The Invisible Cure: Africa, the West, and the Fight Against AIDS

The Invisible Cure: Africa, the West, and the Fight Against AIDS In , Helen Epstein, A Scientist Working With A Biotechnology Company Searching For An AIDS Vaccine, Moved To Uganda, Where She Witnessed Firsthand The Suffering Caused By The Epidemic Now, In Her Unsparing And Illuminating Account Of This Global Disease, She Describes How International Health Experts, Governments, And Ordinary Africans Have Struggled To Understand The Rapid And Devastating Spread Of The Disease In Africa, And Traces The Changes Wrought By New Medical Developments And Emerging Political Realities It Is An Account Of Scientific Discovery And Intrigue With Implications Far Beyond The Fight Against One Tragic Disease The AIDS Epidemic Is Partly A Consequence Of The Rapid Transition Of African Societies From An Agrarian Past To An Impoverished Present Millions Of African People Have Yet To Find A Place In An Increasingly Globalized World, And Their Poverty And Social Dislocation Have Generated An Earthquake In Gender Relations That Deeply Affects The Spread Of HIV But Epstein Argues That There Are Solutions To This Crisis, And Some Of The Most Effective Ones May Be Simpler Than Many People Assume Written With Conviction, Knowledge, And Insight, Why Don T They Listen Will Change How We Think About The Worst Health Crisis Of The Past Century, And Our Strategies For Improving Global Public Health

Helen C Epstein is Visiting Professor of Global Public Health and Human Rights at Bard College She has worked for than 20 years as a public health consultant in Uganda and other countries for such organizations as the World Bank, UNICEF and Human Rights Watch Her book The Invisible Cure Why We Are Losing the Fight against AIDS in Africa was a New York Times Notable Book and s best

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  • Hardcover
  • 326 pages
  • The Invisible Cure: Africa, the West, and the Fight Against AIDS
  • Helen C. Epstein
  • English
  • 01 August 2018
  • 9780374281526

10 thoughts on “The Invisible Cure: Africa, the West, and the Fight Against AIDS

  1. says:

    You don t really think a book written by a molecular biologist and activist could be that interestingyou would be wrong This book is an amazing synthesis of sociology, anthropology, feminism, and public health It speaks of the AIDs crisis in South and East Africa with amazing clarity If you are remotely interested in the subject read this If you are up to date on policy developments in this region of the world it may be a little simplistic.

  2. says:

    Continuing my latest project bringing myself up to date on the global AIDS epidemic, the history, the science, and the realities of life with HIV I picked up a book I d seen recommended in several articles on AIDS narratives, Helen Epstein s The Invisible Cure Why We Are Losing the Fight against AIDS in Africa I was particularly looking forward to comparing Epstein s views with those expressed by Craig Timberg and Daniel Halperin in Tinderbox, which also addressed the specific issues and conditions surrounding the fight against AIDS in Africa Epstein is an American writer and journalist She is also a molecular biologist and has worked as an independent consultant specialising in public health in developing countries for organisations as diverse as The Rockefeller Foundation, Human Rights Watch and the Population Council Her career as as a molecular biologist working on the development of an AIDS vaccine took her to Uganda, where she conducted research Though she was unsuccessful in making any progress on the quest for a vaccine, her experiences in Uganda and later research in other countries served as the basis for this book on AIDS in Africa The book is partly a personal narrative and partly an exploration of the specific conditions surrounding the AIDS epidemic in Africa.As Epstein notes in her Preface, the way that the AIDS epidemic has developed in Africa differs in certain key dimensions from its progress in other areas The worldwide AIDS epidemic is ruining families, villages, businesses, and armies and leaving behind an immense sadness that will linger for generations The situation in East and southern Africa is uniquely severe In 2005, 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 Botswana, Lesotho, and Swaziland, roughly a quarter of adults were infected, a rate ten times higher than anywhere else in the world outside Africa Epstein s narrative is an attempt to identify the reasons for the scope of the epidemic in Africa In terms if the early spread of the disease, and the conditions which facilitated its continued growth and the difficulties in designing effective treatment and education programs, Epstein appears to have come to some of the same conclusions as Timberg and Halperin, particularly on the role that colonialism and globalisation have played in the social disruptions that allowed AIDS to flourish She says its spread has been worsened by an explosive combination of historically rooted patterns of sexual behavior, the vicissitudes of postcolonial development, and economic globalization that has left millions of African people adrift in an increasingly unequal world Their poverty and social dislocation have generated an earthquake in gender relations that has created wide open channels for the spread of HIV Further, she suggests as do Timberg and Halperin that projects and programs imposed from outside the communities by people with little understanding of African life and society are unlikely to be successful Like many newcomers to Africa, I learned early on that the most successful AIDS projects tended to be conceived and run by Africans themselves or by missionaries and aid workers with long experience in Africa in other words, by people who really knew the culture However, Epstein focuses primarily on the causes and consequences of major differences in the epidemiology of the disease in Africa when compared to other areas where the disease has reached epidemic proportions In other world regions, the AIDS epidemic is largely confined to gay men, intravenous drug users, commercial sex workers, and their sexual partners But in East and southern Africa, the virus has spread widely in the general population, even among those who have never engaged in what health experts typically consider high risk behavior and whose spouses have not done so either It is these significant differences in the pattern of AIDS epidemiology in Africa that make fighting the disease so much harder Harm reduction policies that have worked well in other countries have had little success in stemming the rate of new infections, because the behaviours that lead to transmission and the populations affected are not the same as are seen elsewhere Further, the connection between HIV infection and behaviours often seen as immoral or criminal prostitution, anal sex, intravenous drug use tend to convey an attitude of shame, which limits communicators ability to convey a message if harm reduction behaviour to ordinary people who are not part of a high risk population in this book, I suggest that outside of Uganda and Kagera, health officials misunderstood the nature of the AIDS epidemic in this region, in particular why the virus was spreading so rapidly in the general population As a result, the programs they introduced were less effective than they might have been and may have inadvertently reinforced the stigma, shame, and prejudice surrounding the disease Much of the stigma and confusion surrounding AIDS has to do with its common association with perceived irresponsible or immoral sexual behavior This sense of shame associated with AIDS may well have ben intensified by the cultural influence of colonialism and Western racist attitudes toward Africans A prevailing racist narrative, traceable to the earliest reports of Europeans visiting sub Saharan Africa, is that of the hypersexual African Education and prevention programs designed in the West and imported to Africa were influenced by assumptions that AIDS in Africa was spreading so widely because of extreme promiscuity Not only did this result in programs that would widely miss their mark, but in sone cases it generated resistance among Africans, highly sensitive to the perceptions of Westerners, leading them to downplay or deny the severity of the epidemic because of its association with sexual immorality In a speech given at the University of Fort Hare in 2001, South African President Mbeki railed against those who were convinced that we are but natural born promiscuous carriers of germs, unique in the world They proclaim that our continent is doomed to an inevitable mortal end because of our unconquerable devotion to the sin of lust Indeed, Epstein found that in many areas, discussion about AIDS is virtually non existent, and many people acted as if it was not an issue in their communities People refuse testing, deny their positive status, pretend that deaths of friends and family are from other causes In South Africa, where rates of infection are among the highest in the world, an entire multi million dollar educational and social marketing campaign, called loveLife, and aimed at reducing high risk practices among youth, rarely if ever mentioned the term AIDS In many cases, Epstein was told that this silence is due to the fact that AIDS has been presented as a disease of prostitutes and criminals To admit that you are HIV positive, or that someone in your family is, is to admit gross personal immorality and invite shaming, social isolation, and even violence The truth, however, is that in Africa, unlike most other regions, AIDS predominantly affects people in the general heterosexual population, particularly women who have never engaged in what are commonly seen as the high risk behaviours Many HIV positive Africans have had few sexual partners, and most of their sexual relationships have been long term, based on some degree of emotional commitment, and no prone to unfaithfulness than relationships conducted by Westerners The difference which increases the risk of infection for heterosexual Africans is a cultural one in many areas of Africa, the pattern is not one of serial monogamy, but of concurrent polygamous relationships what many people from policy makers, to public health experts, to ordinary African people at risk did not realize is that most HIV transmission in this region results from normative sexual behavior, practiced by large numbers of people It s not that African people have sexual partners, over a lifetime, than people in Western countries do in fact, they generally have fewer However, in many African communities, both men and women are likely than people in other world regions to have than one perhaps two or three overlapping or concurrent long term partnerships at a time A man may have two wives, or a wife and girlfriend, and one of those women may have another regular partner, who may in turn have one or other partners and so on This long term concurrency differs from the serial monogamy common in western countries, and the casual and commercial one off sexual encounters that occur everywhere But long term overlapping relationships are far dangerous than serial monogamy, because they link people into a giant network that creates a virtual superhighway for HIV Concurrent sexual partnerships have strong cultural, social and economic roots in East and Southern Africa, and this has made fighting HIV very difficult Fifteen years of vigorous condom promotion in many African towns and cities has had little effect on the epidemic, probably because most transmission occurs in long term relationships in which condoms are seldom used As family planning experts have known for decades, people use condoms mainly in casual and commercial relationships, and inconsistent condom use offers poor protection against either pregnancy or STD transmission in long term relationships Urging African people to abstain or be faithful has its limitations too, because most people are faithful already, if not to one person, then to two or three Many of those at highest risk of infection are the faithful partners of men or women with only one other trusted long term partner others are in mutually faithful relationships, in which one partner had concurrent partners in the past Epstein sees the pattern of multiple concurrent sexual relationships as the primary reason that AIDS in Africa is not primarily a disease of high risk groups, but a disease affecting the general population, most of whom are neither promiscuous nor engaged in what is normally recognised as high risk activities The reasons for these concurrent relationships vary widely In some communities, polygamy is still the norm, such that each man has multiple wives In some cases, if the man is a migrant worker, he may also have a girlfriend in his place of work and because he cannot financially support both his wives and his girlfriend, she may have a second lover as well At home, one or of his wives may have a longterm clandestine relationship with one of the many unmarried young men who cannot yet afford a bride price In urban areas, many women engage in transactional relationships they agree to be someone s girlfriend in return for gifts or some financial support A young man with some income to spare may have such relationships with several women at the same time One or of these young women may have a second lover, either to augment her financial situation or to pay back her first boyfriend for his infidelities Until recently, education programs focused on the kinds of high risk behaviours identified as key means of transmission in other regions, and did not discuss concurrent relationships as a risk Further, prevention education focused on condom use But because these programs did not take into account the realities of sexual behaviour in many areas of sub Saharan Africa, such programs did little to reduce harm in the relationships most likely to spread infection The condom campaigns were intended to encourage frank discussion about sex among normally reticent African populations and reach out to high risk populations with the message that casual sex was nothing to worry about as long as condoms were used But it is possible to imagine how they might have had the opposite effect By associating AIDS with beer drinking, premarital sex, prostitution, and in the case of the boxing glove and basketball ads womanizing and rape, the lusty condom ads might well have clashed disastrously with local sensibilities concerning decency and self respect and further inflamed the prejudice, denial, and rumormongering that have featured so strongly in the AIDS epidemic, and in virtually all epidemics since biblical times The campaigns were totally wrong, said Nkosazana Ngcobo, who works with a South African organization that helps orphans The message was you had to be a prostitute or a truck driver to get AIDS One thing that runs through many of these patterns of concurrency is the role played by poverty, particularly among women, and by the concentration of work for men in geographically distant areas, which results in partners being separated for long periods of time and thus seeking out secondary relationships for comfort Epstein does not hesitate to place much of the blame for these economic inequities and dislocations on colonialism, globalisation, and the policies of Western development and investment organisations such as the World Bank The reasons why sexual behavior had been so slow to change in response to HIV in many developing countries were complex and mysterious It is also possible that people in communities that have been broken by war, migration, and continuing economic hardship will be slow to take HIV awareness messages seriously It is also possible that improving the social conditions that make the poor vulnerable to HIV is difficult when their fate is sometimes in the hands of remote economists, officials, and businessmen In the first section of the book, Epstein reports on the reasons she sees behind the rapid spread of AIDS in most of sub Saharan Africa She then turns, however, to look at one area where infection rates declined, without significant access to Western AIDS programs or anti viral pharmaceuticals Initially, the spread of HIV infection in Uganda and the adjacent Kagera region of Tanzania was rapid, fueled by border conflicts between Uganda and Tanzania in the 1970s, which resulted in mass movements of soldiers and civilians, and attendant prostitution But by the late 1980s, the prevalence of AIDS had fallen dramatically, even as it was rising in surrounding regions The phenomenon has been studied and many explanations have been put forward for this drop Epstein attributes it at least in part to something she calls collective efficacy It seemed to me that what mattered most was something for which public health experts had no name or program It was something like collective efficacy the ability of people to join together and help one another Felton Earls, the sociologist who coined the term, was trying to explain varying crime rates in American cities, but the phenomenon is present everywhere there is a spirit of collective action and mutual aid, a spirit that is impossible to measure or quantify, but that is rooted in a sense of compassion and common humanity During the 1980s and early 1990s, while people in most African countries were ignoring the AIDS crisis, hundreds of tiny community based AIDS groups sprang up throughout Uganda and Kagera to comfort the sick, care for orphans, warn people about the dangers of casual sex, and address the particular vulnerability of women and girls to infection Yoweri Museveni s government developed its own vigorous prevention campaigns and the World Health Organization provided funding, but much also came from the pockets of the poor themselves Their compassion and hard work brought the disease into the open, got people talking about the epidemic, reduced AIDS related stigma and denial, and led to a profound shift in sexual norms This process was very African, but it was similar in many respects to the compassionate, vocal, and angry response to AIDS among gay men in Western countries during the 1980s, when HIV incidence in this group also fell steeply Epstein also notes that the people in this region understood earlier than others that in this part of Africa, AIDS was not just a disease of prostitutes, truck drivers and other stigmatized high risk groups The post Amin government of Yoweri Museveni undertook a serious education campaign that featured frank talk about sex and popularised the slogans Love Carefully and Zero Grazing encouraging a reduction in concurrent relationships A strong feminist movement brought about legal and social changes that empowered women to assume greater personal autonomy in sexual relationships But at the time, Western AIDS workers and researchers dismissed all this Through the 1980s and 1990s, officials from the World Health Organization, USAID, and other development agencies largely dismissed Uganda s AIDS programs It seemed like chaos, Gary Slutkin, a WHO official who worked in Uganda in the late 1980s, told me much later For many of my colleagues, the problem was there was no theory behind Uganda s approach Public health programs were supposed to be rational, budgeted, and targeted at those groups thought to be most at risk They were not supposed to be a free for all But what WHO officials did not understand at the time was that there was a theory It just wasn t their theory The intimate, personalized nature of Uganda s early AIDS campaigns the open discussions led by government field workers and in small groups of women and churchgoers, the compassionate work of the home based care volunteers, the courage and strength of the women s rights activists helped people see AIDS not as a disease spread by disreputable high risk groups or others but as a shared calamity affecting everyone In recent years, the frank campaigns based on reduction of partners have disappeared In their place, abstinence only programs operated by evangelical Christian organisations and funded by a US government opposed to any other preventative approaches have become standard Shame and stigma are increasingly directed toward immoral AIDS sufferers And the prevalence of AIDS in Uganda is no longer falling.Epstein concludes her book with an examination of the kinds of locally designed and operated programs that may help to alleviate suffering and change behaviours, and how these are often undermined by programs designed and funded by Western organisations Ultimately, she says, there is a place for both, but each must be allowed to do what it is best suited for.Epstein s familiarity with Africa, gained through years of research into public health issues in multiple areas if the continent, makes this book an invaluable resource tor understanding what has gone wrong with the fight against AIDS in Africa, and what can be done to set it right.

  3. says:

    There were than a couple of times during this book that I wished for or better editing However, the information about AIDS in Africa that she conveys is really what s important I guess I d thought that the problems with the AIDS epidemic in Africa was an unwillingness to use condoms Although she does indicate that condom use could be greater, she also shows how that s not really the main problem the main problem long term sexual relationships with than one partner what she calls concurrent relationships provides a kind of speedway for HIV through the general population The other problem is that western attempts to help have done very little good because they have tended to ignore or not understand exactly that point Attempts to curb the virus by some African groups have been successful though and she points to those groups and their methods as models for the future This is important information because the epidemic itself is important but it s also important for people who want to donate to African AIDS relief programs this starts to give you a basis for understanding which of those programs might be most successful.

  4. says:

    I really enjoyed this book I think the best part is Helen Epstein Her perspective as a molecular biologist, turned public health advocate sociologist is so rare, yet pivotal to unraveling the problem of AIDS in sub saharan Africa I really enjoyed her analyses of prior theories and why they have failed to fully explain the AIDS epidemic in Africa Her writing is smooth and clear, yet very evidence based I only wish that the new theories she proposes, such as the importance of concurrent partnerships in the spread of HIV, had the same scrutiny behind them She quoted studies for these as well, but at times they seemed too perfect How can everything be so clearly divided into right and wrong Still, Epstein s empathy prevails throughout the book and she imparts the importance of humanism, practicality, and humility in having any success with improving the state of people s health.

  5. says:

    Well done book An excellent critique of the international response to the HIV AIDS crisis in Africa Epstein examines the efforts of Western donors and African governments and finds both wanting She doesn t try to do too much The book is critical of the naive and condescending Western funded programs which have been so ineffective It is also critical of the African government policies that have contributed to the sense of shame associated with the disease Epstein proposes no magic elixir, but stresses the necessity of better communication and of removing the stigma associated with HIV AIDS Along with Easterly and Stiglitz, this is one of the better critique s I ve read of Western aid in Africa.

  6. says:

    Cross but strikingly clear social history reportage account of the intersection of Western politicised philanthropy and the AIDS crisis in southern Africa, with particular focus on the contrasting cases of South Africa and Uganda The multifaceted legacies of colonialism are illustrated very effectively, as Epstein whose close involvement in and critical research into governmental and NGO AIDS projects in multiple African countries over multiple years gives her the contacts and the experience to ferret out the lesser known complications of it all repeatedly demonstrates how local expertise and locally tailored solutions have been ignored and or overridden by money, stigma, racism, etc, to the cost of those suffering, directly or indirectly, from the disease Occasionally falls into Africa is a country generalisations and platitudes, but for the most part this is a book structured around the problem of one size fits all explanations and solutions.

  7. says:

    Technical but very enlightening I d never heard of thr concept of concurrent relationships as a cultural norm Many of the things in this book make a lot of sense.

  8. says:

    A quick, good read for all writers You will feel buoyed and validated in Goldberg s hands.

  9. says:

    It took me longer than usual to get through Helen Epstein s The Invisible Cure Africa, The West, and The Fight Against AIDS than it does with other books, both on similar topics and not While wholly readable and not overly academic in tone, Epstein provides a wealth of information on the subject of HIV AIDS in Africa She gives a multi faceted look into the biology of HIV AIDS and how various African countries have dealt with the epidemic While it would be impossible to cover it all, Epstein certainly does a great job of explaining the historical, political, and social contexts of the epidemic in Africa, as well as the effects of international aid and how it has been dispersed In particular, it was fascinating for me to read about the culture of long term concurrent sexual relationships, which Epstein presents as a major reason as to why HIV AIDS spread so quickly in Africa She accurately points out that AIDS awareness campaigns are not uniform and must make sense within the cultural context of the people it attempts to educate and help I believe that s a valuable lesson and certainly one that should be heeded Instead of imposing Western solutions on African peoples, it would make most sense to use the social models that exist to open lines of communication about HIV AIDS awareness, prevention, treatment, etc.

  10. says:

    This was an interesting perspective on the problems with AIDS programs in Southern Africa Helen Epstein s interest was picqued when she went to Uganda in the early 1990 s to do AIDS vaccine research and sees the difference in community response to the AIDS crisis Her quest to get to the ground truth is amazing I was worried that I would tire of reading about this topic especially since the book is almost 300 pages but I found that I really enjoyed the way she told her story The chapter and topic breaks make it easy and almost fast to read Although it seems almost unnecessary to say, the chapter on rape and abuse is very distrubingand this is coming from someone who had to read and learn about it for the past 3 years in school Maybe it is in the way she tells it, but it got to me even than the readings for my classes did.If you are looking for a good primer on AIDS programs in Africa, both from the grass roots level and the international big aid level, and what appears to work and what absolutely does not, this is a rgeat book.

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