Tasha Morrison
“The Invisible Cure. Why we are losing the fight against AIDS in Africa.” Helen Epstein. New York: Picador, 2007. 324
HIV/AIDS is a disease that continues to devastate many lives, and boggles the minds of physicians, scientists and public health professionals alike. The AIDS epidemic in Africa is an unfortunate current event that is so complex in nature. Unlike other areas in the world where AIDS could be basically narrowed to a certain demographic, there is no clear reason or answer as to why Africa has the highest percentage of HIV infection in the world. In “The Invisible Cure,” Helen Epstein confronts the different approaches made in Africa to decrease the spread of HIV. Not only is she critical of the campaigns and programs used, she also looks at the motives behind them to determine why they were or were not successful. Epstein is a scientist-turned-public health professional, who has truly described so well the difficulties of the fight against AIDS in Africa. She also voices her opinion in a way that will cause many people to look inwardly within themselves to determine if that have been a helping hand or road block to the spread of HIV in Africa.
Epstein begins her book as a scientist traveling to Uganda to begin research using AIDS patient blood samples at the Uganda Cancer Institute. A research institute in the United States discovered that HIV/AIDS patients expressed antibodies against one of four different subtypes. They also found that two of those subtypes were prevalent in HIV/AIDS patients in the United States. Therefore, Epstein went to Africa to determine which antibodies Africans with HIV were producing the most. After testing many blood samples, she could not come to any conclusion as to which subtype was more prevalent. Some patients even had antibodies against more than one subtype, which was rare compared to patients in the United States. It was at this point I believe Epstein realized the complexity of HIV/AIDS in Africa. I believe this is what drove her to investigate further not only the scientific aspects, but the social aspects of what was behind the AIDS epidemic in Africa.
Throughout the book, Epstein engages in the political, organizational, social, economical and religious issues associated with the AIDS epidemic in Africa. She expands in great detail about each of these issues to make it vivid to the reader the rooted problems within AIDS in Africa. Although each of these issues are important in their respective places, only two of these issues had a great impact on me and how I currently see the AIDS problem in Africa. Epstein’s descriptions of the social and organizational interventions in Africa are the only two issues I will elaborate on here.
The most important claim Epstein makes about the reason why HIV spreads so rapidly in many places in Africa involves the structure of their social system. In her chapter “Why Are HIV Rates So High in Africa,” she mentions the work of Martina Morris, who studied the sexual behaviors in populations with high infection rates. The two social systems Epstein learned from Morris’ work are serial monogamy and long-term concurrency. Serial monogamy is the social behavior of staying with one sexual partner for long periods of time. Long-term concurrency is having more than one sexual partner for extended periods of time. In the United States, people normally have serial monogamous relationships, while people in parts of south and east Africa have long-term concurrent relationships. The reason why these types of relationships caused HIV to spread so differently in both countries is due to the biological science of how HIV infects people. When a person is infected with HIV, they do not automatically have AIDS. The virus’ concentration within the immune system is initially high. But then it decreases and slowly weakens the immune system. Once the immune system is compromised, the virus takes over, and it is at this point in time that the person is diagnosed with AIDS. Only during the few months after infection and when the person is said to have AIDS is when they are more likely to spread the virus to their sexual partners. In serial monogamous relationships, the infected person can only spread HIV to their sexual partner. If they discontinue their relationship in a year or so, and both begin another sexual relationship, they will be less likely to spread HIV since the viral concentration is so low. In long-term concurrent relationships, the infected person can spread HIV to each of their sexual partners. Since their sexual partners are more likely to have other concurrent sexual partners, they also are more likely to be infected as well. And the cycle continues. Why the process of concurrency leading to a rapid HIV infection is not so important to so many people is beyond my understanding. Epstein’s conclusion as to why organizations did not campaign more about this issue of concurrency is because it will offend populations where this is a part of their culture. However, the only realistic way of stopping the rapid spread of HIV is to stop certain sexual behaviors, and the only way to stop those sexual behaviors is by talking about them.
Epstein’s new found knowledge of concurrency led her to preach about concurrency everywhere she traveled in Africa. It is at this stage of her public health career that she finds one of the true underlying causes to the continued rapid infection rate in certain parts of Africa. Differences in infection rates began to show in Africa. Uganda started to have significant decreases in infection rates, while South Africa’s rates continued to incline. Epstein eventually discovers that Uganda changed their social systems. She also discovered that organizations in South Africa sponsored by large international government and private programs were masking the rooted problems to the AIDS epidemic with tactics normally used to increase the sales of soda to young people. Organizations in South Africa such as loveLife and Hope Worldwide, sugar-coated the seriousness of HIV/AIDS. In loveLife, AIDS was taught to young people indirectly and not personally, therefore causing stigma and making it hard for them to accept AIDS. In contrast, Uganda embraced the seriousness of AIDS, and spoke about it openly to change behaviors, and show compassion to those infected and affected by the terrible disease.
Epstein’s journey and experience through the world of HIV/AIDS in Africa is truly inspiring and thought-provoking. She allowed me to look through the eyes of one who personally experienced the epidemic in Africa, rather than making assumptions from abroad. In the conclusion of her accounts, she writes “although there are no easy answers, one thing that always mobilizes people is a common enemy…….Uganda recognized early that the enemy was HIV itself.” Epstein saw both the united and divided fronts against HIV/AIDS, and therefore was able to confidently disclose the fact that if HIV is not the common enemy to populations and communities affected by it, this virus will continue to destroy lives.
