Product Description

Product Details

• Amazon Sales Rank: #142824 in Books
• Published on: 2007-05-15
• Released on: 2007-05-15
• Number of items: 1
• Binding: Hardcover
• 352 pages

From Publishers Weekly
Starred Review. Epstein, a public health specialist and molecular biologist who has worked on AIDS vaccine research, overturns many of our received notions about why AIDS is rampant in Africa and what to do about it. She charges that Western governments and philanthropists, though well-meaning, have been wholly misguided, and that Africans themselves, who understand their own cultures, often know best how to address HIV in their communities. Most significant is Epstein's discussion of concurrent sexual relations in Africa. Africans often engage in two or three long-term concurrent relationships—which proves more conducive to the spread of AIDS than Western-style promiscuity. Persuade Africans to forgo concurrency for monogamy, and the infection rate plummets, as it did in Uganda in the mid-1990s. On the other hand, ad campaigns focused on condom use helped imply falsely that only prostitutes and truck drivers get AIDS. In addition, Epstein examines what she calls the "African earthquake": social and economic upheaval that have also eased the spread of HIV. Epstein is a lucid writer, translating abstruse scientific concepts into language nonspecialists can easily grasp. Provocative, passionate and incisive, this may be the most important book on AIDS published this year—indeed, it may even save lives. (May)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist
Some countries in Africa report that approximately one-third of their adult populations are infected with HIV. Epstein wondered how such a state of affairs came about. Seeking answers, she contracted with a biotechnical company to go to Africa and work toward discovering an AIDS vaccine. What she subsequently learned exploded some preconceived and widely shared notions about AIDS, about how African culture all but ensures its spread, and about what might be a deceptively simple answer to the complex question of how to stem that spread. Her absorbing report reveals governmental inefficiencies and medical bureaucracies and social structures that have done nothing to slow the epidemic's pace—and may be accelerating it. Besides the epidemic's social and medical aspects, she discusses the business of AIDS, and she examines the mystery of how the HIV infection rate dropped some 70 percent between 1992 and 1997 in Uganda and the Kagera region of Tanzania; she believes that the invisible cure involved in that plunge provides clues to resolving the issue of AIDS in Africa generally. Chavez, Donna
Copyright © American Library Association. All rights reserved

Review
"Her tone is level and undogmatic, but the news that Helen Epstein brings from the African front lines about AIDS is searing. So many lives have been lost, so much time and money wasted in badly-designed public and private campaigns against the disease. What actually works is both simple and subtle. There may be no magic bullet--there may never be a vaccine--but there are success stories, even in very poor countries. This is a landmark study. "
--William Finnegan, author of Cold New World: Growing Up in a Harder Country and A Complicated War: The Harrowing of Mozambique

Customer Reviews

hiv prevention: now and how
"As a woman living with HIV," says Beatrice Were of Uganda, "I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives." With a vaccine against HIV far off in the distant future (if at all), and with treatment of AIDS in the two-thirds world difficult, expensive, and limited in effect, the name of the game in HIV-AIDS is prevention. But in places like Africa, which is the focus of Helen Epstein's book, prevention is not as simple as it sounds. As she notes in her appendix, measles, syphilis, tuberculosis, and other entirely preventable diseases still kill millions of people even though they can be treated for pennies.

Why has HIV-AIDS ravaged eastern and southern Africa like no place on earth? "In 2005," she writes, "roughly 40 percent of all those infected with HIV lived in just eleven countries in this region-- home to less than 3 percent of the world's population." In some of these countries the infection rates have hit 30 percent, decimating the general population, while in the west, for example, rates hover at about 1% and are generally limited to specific demographics like gay men, intravenous drug users, and commercial sex workers." Theories abound about this discrepancy, but Epstein argues a narrow point, that Africa's problem is not profound promiscuity, or even the normal culprits of high risk groups like prostitutes or truck drivers, but instead a social phenomenon of "concurrent partners." That is, Africans do not have more sexual partners than in other places in the world, and nowhere near as many as gay men among whom infection rates are exponentially lower; but they do have a small number of sexual partners concurrently, at the same time, rather than one at a time or sequentially. This has set the virus loose among the general population like a runaway train.

And why has prevention been so elusive? Epstein appeals to what she calls the comprehensive "social ecology" of denial, silence, shame, adverse gender roles, and stigma about HIV-AIDS. Western-initiated and donor-funded programs will always be less successful than listening to Africans themselves and their own suggestions about how to address the problem. Uganda, of course, has been the amazing success story in this regard, and the subject of bitter debates about why. In 1989 Uganda had one of the highest infection rates in the world, but from about 1992-2002 the infection rate dropped by two-thirds. The key to the success, argues Epstein, was not in the billions of dollars from the west, but from the "collective efficacy" of a "shared calamity," by people helping each other and talking openly about the scourge. In particular, "partner reduction," she says, and not the much vaunted condom use, helped Ugandans to address the cultural phenomenon of concurrent partners. Partner reduction, as one worker described it, is thus the "neglected middle child of the ABC approach" of abstinence, fidelity ("be faithful"), and condoms. Zero Grazing, as Uganda's president Yoweri Museveni called for, is thus the silent cure already available, however valuable other prescriptions.

Epstein, a molecular biologist who has written widely on public health issues, combines rigorous science and the anecdotal evidence of substantial field research. She's clearly as comfortable with and interested in meeting with a dozen African widows under a mango tree as she is in the latest results of a demographic study. Her book has received strong reviews in the New York Times and the New York Review of Books (where her mother was a co-editor before she died), and also a rebuttal of sorts on the home page of UNAIDS that was provoked by her somewhat conspiratorial stance toward research that she argues they ignored because it didn't fit their partisan ideology.

Clear Thinking About Slowing the AIDS Epidemic in Africa
We have been overwhelmed by bad information about what causes AIDS to be so much more prevalent in the eastern and southern parts of Africa than elsewhere in the world. Even though more money than ever is being directed to stopping this epidemic, that money is hardly ever being spent for a helpful purpose. Helen Epstein carefully describes what she learned on site in Africa about what the primary problems really are and how best to deal with those problems . . . rather than the problems that politicians and NGOs want to address. Millions of lives are at stake: Please read what Ms. Epstein has to say and share what you learn with others.

So what's different about people in eastern and southern Africa that makes AIDS so much larger a risk there?

1. Men are much less likely to be circumcised. Circumcion cuts infection risk dramatically.

2. Although the people in that part of the world have no more (and often fewer) sexual partners over a life time, these people are more likely to be active with more than one sexual partner at a time. That habit causes those who become infected to spread the disease much faster and further.

What can be done?

Uganda (once the area most affected by AIDS) provides the answer: Make sure everyone knows that AIDS risk is there for everyone who is a drug user and shares needles, or has sex with anyone who has more than one partner without using a condom. The public in general, and politicians as well, like to paint AIDS as being a problem limited to homosexuals, sex workers, and promiscuous people. But in places like eastern and southern Africa, those who monogamous can be almost equally at risk. In fact, Uganda doesn't use these good policies any more ("No Grazing") because fighting AIDS has gone from being a local activity to being a national policy.

Ms. Epstein reports in detail how local initiatives to get the correct information out can make a big difference (saving an estimated one million lives in Uganda). National and international initiatives seem to waste almost all of the money (as she points out in several examples).

By not paying attention to what works and what doesn't, country leaders and international NGO leaders run the risk of making everyone feel like everything is being done . . . when the wrong things are being done. As a result, millions will die.

It's a sad story of how everyone wants to help, but they see the problem as being like the nail in the eye of a carpenter. You hit the nail to solve the problem. Drug companies want to develop vaccines. Condom makers want to sell condoms. Churches want to preach sexual abstinence. Politicians want to ignore the frequency of rape, casual sex, and cheating among married people. Individuals want to believe they are safe because they know the people they have sex with. But most of these nails don't make much difference.

Let's start hitting the right nail!

An important contribution to addressing this ongoing tragedy
I'm an American doctor working in rural KwaZulu-Natal, South Africa. I can attest to the substance of much of the material presented in this book and the importance of its message, specifically that norms of sexual behavior in this culture need to be discussed and changed for prevention efforts to begin to be effective. As the author aptly discusses, numerous aid organizations, flush with good intentions and funds, seem to operate on the periphery of this central issue. One of the most disturbing lessons of my time in the midst of this horrible tragedy is the realization that the stigma attached to this disease in many parts of sub-Saharan Africa remains so severe that many people prefer to die than to find out that they have AIDS, a point the author seems to get across through with many informative anecdotes. The fundamental thesis is that we need to begin to engage the leaders within these societies at a fundamental cultural level regarding relationships and sexual behavior. No small task. I would highly recommend this book as the first read for someone trying to understand why AIDS is so unbelievably prevalent in Sub-Saharan Africa. As of today, for every person we enroll in antiretroviral treatment in rural KwaZulu-Natal, five will be newly infected. It's very depressing to see so many people dying from a preventable disease--1,000 people die of it every day in South Africa alone.