ol two teins to tianslate
Fieuds Vcrwcrjung (the othei leing rcjct), Foucault used the tein rcjus to ielei to the
nadness ol Sadean soveieignty. See Foucault, Mudncss und Civi|izuticn. A !istcry cj
!nsunity in tnc Agc cj Rcuscn, tians. R. Howaid (New Yoik: Vintage Books, 6), z8.
o See Gilles Deleuze, What Is a Dispositil ? in Micnc| Fcucuu|t, Pni|cscpncr, tians. Tin-
othy Ainstiong (New Yoik: Routledge, z), 66.
See Culhane, Recuiiing Nightnaie, 86. The ACT UP slogan SILENCE = DEATH
was ained, in laige pait, at Reagan, who did not even uttei the woid A!DS until May ,
8;six yeais altei the eneigence ol HIVin the United States. The nuideious hono-
806 Adun Sitzc
pholia ol this silence nust not le loigotten. The assunption ol eaily epideniologists
was that AIDS would le linited to gay connunities and diug useis, and that altei satu-
iating these populations, it would soon iun out ol victins oi iun its couise. The
sane epideniologists wondeied aloud whethei Aliicans did not alieady sonehow pos-
sess a natuial innunity to the viius. See F. P. Siegal and M. Siegal, A!DS. Tnc Mcdicu|
Mystcry (New Yoik: Giove Piess, 8), zzq.
z Nana Poku aigues that with the exception ol Uganda and Senegal, Aliican leadeis aie
engaged in denial, typically asseiting that the noial values ol theii societies would not
peinit tiansnission ol an agent such as HIV that is associated with iisky sexual lehav-
ioui, honosexuality, and inecting diug use (Aliicas AIDS Ciisis in Context, ).
Anson Silanda has likewise noted ignoiance and denial as lactois loi the spiead ol
HIV[AIDS in Zinlalwe (A Nation in Pain: Why the HIV[AIDS Epidenic Is Out ol
Contiol in Zinlalwe, !ntcrnuticnu| ]curnu| cj !cu|tn Scrviccs o.q [zooo|: ;o, ;).
Caiolyn Baylies concuis, noting that instead ol inteivening in the pandenic, Aliican
goveinnents have iesponded with a stance ol denial, oi, alteinately, ocial acknowl-
edgenent ol the need loi an AIDS policy coupled with a peisistent lailuie to accept the
depth ol the ciisis ol the uigency ol the situation, nuch less to lollow thiough on the
constiuction ol a conpiehensive policy (Baylies, Oveiview: HIV[AIDS in Aliica, q88,
q, lut conpaie Cheiu, Delt Reliel and Social Investnent, z6).
See Alain Badiou, Etnics. An Essuy cn tnc Undcrstunding cj Evi|, tians. Petei Hallwaid
(New Yoik: Veiso, zooz), o, especially .
q I take it as axionatic that, since the days ol the Dutch East Indies Conpany, il not eailiei,
coipoiations have aiiogated to thenselves the pieiogatives ol soveieignty (teiiitoiial
contiol, nonopoly ovei legitinate violence, iight to decide lile and death, police powei
in the lioadest sense, etc.) and that the Kantian distinction letween a lands supiene
ownei (Obcrcigcntuncr) and its supiene connandei (Obcrbcjcn|snubcr) is no longei
helplul, il it evei was, loi giasping nanilestations ol soveieign powei. Instead, as Agan-
len aigues, soveieignty can no longei le undeistood as an exclusively political concept,
an exclusively uiidical categoiy, a powei exteinal to law, oi the supiene iule ol the
uiidical oidei (Gioigio Aganlen, !cnc Succr !. Scvcrcign Pcwcr und Burc Lijc, tians.
Daniel Hellei-Roazen [Stanloid: Stanloid Univeisity Piess, 8|, z8). See Innanuel
Kant, Tnc Mctupnysics cj Mcru|s, tians. M. Giegoi (Canliidge: Canliidge Univeisity
Piess, 6), oo, Einest Mandel, Murist Eccncnic Tnccry, vol. z, tians. Biian
Peaice (New Yoik: Monthly Review Piess, 68), q6;z, Michael Haidt and Antonio
Negii, Enpirc (Canliidge: Haivaid Univeisity Piess, zooo), o, , 6, Mlenle, On
tnc Pcstcc|cny zo, ;8;, Gioigio Aganlen, Tnc Ccning Ccnnunity, tians. Michael
Haidt (Minneapolis: Univeisity ol Minnesota Piess, ), ;. Foi the opposing view,
see Cail Schnitts ciitique ol Welei and KelseninTnc Crisis cj Pur|iuncntury Dcnccrucy,
tians. Ellen Kennedy (Canliidge: MIT Piess, 88), zqz.
Quoted in Maik Schools, Fliiting with Pseudoscience, Vi||ugc Vcicc, Maich z,
zooo, 6.
6 It is inpoitant to note that wheieas Aiticle ol TRIPs ly no neans rcquircs a decla-
iation ol health eneigency to invoke conpulsoiy licensing, it peinits ceitain linita-
tions on conpulsoiy licensing to le waived in the case ol such a declaiation, and so
Dcniu|isn 807
places consideialle poweis at the disposal ol goveinnents, at the sane tine it iaises
the stakes on the exeicise ol those poweis. In eect, the soveieign exception is the only
loin ol political powei TRIPs peinits states to exeicise ovei licensing questions. See
Foid, Conpulsoiy Licensing Piovisions, .
; In Octolei , Mleki nade his denialisn pullic in a speech leloie the National
Council ol Piovinces. In May zooo, he convened an HIV[AIDS advisoiy panel con-
posed ol denialists. In ]uly zooo, Mleki deliveied the opening addiess to the Thiiteenth
Inteinational AIDS Conleience, in which he declaied that he doulted whethei eveiy-
thing could le llaned on a single viius. In Septenlei zooo, Mleki oeied denialist
ienaiks in Tinc nagazine, and Ministei ol Health Tshalalala-Msinang oeied sinilai
ienaiks on South Aliican iadio. See Mlali, HIV[AIDS Policy-Making, zo.
8 Ol Castio Hlongwane, Achnat said, On the iecoid, you had, loi the ist tine, an
indication ol the nadness, the iiiationality, the llindness, the willlulness, the vindic-
tiveness ol Mleki on this question (quoted in Sanantha Poweis, The AIDS Relel,
Tnc Ncw Ycrkcr, May , zoo, 6). Conpaie also Pietei-Diik Uys AIDS Cones lion
Venus, HIV Cones lion Maisl !ndc cn Ccnscrsnip q (zoo): zzz, Newaal Deane,
The Madness ol Queen Manto, Mui| und Guurdiun, Apiil , zoo.
This nonogiaph accepts that oui people, and otheis elsewheie in Aliica and the iest ol
the woild, lace a seiious piollenol AIDS. It accepts the deteinination that AIDS stands
loi Acquiied Innunodeciency Syndione. It accepts that a Syndione is a collection
ol diseases. It pioceeds lion the assunption that the collection ol diseases geneially
desciiled as lelonging to the AIDS syndione have known causes. It ieects as illogical
the pioposition that AIDS is a single disease caused ly a singulai viius, HIV. In othei
woids, it accepts that AIDS is eithei a syndione oi a disease. It cannot le loth. Its acio-
nyncoiiectly desciiles it as a syndione. Foi this ieason, it is not desciiled as AIDD. It
accepts that an essential pait ol AIDS is innune deciency. This constitutes the ID in
AIDS. It accepts that this innune deciency nay le acquiied, accounting loi the A in
AIDS. It asseits that theie aie nany conditions that cause acquiied innune deciency,
including nalnutiition and disease. . . . It accepts that HIV nay le one ol the causes ol
this innune deciency, lut cannot le the only cause (q).
oo Beinstein nakes the inpoitant olseivation that [AIDS is| the ist disease that no one
cansuivive ly denition. Not only is this desciiptionol AIDS logically lankiupt, it sends
the denoialising and inaccuiate nessage to people with HIV oi AIDS that they have a
disease that is not woith ghting. Anoie legitinate, and noie hopelul, denition nust
le devised. Because ol all this, it has lecone inpeiative loi us to know as piecisely as
possille what oui people aie dying lion, specically. To say that oui people aie dying ol
AIDS will not help us in oui stiuggle to inpiove the health ol oui people. As Beinstein
says, to say this would le to say oui people have a disease that is not woith ghting. This
would ceitainly condenn then to pienatuie death. !t is tnis tnut wcu|d ccnstitutc gcnc-
cidc (8, enphasis in oiiginal). In a sinilai vein, Mokala aigued that we cannot allow
oui people to take sonething [i.e., ARV theiapy| so dangeious that it will actually extei-
ninate then. Howevei well neaning, the hazaids ol nisplaced conpassion could lead
to genocide (quoted in Petei Kwan, Biogiaphy ol a Nightnaie: HIV[AIDS in South
Aliica, Tnc ]cnn Mursnu|| Luw Rcvicw [zooz|: q).
808 Adun Sitzc
o See ]acques Lacan, Ecrits. A Sc|ccticn, tians. A. Sheiidan (NewYoik: Noiton, 8), zoo.
oz See ]acques Lacan, Tnc Etnics cj Psycncunu|ysis, rr6c, in Tnc Scninur cj ]ucqucs
Lucun, look ;, ed. ]-A. Millei, tians. D. Poitei (New Yoik: Noiton, z), 66.
o Lacan, Ecrits, o, zozq, zo6.
oq Ilid., 8q, zoz, zoq.
o The Book ol Genesis in the Holy Bille says: And God said, Let theie le light, and
theie was light. God sawthat the light was good, and he sepaiated the light lionthe daik-
ness. Taking exanple lion this, though disadvantaged ly the lact that we do not have
the powei ol the Cieatoi, we tiust that we piesent inthis liiel discouise will help all ol us
to sepaiate the light lionthe daikness with iegaid to the issue ol AIDS. This nay le dil-
cult. It is, neveitheless, ciitically inpoitant. Given that oui ninds on this nattei have
lecone thoioughly clogged ly the inloination connunicated ly the onnipotent appa-
iatus, a niiacle will have to le achieved to get all oui people to use theii liains, iathei
than peiish on enotional iesponses lased on gieatly heightened levels ol leai ().
o6 See Mlenle, On tnc Pcstcc|cny, 8, Cail Schnitt, Pc|iticu| Tncc|cgy. Fcur Cnuptcrs cn tnc
Ccnccpt cj Scvcrcignty, tians. G. Schwal (Canliidge: MIT Piess, 88), 6, Cail Schnitt,
Dic Diktutur (Beilin: Dunckei and Hunllot, q), .
o; See Mlenle, On tnc Pcstcc|cny, zz.
o8 See Gilles Deleuze and Flix Guattaii, Anti-Ocdipus. Cupitu|isnund Scnizcpnrcniu, tians.
R. Huiley, M. Seen, and H. R. Lane (Minneapolis: Univeisity ol Minnesota Piess, 8),
zq, Gioigio Aganlen, !cnc Succr, :.
o See Poweis, The AIDS Relel, 6o, 6.
o Diew Foiiest, Social Movenents: Ultia-Lelt oi Glolal Citizens, Mui| und Guurdiun,
]anuaiy , zoo.
See Richaid Calland, A Case ol Powei and Who Contiols It, Mui| und Guurdiun, ]anu-
aiy 8, zooz, Klug, Five Yeais On: How Relevant Is the South Aliican Constitution?
Vcrncnt Luw Rcvicw z6.q (Sunnei zooz): 8oq.
z See Foiiest, Social Movenents, 8, Poweis, The AIDS Relel, 6, 6o6, 6q6,
Mlali, HIV[AIDS Policy-Making, , zzz.
Nyaneko Bainey Pityana, Revolution within the Law? in Bcunds cj Pcssibi|ity. Tnc
Lcgucy cj Stcvc Bikc und B|uck Ccnscicusncss, ed. N. B. Pityana, M. Ranphele, M. Mpunl-
wana, L. Wilson (Cape Town: David Philip, ), zozq.
q Ilid., zz.
See Hoyt Well, The Constitutional Couit ol South Aliica: Rights Inteipietation and
Conpaiative Constitutional Law, ]curnu| cj Ccnstituticnu| Luw .z (Fall 8): z8,
]. Tholakele H. Madala, Rule undei Apaitheid and the Fledgling Denociacy in South
Aliica: The Role ol the ]udiciaiy, Ncrtn Curc|inu ]curnu| cj !ntcrnuticnu| Luw und Ccn-
ncrciu| Rcgu|uticn z6 (zoo): ;q8, ;o6, ;.
6 See Patiic Mzolisi Mtshaulana, The Histoiy and Role ol the Constitutional Couit ol
South Aliica, in Tnc Pcst-Apurtncid Ccnstituticns. Pcrspcctivcs cn Scutn Ajricus Busic
Luw, ed. P. Andiews and S. Ellnann (]ohannesluig: Witwateisiand Univeisity Piess,
zoo), q;.
; See Pieiie de Vos, Pious Wishes oi Diiectly Enloicealle Hunan Rights? Social and
Econonic Rights in South Aliicas 6 Constitution, Scutn Ajricun ]curnu| cj !unun
Rignts . (;): 6;o. It should le noted, howevei, that lecause ol South Aliicas
Dcniu|isn 809
quasi-ledeial systen, the executive does not diiectly contiol AIDS spending. See Helen
Schneidei and ]oanne Stein, Inplenenting AIDS Policy in Post-Apaitheid South Al-
iica, Scciu| Scicncc und Mcdicinc z (zoo): ;zq.
8 Klug, Five Yeais On, 8, conpaie Heinz Klug, Intioducing the Devil: An Institu-
tional Analysis ol the Constitutional Powei ol Review, Scutn Ajricun ]curnu| cj !unun
Rignts (;): 8zo;.
See Calland, A Case ol Powei and Who Contiols It, Accountalle to the Constitution,
Mui| und Guurdiun, ]anuaiy 8, zooz, South Aliicas Independent ]udiciaiy Is Sale
Foi Now, Mui| und Guurdiun, August z;, zooz, A Failuie ol Legal Inagination in Pio-
Pooi Law, Mui| und Guurdiun, May , zoo.
zo See Klug, How Relevant Is the South Aliican Constitution, 8.
z Which, undei Pityanas leadeiship, had eailiei capitulated to piessuie lion the execu-
tive to withdiaw its suppoit loi the TACs lawsuit. See Thuli Nhlapo and Nawaal Deane,
How Pityana Buckled, Mui| und Guurdiun, Novenlei o, zoo.
zz Zackie Achnat, The Long Walk to Civil Disoledience, Mui| und Guurdiun, Apiil q,
zoo. In lact, no systenatic ARV ioll-out has taken place even altei Mlekis calinet
diiected the Depaitnent ol HealthinAugust zoo to develop anopeiational planwithin
one nonth to piovide ARVs inthe pullic sectoi, altei Mlekis announcenent inNoven-
lei zoo that his adninistiation would tiiple its AIDS ludget to s.; lillion, oi altei the
TACs piessuie inSouthAliicas ConpetitionConnissionloiced GlaxoSnithKline and
Boehiingei Ingelhein, in a contioveisial Decenlei zoo settlenent, to issue licenses
on AZT and Lanivudine to loui geneiic pioduceis. See Shaion LaFianieie, South
Aliica Is Ciiticized loi Delay in AIDS Tieatnent, Ncw Ycrk Tincs, Feliuaiy zo, zooq.
z On the piinaiily tenpoial node ol the soveieign exception, see Aganlen, Mcuns witn-
cut Ends, , q.
zq Kistnei, The Constitutional Right to Live, and the Political Powei to Let Die, 6, see
also Achille Mlenle, Biopolitics and Soveieignty, Ncws|cttcr cj tnc Wits !nstitutc jcr
Scciu| und Eccncnic Rcscurcn z. (]une zoo): , .
z See Pat Sidley, Chuiches, Unions Lay DownLine onAIDS, Busincss Duy, Septenlei z,
zoo, .
z6 It is haid to know what constitutional piovisions could le deployed against this non-
applicationol soveieignpowei: eventhoughSection;() ol the 6Constitutiongives
the udiciaiy the powei tc |init executive declaiations ol states ol eneigency, no clauses
piovide poweis that would enalle the udiciaiy to iequiie the executive tc dcc|urc a health
eneigency. The TACs MTCT case was, in a way, designed to loice Mlekis hand on this
question. MTCT is noie ieadily conceptualized as a health eneigency than neie
seiopositivity, which in a ceitain stiict sense is classied only as a chionic condition.
See Stephen Ellnan, AConstitutional Conuence, in Tnc Pcst-Apurtncid Ccnstituticns.
Pcrspcctivcs cn Scutn Ajricus Busic Luw, ed. P. Andiews and S. Ellnann (]ohannesluig:
Witwateisiand Univeisity Piess, zoo), q6o. Theie is also a sense in which the TACs
inplicitly pionatal legal stiategy played into the liopolitical ieduction ol wonen to and
as iepioductive oigans, while at the sane tine enliacing the tiopes ol innocence that
lecone availalle once one advocates on lehall ol inlants. As Heinz Klugs ieading ol
the case suggests, the linit ol this stiategy was appaient in the discouise ol the iuling
itsell (How Relevant Is the South Aliican Constitution? 8;).
810 Adun Sitzc
z; See ]acques Ranciie, Disugrccncnt. Pc|itics und Pni|cscpny, tians. ]ulie Rose (Minneapo-
lis: Univeisity ol Minnesota Piess, ), .
z8 See Mlali, HIV[AIDS Policy-Making, 8.
z See Aganlen, Mcuns witncut Ends, o6;, conpaie G. W. F. Hegel, Pncncncnc|cgy cj
Spirit, tians. A. Millei (Oxloid: Oxloid Univeisity Piess, ;;), paia. .
o See Mlali, HIV[AIDS Policy-Making, .
See Why AIDs Canpaigns Aie Not Woiking, Nursing RSA 6.6 (]une ): 6. The
necessity and possilility loi these canpaigns had leen outlined in a seiies ol 88
aiticles ly C. B. Isselnuiden, et al. See AIDS and South AliicaTowaids a Conpie-
hensive Stiategy, Pait I: The Woild-Wide Expeiience, Pait II: Scieening and Contiol,
and Pait III: The Role ol Education, Scutn Ajricun Mcdicu| ]curnu| ;.8 (Apiil 88):
q6o, q66q, q66;.
z Wiiting in z, Alan Flening aigues that one ol the unique leatuies ol the HIV[AIDS
pandenic in South Aliica is piecisely this loieknowledge: East and cential Aliican
countiies had no waining, as the epidenic was natuie and seiopievalence alieady high
when seiological tests weie ist intioduced in 8, wheieas South Aliica had the wain-
ing seven yeais ago when seiopievalence was still extienely low lut the spiead south-
waid ol HIV- was inevitalle (South Aliica and AIDSSeven Yeais Wasted, Currcnt
A!DS Litcruturc . [Novenlei z|: qz, Flenings aiticle was also pullished in Nurs-
ing RSA 8.; []uly |: 8).
Ilid., qz6.
q See Giundlingh, HIV[AIDS in South Aliica, ;, 8o8, Giundlingh, Goveinnent
Reponses to HIV[AIDS, z6, z.
Discussing HIV[AIDS educational piogians, Flening aigues that to date nothing is
in place in the goveinnent schools, which aie attended ly the naoiity in all ethnic
gioups, while the estallished AIDS Tiaining and InloinationCenties (ATICs) aie in
locations wheie they seive alnost exclusively the white population, and only now[z|
has an ATIC in Soweto leen appioved (Seven Yeais Wasted, qz;).
6 See Schneidei and Stein, Inplenenting AIDS Policy, ;z.
; See Kwan, Biogiaphy ol a Nightnaie, 8.
8 Flening, Seven Yeais Wasted, qz8.
Wilson Caiswell, HIV in South Aliica, Luncct qz (]uly ): z.
qo Sontag, A!DS und !ts Mctupncrs, 6z.
q See Bionwen Roleits, Apaitheid Foices Spiead AIDS, Mui| und Guurdiun, Noven-
lei z, . Conpaie ]acques Pauw, !ntc tnc !curt cj Durkncss. Ccnjcssicns cj Apurtncids
Assussins (]ohannesluig: ]onathan Ball Pullisheis, ;), ;o;.
qz Uys, AIDS Cones lion Venus, z
q Steven Biko, ! Writc Wnut ! Likc, ed. A. Stulls (NewYoik: Haipei and Row, 86), 86.
qq See Schneidei and Stein, Inplenenting AIDS Policy, ;z.
q Ilid., ;z8, Mlali, HIV[AIDS Policy-Making, z6.
q6 See ]ohn Donnelly, A Vigilant Voice loi AIDS Victins, Tnc Bcstcn G|cbc, May ,
zoo, Maigaiette Diiscoll, I Wont Buy Lile While Otheis Die, Sunduy Tincs (Lon-
don), May z, zoo, Nicol Innocenti, Aids Activist in Gandhi Mould, Finunciu| Tincs,
Maich zq, zoo, Tina Rosenleig, In South Aliica, a Heio Measuied ly the Advance
ol a Deadly Disease, Ncw Ycrk Tincs, ]anuaiy , zoo, Roiy Caiioll, A Good Man in
Dcniu|isn 811
Aliica, Tnc Guurdiun, Decenlei o, zooz, Matt Steinglass, Killing HinSoltly, Bcstcn
G|cbc, Decenlei 8, zooz.
q; See Poweis, The AIDS Relel, q.
q8 Zackie Achnat, O the Contiol Tiack: Powei, Resistance, and Repiesentation in
South Aliican Docunentaiies, Tnc ]curnu| cj tnc !ntcrnuticnu| !nstitutc .z (Sunnei
q), www.unich.edu[

iinet[ouinal[volnoz[achnet.htnl (accessed Apiil q, zooq).

q Achnat, O the Contiol Tiack, pait , enphasis in oiiginal.
o In the case ol saciice and naityidon, this inage we possess ol those naityied, and
to which nothing is opposed othei than the saciicing ol lives in the lattle against apait-
heid, is also one that possesses us (Achnat, O the Contiol Tiack, pait ).
In O the Contiol Tiack, Achnat claiies that his concluding section is ieally only a
leginning (pait ), while he concludes My Childhood as an Adult Molestei with the
sentence, It was the leginning ol a lile ol sex and politics (in Dcunt Dcsirc, ed. Maik
Gevissei and Edwin Caneion [New Yoik: Routledge, |, q).
z Achnat, O the Contiol Tiack, pait .
Ilid.
q Foucault, !istcry cj Scuu|ity, :.
See Kant, Mctupnysics cj Mcru|s, paiagiaph q, G. W. F. Hegel, Pni|cscpny cj Rignt, tians.
A. M. Knox (Oxloid: Oxloid Univeisity Piess, 6;), paias. ;;8o.
6 See Michel Foucault, Etnics, Subjcctivity, und Trutn. Tnc Esscntiu| Wcrks cj Micnc| Fcu-
cuu|t, rr6, vol. , ed. P. Ralinow, tians. R. Huiley et al. (New Yoik: New Piess,
;), 88, zqzq.
; Achnat, My Childhood as an Adult Molestei, z.
8 Quoted in Poweis, The AIDS Relel, 6.
Alexandei Gaica Duttnann, At Odds witn A!DS. Tninking und Tu|king ubcut u Virus,
tians. P. Gilgen and C. Scott-Cuitis (Stanloid: Stanloid Univeisity Piess, 6), z.
6o The authoiity ol which, as Paitha Chatteiee points out, is deiived entiiely liona noial
clainol peisonal couiage and saciice and a patent [sic| adheience to tiuth. So nuch
so that the supiene test ol political leadeiship was death itsell (Nuticnu|ist Tncugnt und
tnc Cc|cniu| Wcr|d. A Dcrivutivc Disccursc [Minneapolis: Univeisity ol Minnesota Piess,
|, o).
6 I an not the only one, Achnat said ol leing without ARVs to Tavis Sniley in a No-
venlei q, zoo, inteiview, www.npi.oig[leatuies[leatuie.php?wd=o6q (accessed
Apiil q, zooq).
6z It is stiiking to nd Achnat iesponding to a question alout the Deance Canpaign ly
claiilying that it is the Chiistophei Moiaka Deance Canpaign and ly iepeating the
testinony Moiaka gave, two nonths leloie his death lion AIDS, against Pzei. Heie
testinony and piotest, nouining and nolilizing, neige to the point ol indistinction.
See Weissnan and Achnat, Delying the Diug Caitel, z.