Public-health specialist Epstein (Where She Came From, 1997, etc.) takes a stark yet hopeful look at the AIDS epidemic in Africa.
Forty percent of the world’s population infected with HIV live in African countries that are home to only three percent of the world’s population, she states, illustrating the severity of the problem. Trained as a molecular biologist, the author opens with an account of her naïve and frustrated attempts to study HIV in Uganda in 1993. Since then, Epstein has traveled widely in Africa, studying gender relations and developing a theory about the spread of AIDS. She argues that the epidemic has been triggered by upheavals caused by the rapid shift for millions of Africans from an agrarian, tribal society to a semi-urbanized way of life in a bureaucratic state, as well as the consequent disruptive shift in the balance of power between the sexes. She credits Uganda’s homegrown Zero Grazing campaign of the 1980s with reducing the HIV rate more than either abstinence or condoms. The program recognized that polygamy, formal or informal, was the norm, but encouraged men to stick to one partner or, if they must have multiple partners, to avoid casual encounters with prostitutes. According to Epstein, such a program could not operate in the current political and religious climate. AIDS, she maintains, is now a multibillion-dollar enterprise with highly paid outside consultants offering a menu of options that fail to consider the cultures of those they seek to reach. What is needed is not just medical treatment for those already infected, but support for community-based, locally conceived and locally controlled preventive initiatives.
Critical analysis of a dire situation and a compelling argument for the power of social mobilization.
