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• Amazon Sales Rank: #28071 in Books
• Published on: 2006-06-05
• Number of items: 1
• Binding: Paperback
• 464 pages

From the New England Journal of Medicine, March 6, 2003
In only two decades, the epidemic of human immunodeficiency virus (HIV) infection and AIDS has progressed from being a medical curiosity to its current status as a global killer, changing the family structures, economic development, and even the security of many countries in the developing world. Tony Barnett, professor of development studies at the University of East Anglia in the United Kingdom, and Alan Whiteside, director of the Health Economics and HIV-AIDS Research Division at the University of Natal in South Africa, have written a book that examines the social and economic effects of the HIV-AIDS epidemic, failures in responding to the epidemic, and what must be done to combat the epidemic. Appropriately, Barnett and Whiteside devote considerable attention to Africa, the home of most of the world's HIV-infected persons. Although disorder, social inequalities, exploitation, and poverty are common throughout sub-Saharan Africa, the authors note that the underlying risk factors for the spread of HIV in this region vary according to country. For example, they maintain that corrupt governments and war gave rise to the epidemics in Uganda and the Democratic Republic of Congo, whereas more gradual economic and social changes created a high-risk environment in Tanzania. In the Republic of South Africa, the authors trace the origins of the epidemic in large part to the legacy of apartheid. The need for black workers in mines and factories owned by white persons created a culture in which men left their families to find work and then turned to local prostitutes for sex. The authors also cite the remarkable claim that the apartheid government employed HIV-infected men for the purpose of infecting female sex workers. Beyond the sheer numbers of infections, the effects of the epidemic in the most severely affected countries can be measured by its effects on families, economies, and governments. Barnett and Whiteside give poignant examples of families consisting of children and their grandparents and households where more money is spent on funerals than on medical care. Orphaned girls are often vulnerable to sexual abuse, and orphaned boys forced to serve as soldiers. The loss of adult workers further affects the already weak economies of poor countries. The loss of farmers may lead to the sale of their lands or cultivation of crops that are easier to grow. In businesses, HIV infection increases absenteeism and health insurance costs. In addition, companies may lose their customer base and are forced to write off the debts of customers who have died. African governments may no longer be able to meet their development targets and must cope with the loss of much of their own workforce. One unfortunate irony of the epidemic is that the large numbers of deaths among children and young adults actually allow governments to save money by spending less on education and pensions. Although the large amount of demographic and economic detail provided in the book may not be of interest to most readers, some facts are particularly compelling. For example, in Botswana, the country with the world's highest prevalence of HIV infection, life expectancy for a child born in 2000 has dropped from an anticipated 70 years in the absence of AIDS to only 39 years. Botswana is a relatively wealthy African country because of its diamond industry. However, among employees of Debswana, the diamond company that accounts for a third of Botswana's gross domestic product, HIV seroprevalence is almost 29 percent. In Zambia, a country where the epidemic is almost as severe as in Botswana, the number of teachers who die annually from AIDS now exceeds the number of teachers graduating from all training colleges each year. Unfortunately, the authors note, knowledge and observation of the African HIV-AIDS epidemic have not been translated into appropriate action. They argue that effective prevention efforts will need to move beyond focusing on biomedical and behavioral interventions to changing high-risk environments. The latter goal will require political leadership and multisectoral approaches that extend beyond health agencies. The successes of Uganda in prevention are cited as goals for other countries. In their acknowledgments, the authors thank the staff of KLM Airlines because sections of the book were written on KLM flights and in the KLM lounge in Amsterdam. Unfortunately, the sorts of problems that might result are apparent in the book. These problems range from errors of fact (Pneumocystis carinii is carried by birds, and HIV infects the Sykes monkey) to simple oversights, such as the inclusion of figures that are not referenced in the text. The authors also reveal their backgrounds in economics rather than clinical medicine by failing to define terms that are unlikely to be understood by noneconomists (e.g., "Gini coefficient" and "parastatal middlemen") and making misleading statements about medicine ("Some clinicians prefer to step up the treatment gradually with single drug therapy"). The book is further marred by truisms, such as "Mortality rates crucially affect life expectancy indices" and "The further you look into the future, the less certainty there is." The reader is left wishing that the authors had spent less time on airplanes and more time consulting with a medical editor. Although AIDS in the Twenty-First Century will primarily be of value to persons interested in health economics and international development, even the most casual reader will be struck by the global tragedy of AIDS and the likelihood that the epidemic will progress from bad to worse. Harold W. Jaffe, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Harold W. Jaffe, New England Journal of Medicine, Mar 6 2003
...even the most casual reader will be struck by the global tragedy of AIDS

Review
"A unique and important book. It is accessible, innovative and far-sighted. This is the most important recent book to understand the longterm consequences of AIDS in Africa."--Peter Piot, Executive Director UNAIDS

"Literally dozens of potential research questions emerge from almost every chapter. This book ought to be at the side of any social scientist wanting to conduct systematic work on HIV/AIDS."--Dr Robert Mattes, Associate Professor, Political Studies, University of Cape Town, Journal of South African Studies

"The foundation text for postgraduate courses on AIDS and development, AIDS and politics and so on... the best reference book for those who are - or should be - grappling with the implications of AIDS in development planning, business and public affairs."--Alex de Waal, London Review of Books

"The single best introduction to the global pandemic and its consequences. It is clear, thorough, and authoritative. ...this is a must-read for policy-makers, scientists, and the general public."--Craig Calhoun, President, Social Science Research Council

"A powerful book which needs to be read by all senior African politicians and policy makers. It is honest about the scale of the pandemic and the problems we face in addressing it but there is a real message of hope. We can beat this disease."--KY Amoako, Executive Secretary, Economic Commission for Africa

"The book presents important ideas and presents eloquently and thoroughly the arguments of emerging thinking around the impact of the disease on society."-- African Security Review

"This is an outstandingly written book with a wealth of information that makes it priority reading for policy makers, students, and anyone who is concerned about or studying the relationship between poverty, inequality, and infectious diseases. A highly recommended book for all libraries."--H.Robert Malinowsky, AIDS Book Review Journal

"This book should be read by every businessman, not only in Africa, throughout the world - because it uncovers in new and more meaningful ways the terrifying global, social and economic impact of HIV/AIDS...[It] breaks fresh ground by offering solid reasoning why the conventional wisdom that relates wealth and poverty to the extremes of HIV/AIDS prevalence needs to be revisited."--African Business

"Even the most casual reader will be struck by the global tragedy of AIDS."-- Harold W. Jaffe, New England Journal of Medicine

"The book is a very rich resource - a 'must read' for students, HIV/AIDS activists, social science researchers, public health experts, policy makers and programmers."--Oluwole Odutolu, International Journal of Health Planning and Management

"This is an important and wide-ranging book which fills a series of gaps in current understandings of the origin and impact of HIV/AIDS."--Catherine Campbell, Social Psychology, London School of Economics and Political Science, Development in Practice

"AIDS in the Twenty-First Century explains the background to the epidemic, and explores why Africa has been hit so hard and why some countries have been hit harder than others. Reading this book will shock you into an understanding of the long - perhaps century-long - impact we are all going to feel from this disease."--New Agriculturist On-line

"Aimed at a general audience, this is a valuable and well-written addition to the literature on the HIV/AIDS epidemic, commonly dominated by biomedical and epidemiological perspectives."--John Bongaarts and Geoffrey McNicoll, Population and Development Review
"This book needs and deserves to be read. Unlike some writers on AIDS, who appeal emotively to compassion and a sense of injustice, Barnett and Whiteside explicitly address the reader's pragmatism, self-interest and capacity to reason. Somehow, this makes the book's underlying humanity and call to action all the more compelling. If it is read and acted upon, as the authors hope, AIDS would still change history, but perhaps for the better."--Vicki Luker, Papua New Guinea Medical Journal

"Economists Tony Barnett and Alan Whiteside's AIDS in the Twenty-First Century: Disease and Globalization provides impressively comprehensive coverage of the social and economic roots and likely impacts of HIV/AIDS."--Michael J. Selgelid, Developing World Bioethics

"Barnett and Whiteside have constructed a monumental book . . . It wrestles with complex moral dilemmas such as how we define our responsibilities to others, as well as providing a wealth of informative graphs and tables that nail down the statistics and trends behind HIV/AIDS...the book is a very valuable resource. Stylistically easy to read, it provides clear, sharp and incisive commentary on the unfolding epidemic. It can be used as a reference book for both novices in the HIV/AIDS field and those who need quick access to a range of studies and statistics."--Kerry Cullinan, Transformation: Critical Perspectives on Southern Africa

Customer Reviews

A rare focus on the social and economic context
This is the only book-length exploration of the social and economic context of the the HIV/AIDS epidemics. What comes through is that the authors are not journalists who dashed off a book on AIDS, but longtime researchers, with world-ranging experience.

WHile well documented, it is readable. The next college level course I teach on contemporary issues will surely include this as required reading. My students will thank me for it.

The best comprehensive treatment of HIV/AIDS
Tony Barnett and Alan Whieside have done a fantastic job of placing the issue of HIV/AIDS within a comprehensive context. It is easy to read, well researched, thoughtful in it's analysis, and comprehensive - that is, it places the pandemic amidst the global forces that are affecting it and which must be understood if we're to successfully turn the tide. I am recommending it to many of my colleagues! It is the best book I have read to-date on the most challenging crisis facing the human family.