HIV Science and Institutional Interpretations: The Politics of Life and Death in Brazil and South Africa

Throughout the 1990s, Brazil and South Africa faced the dual challenges of consolidating their new democratic forms of government while managing AIDS crises that were rapidly spiraling into full-fledged epidemics. Disregarding existing international consensus about the best practices for developing countries to address the HIV epidemic, these countries took approaches at odds with recommendations by widely recognized experts in public health and economics. Leaders of both countries expressed beliefs that the responses established for addressing the HIV epidemic lacked concern for the lives of people in developing countries and sought nationalist solutions to the problems of HIV/AIDS. However, in their opposition to the scientific hegemony of the moment, Brazil and South Africa followed very different policy paths. Brazil challenged the international consensus that cost and low levels of education were prohibitive barriers to providing antiretroviral (ARV) treatments to people in developing countries. Further, Brazil challenged the necessity of securing intellectual property rights by announcing that it would manufacture domestic, generic versions of HIV drugs and refused to back down in face of a subsequent lawsuit filed with the World Trade Organization (WTO) by the United States. By contrast, South Africa challenged the international medical consensus that HIV was the cause of AIDS and that ARV treatment would reduce AIDS mortality, refusing to provide access within the public health system to medications for South Africans living with HIV. Brazilian opposition to the scientific consensus is credited, in part, with avoiding 700,000 new infections and substantially reducing mortality. South African denialism is blamed for the avoidable deaths of 300,000 South Africans.This paper explores why these two countries chose to combat widely-held scientific conclusions about HIV and treatment processes and why their counter-hegemonic approaches took such different directions. Both countries adopted the national human rights institutions -- seen as essential for addressing HIV, including judicial protections for rights and a vibrant civil society -- but these institutions were insufficient for guaranteeing policies that matched international recommendations. Instead, the approaches taken by each country reflected its particular situation in an international order marked by unequal power relationships between countries. In particular, Brazil responded to global discourses of power that placed lower value on lives in developing countries, while South Africa responded from legacies of racialized sexual and gendered forms of power in which the authority of the state to enact public health policies was used as a form of sexualized and socio-economic control. My contention is that those marginalized within the international system have good reason to question hegemonic scientific narratives and that unequal power relationships, past and present, shape national responses to international crises. It therefore follows that, while institutions are necessary for addressing national challenges, their mere existence does not sufficiently predict policy convergence. Attention to specific contexts is needed to understand the lingering effects of national histories and to craft lifesaving strategies.