After Thabo Mbeki became president in 1999, Aids was presented as a conspiracy engineered by ruthless pharmaceutical companies promoting an ill-defined virus for financial gain.
Racist Western nations who saw Africa as a pit of promiscuity were blamed for encouraging the idea that this virus was sexually transmitted, while poverty was blamed for the immune deficiency killing healthy middle-class people in their prime.
Though Nelson Mandela seldom spoke about Aids during his presidency, preferring the health department to handle what was generally considered one of a number of competing problems, there was never doubt that HIV/Aids was potentially fatal and largely sexually transmitted.
The "Aids dissident" views were virtually unknown in SA until Mbeki put them on the national agenda, turning Aids into a struggle over the interpretation of the causes of immune deficiency and over who had the right to define these causes.
Unlike his predecessor, Mbeki took an active interest in the science of Aids. But he seemed particularly drawn to views contrary to those of the scientific establishment.
As deputy president he had helped to promote the drug Virodene, which its manufacturers, Cryopreservation Technologies, claimed could kill the human immunodeficiency virus (HIV).
Virodene's safety had not been established, but Mbeki put enormous pressure on the Medicines Control Council to approve human trials of the drug. It was found to contain a highly toxic industrial solvent, dimethylformamide, which can cause fatal liver damage.
Though the Virodene incident seemed to make Mbeki wary of drug-based solutions to Aids, it did not diminish his interest in anti-establishment scientific views.
So it is not surprising that Mbeki took an interest in Aids dissident Anthony Brink's manuscript "Debating AZT". Brink claimed that the drug AZT, rather than HIV, caused people to "waste away".
Mbeki read the manuscript soon after he became president and it led him to the world of the Aids dissidents.
The first inkling of his new interests came in October 1999 when he warned the national council of provinces that AZT was potentially toxic.
By January 2000 Mbeki was in contact with US dissident David Rasnick, who says Mbeki asked "if I would support his efforts regarding AZT and Aids".
In a passionate letter to world leaders in April that year, Mbeki said that while there was an "orchestrated campaign of condemnation" of his association with the dissidents, "a simple superimposition of Western experience on African reality would be absurd and illogical".
US officials apparently thought the letter was a hoax and when they realised it was real it was leaked to the media.
Mbeki later accused the CIA of plotting against him.
In May 2000 Mbeki set up his presidential advisory panel on HIV/Aids. Made up of orthodox and dissident scientists, it was given the task of settling questions such as: What causes the immune deficiency that leads to death from Aids?
Orthodox scientists who agreed to be on the panel privately said it was like debating with members of the flat earth society.
But Mbeki, believing the dissidents to be modern-day martyrs persecuted by the scientific establishment, continued to promote them.
"A whole variety of things can cause the immune system to collapse," Mbeki told Time magazine in September 2000.
"Now it is perfectly possible that among those things is a particular virus. But the notion that immune deficiency is only acquired from a single virus cannot be sustained."
Mbeki also condemned Western nations and "certain" South Africans for buying into the racist view that, in Africa, the "Aids pandemic [is] caused, it is said, by rampant sexual promiscuity and endemic amorality".
ANC maverick Peter Mokaba (who died in 2002) weighed in with support for Mbeki, claiming authorship for the bizarre "Castro Hlongwane" document, which developed Mbeki's racial thesis.
Mandela was apparently given a copy when he publicly supported the use of antiretroviral drugs.
A weekly newspaper later traced an electronic version of the document to Mbeki's own computer.
As Mbeki's denialism spun on with health minister Manto Tshabalala-Msimang in attendance, the Treatment Action Campaign (TAC), formed in late 1998, found its task of getting treatment for people with HIV/Aids becoming increasingly politicised.
TAC founder Zackie Achmat has always been at great pains to show that his organisation does not want to contest power but campaigns on a single issue.
However, Mbeki apparently told the ANC parliamentary caucus that the TAC was in the pay of the pharmaceutical companies and trying to infiltrate trade unions.
Mbeki also attacked his critics, in an address at the University of Fort Hare in late 2001, saying that people "who consider themselves to be our leaders take to the streets carrying their placards, to demand that because we are germ carriers, and human beings of a lower order that cannot subject its passions to reason, we must perforce adopt strange opinions, to save a depraved and diseased people from perishing from self-inflicted disease".
By remaining focused, however, and through careful lobbying and alliance-building, the TAC has become democratic SA's most successful civil society organisation.
Using many of the tactics of the anti-apartheid United Democratic Front - a combination of developing an activist core, mass mobilisation, media coverage and legal action - it has managed to capture the public imagination and win important victories.
The most significant of these came in December 2001, when the Pretoria high court ruled in favour of the TAC's application that government should supply the antiretroviral drug nevirapine to HIV-positive pregnant women attending all government facilities, not just those at 18 pilot sites.
The court case showed that government no longer occupied the moral high ground it had enjoyed since 1994, and seemed to be a wake-up call for the ANC.
With little warning, cabinet announced on April 17 2002 that antiretroviral (ARV) drugs would be offered to survivors of sexual assault to prevent them from getting HIV.
Six months later cabinet's "Campaign of hope" statement said government was trying "to make it feasible and effective to use anti-retrovirals in the public sector".
A year later, on November 19 2003, cabinet approved the antiretroviral provision plan for the country. There are still numerous deadly delays, but it is almost impossible for government to renege on this decision.
Mbeki is reluctant to speak about the ARV programme, perhaps because he still supports the dissidents or because it is difficult for him to admit that he was wrong.
What is striking about the Aids debate, however, is that the president's views were ultimately defeated. This took time, but it is a positive sign for our democracy that mass action and the internal processes of the ANC were able to achieve it.
- Cullinan is a health journalist and works for Health-e News Service.
