Christopher Libby

The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa by Dr. Helen Epstein.  The Importance of African Culture

Throughout Eastern and Sub-Saharan Africa, infectious disease was a rare killer for those in their twenties and thirties. HIV/AIDS changed that. In 1982 HIV/AIDS was first recognized in the small African nation of Uganda; by 1992 its people suffered the highest infection rates in the world at 18% of its adult population.(22) Contrary to popular assumption, the majority of the victims were ordinary people in heterosexual relationships.  They did not engage in what the World Health Organization (WHO) termed as high-risk behaviors such as prostitution or IV drug use. In 1993 a molecular biologist named Dr. Helen Epstein gave up her career as a researcher in San Francisco and traveled to Uganda with the hope of developing a vaccine against HIV. Due to the virus’s high rate of mutation, many scientists concluded that a vaccine would be impossible to create. So when Dr. Epstein realized that a vaccine would not be made in her small, underfunded lab in Uganda, she turned her attention to the transmission of HIV/AIDS. The virus itself was no different than the virus that devastated the homosexual community in the United States in the 1980’s, so Dr. Epstein focused on why HIV/AIDS is significantly more prevalent in Africa than anywhere else in the world.

Dr. Epstein’s work led her throughout Eastern and Southern Africa as a “hitchhiker” (27) who could observe the problems more clearly than those seeking governmental funds. What she discovered about the spread of HIV/AIDS in Africa, she writes about in The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa. The book is remarkably easy to read, separating the core topics of HIV history, work in Uganda, the failures of South Africa, and programs on the front lines. Her writings demonstrate to the readers that most western aid organizations fail to truly understand the social relationships in African culture. (150) Without assigning blame, Dr. Epstein explores the complex history of HIV in Africa and the history of the HIV/AIDS response from the west. She focuses on personal stories from victims and their families to portray how HIV/AIDS has impacted all facets of African life. Coupled with scientifically accurate data, Dr. Epstein attempts to provide vital insights into the tragedy that still ravages Africa.

Epidemiologists have long subscribed to the “high risk/ low risk mixing” (53) hypothesis as a means to explain why HIV/AIDS has spread through the social barriers of Africa. The theory proposes that sex in Africa occurs frequently among members of varying social classes and that the poor men frequently visit prostitutes as they migrated to find work. This theory guides many Non-Governmental Organizations (NGOs) to target the high risk groups who interact with these migrant men; prostitutes, IV drug users, and the migrant workers themselves. However, Dr. Epstein argues that this assumption is erroneous. The countries with the highest prevalence of HIV/AIDS are not those with the most promiscuous populations, but those whose populations embrace what she calls “long term concurrent relationships” with the opposite sex. (61) While people living in the west tend to have more sexual partners over the course of their life than people in Africa, the “long term concurrent relationships” in African culture mean that individuals may be having sex with multiple partners at the same time for months or years. This social construct links people together like a giant web which provides the “super-highway” that explains how HIV/AIDS spread so quickly in Africa. So when one person contracts HIV in this web, everyone is at risk of contracting the virus.

Using both scientific data and her own personal accounts, Dr. Epstein depicts how concurrency is part of the culture in Africa and makes a persuasive argument for why it may be the reason why HIV/AIDS is so prevalent. She uses Africa’s own example of the rapid decline of HIV/AIDS in Uganda in the mid 1990’s. Ignited by the fear of AIDS, the Ugandan government began a campaign of openly talking about AIDS with its people. It promoted a groundbreaking campaign of “Zero Grazing.” Rather than tell people to abstain from sex, choose only one partner, or always use a condom, they catered to the Ugandan culture promoting fewer more faithful partners. The approach focused on the communities as a whole, rather than the individual, in order to break up the networks of sexual partners that allowed the virus to spread.(176) This contrasts western programs that have focused on the individuals by scaring them into using condoms or abstinence as a way to protect themselves rather than focusing on the collective efficacy of the community.(160) As Dr. Epstein demonstrates, Uganda not only recognized concurrent relationships and made social change campaigns fit with the culture, but they were self motivated to do so. Uganda made it evident to each and every citizen that AIDS is “everyone’s disease”; a community based strategy that Dr. Epstein proves is vital to any sustainable effort in the developing world.

The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa brings a new perspective to looking at HIV/AIDS in Eastern and sub-Saharan Africa. The concurrency theory is not as well embraced by the international community as Dr. Epstein had hoped. (178) One roadblock to its popularity is that it is far more difficult to implement programs to combat disease when a shift in cultural norms is needed. Dr. Epstein points out that many African leaders would not allow programs implying that African men are unfaithful to be introduced by the same western world that conquered the continent not long ago. (151) Exacerbating the problem is the reality of monetary aid distribution to both condom distribution programs and abstinence programs have been linked to the political left and right respectively. Large sums of money go to the larger NGOs in order to promote a political agenda, rather than the smaller sustainable community based outreach projects that the people themselves have created. The IMAGE project in South Africa is one successful project that helps to empower women to stand up for themselves and their communities. (249) However, Dr. Epstein argues that until western aid organizations begin to embrace the African culture and stop trying to politicize the ineffective policies that have recently dominated the HIV/AIDS funding, there will be little, if any, strides in reducing the HIV/AIDS problem.

The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa fails to provide any real solutions to slowing the spread of HIV/AIDS, despite all the problems it brings to light. This leaves the book as a balanced assessment of the problems with HIV/AIDS in Africa, yet leaves hope in the few working programs it highlights such as the “No Grazing” campaign and the IMAGE project. No one person or organization is left at fault for the failures of various aid programs, rather it is a result of a flood of good will coupled with a poor understanding of Africa. However, this often leads Dr. Epstein to an overly simple explanation of government power and the economics of poverty in Africa. She portrays the South African government as one of secrecy and ignorance, then defends their positions as a logical outcome of their past. (125) Since the focus of the book is not on African politics, it does not divert the reader from the core issue of understanding the African culture before combating the spread of HIV/AIDS.

Dr. Epstein uses the book as a means to challenge NGOs to rethink their strategies of combating HIV/AIDS. Rather than just pouring money into larger programs, it must go to the smaller community based programs that are more personal to the people. They must abandon their naïve notions that strategies that work in the United States will work in Africa, and embrace Africa’s own unique interconnected culture. The “invisible cure” is not something that will be bought, but something that must be cultivated in the hearts and minds of Africa. This message is essential for anyone interested in working to control HIV/AIDS anywhere in the world, as its underlying message is one of understanding the population your working with.