Predominantly, social and biomedical-driven accounts suggest that the South African AIDS epidemic occurred through a mixture of multiple sexual partnerships, poor labor conditions, and a lack of access to contraception. But the truth of the matter is that such a narrative is incomplete at best and maleficent at worst. The AIDS epidemic was the result of historical and structural forces converging with the emergence of HIV in the beginning of the 1980s. Although few complete accounts of the history of HIV/AIDS in South Africa exist, the conditions under apartheid that enabled the spread of HIV can easily be drawn from Randall Packard’s accounts of the political economy of disease in South Africa. In his texts “Black Labor” and “The Making of a Tropical Disease,” Packard argues that the South African tuberculosis epidemic of the twentieth century was both “a product of a particularly pathological intersection of political, economic, and biological processes,” with large culpability falling upon the apartheid state and its negligence of black populations, especially migrant workers, for several decades.

These same conditions provided the foundation for AIDS epidemic in South Africa. As Packard concluded later, HIV/AIDS “was a pandemic waiting to happen.” Even after the first case of HIV was diagnosed in South Africa in 1982, the spread of the virus was barely recognized by health officials, and the apartheid state took very limited action to protect its citizens. Packard concisely described this initial response to HIV/AIDS as “neglect, coercion, and stigmatization.”

As the incidence of HIV/AIDS grew throughout the non-white South African populations, Afrikaner politicians began publicly celebrating the virus as a method to control the growth of the black population. Later, the political struggles and rising violence over control of the South African state effectively obscured the apparently minimal threat posed by HIV. The cruel irony of the new South African democracy was the emergence of a larger threat to the stability of the country: a full-blown AIDS epidemic. By this point, there was little political support for HIV prevention and treatment measures. The first National AIDS Plan, agreed upon during the transitional period in 1992, was underfunded and caught up in bureaucracy despite the support of the first post-apartheid Minister of Health. Similar to other social and economic policy measures enacted during this period, there was a significant divide between policy planning and implementation. Ultimately, a severe lack of proper government infrastructure guaranteed that no effective measures to counter the underlying causes of the HIV epidemic were initiated in the early years of the epidemic.

Even if this lack of action appeared to signal “the demise of a shared vision for AIDS in South Africa,” it is important to note that there still had not been any South African challenges to the science supporting conventional understandings of AIDS causality. Unlike in America, where scientists such as Peter Duesberg notoriously criticized the scientific establishment over the orthodox claim that HIV was the direct cause of AIDS, South African scientists and leaders did not initially question the underlying scientific assumptions surrounding HIV and AIDS. However, with the opening up of new democratic space in South Africa, it was only a matter of time before the international AIDS dissident community entered into the national dialogue only further delaying action by the government.

These various failings by the apartheid-era government directly led to the epidemic and the likely hundreds of thousands of deaths that resulted because of it. As anyone can plainly see, the causes of the AIDS epidemic were far more political than many in power are willing to admit.

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