Faith, Hope and Science in the time of AIDS

Historians of medicine in South Africa have demonstrated that in the late 19th and 20th centuries instances of South African medical research and clinical innovation gained global recognition, notably in malaria and tuberculosis work; in malnutrition and breastfeeding studies; in emergency medicine and intensive care nursing; in occupational medicine (the study of silicosis and related diseases); in community oriented primary health care; and in transplant medicine. In the late 1980s, as activists inside of South Africa and the global community pushed for the final dismantling of Apartheid, the HIV epidemic engulfed Southern Africa. This paper is an extract from a larger work examining the history of one medical institution at the centre of a massive regional response to HIV. We trace the long roots of health care and the layers of institution-making in the Durban area, and the long and complex road leading to the response to HIV -- replete with complex political struggles and with huge energy and overlapping domains of power and resources in the areas of clinical care, social treatment, and pharmaceutical innovation and research. We examine the complex relations between local and international medical scientists, researchers, nurses and doctors from the late 1980s to the 2010s, and weigh the role of northern-hemisphere HIV researchers in the epicentre of the HIV epidemic -- the province of Kwazulu-Natal. These northern researchers mentored, shaped, informed, nudged, nurtured and funded the emerging HIV research activities in this east coast province of South Africa. In writing the history of McCord Hospital from 1985 to 2010 the wider work examines three main themes: Pioneering Medical Research (here we examine the rapidity and breadth of the response of medical science to HIV; the meteoric rise of networks, collaborations, and new entities); Funding (resource imperatives, balances of power and obligation, and staffing); and Research Ethics (complexities contingent on human subject research, knowledge ownership, and publication). We trace this complex and imbricated history of medicine to earlier engagements between northern and southern medical professionals in times of emergencies, epidemics and breakthroughs. Oral histories with more than 30 key actors, as well as archival sources and close reading of published works, form the evidentiary basis of the work and this paper. Drawing on the insights from one set of very telling interviews, we draw on the role of religion and science to root our analysis of this key hospital, and a regional medical school, both of which became the epicentre for globally-significant HIV work, forging links with USA based entities -- Columbia, Yale, UC SF, Harvard; and with the UCL in the UK.