Newspaper article International Herald Tribune

A Search for Answers about AIDS

Newspaper article International Herald Tribune

A Search for Answers about AIDS

Article excerpt

"Tinderbox" sets out to identify why AIDS emerged when it did; why Africans were so disproportionally affected; and why some countries have succeeded in reducing infection rates while others have not.

Tinderbox. How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It. By Craig Timberg and Daniel Halperin. Illustrated. 421 pages. The Penguin Press. $29.95.

In "Partner to the Poor," the medical anthropologist Paul Farmer writes that "the failure to contemplate social and economic aspects of epidemics stunts our understanding of them." To this one might add: And hinders our ability to contain and defeat them. Craig Timberg, a journalist for The Washington Post, and Daniel Halperin, an epidemiologist and medical anthropologist at the University of North Carolina, have collaborated on "Tinderbox" precisely to explore these very aspects of the AIDS epidemic in Africa. They set out to identify why AIDS emerged when it did; why Africans were so disproportionally affected; and why some countries have succeeded in reducing infection rates while others have not.

The last two questions are especially pressing, as AIDS continues to spread in large sections of Africa. Currently, South Africans turning 15 have a 50 percent risk of becoming infected with H.I.V. Mr. Timberg and Dr. Halperin argue that while treatment is important, prevention is even more so, and their frustration that not enough is being done is palpable. "Putting millions more people on medicine, while an urgent humanitarian priority, should not distract from the imperative of preventing new infections."

After AIDS first appeared in the United States in 1981, it became clear that there were in fact three distinct epidemics going on. The disease primarily afflicted intravenous drug users, the recipients of contaminated blood products and homosexual men and sex workers. Ultimately, the best responses would take into account the particularities of each population. Needle exchanges succeeded in reducing H.I.V. transmission among drug users; the screening of blood products minimized the risk of infection from transfusions; and condoms have been effective in decreasing the dangers of sexual contact. Only by targeting the specific risks for each group did these efforts succeed.

The AIDS epidemic in Africa has a different profile, and requires different remedies. H.I.V. is spread mainly by heterosexual contact. More women are infected than men. And the proportion of the population that acquires the disease is much greater there than anywhere else.

Two factors appear to have especially accelerated H.I.V.'s spread in Africa. One is the relatively low number of circumcised men in some areas. It has been found that circumcision reduces infection in men by as much as 76 percent. The other is multiple sexual relationships, a common practice within some African societies. One large survey in Uganda found more than half of women and men over 30 had at least one concurrent sexual relationship, with the liaisons lasting on average for more than two years. The mathematics of epidemiology are unforgiving: such sexual relationships place many more people at risk of infection.

Many Africans have recognized how vulnerable this kind of sexual behavior makes people, and have sought to change it. Popular entertainers are performing songs with explicit messages ("Avoid picking up just anybody/Think before you make love?/Even if you desire someone, be careful. Think first"). In Uganda the government has sponsored campaigns mixing messages of fear with advocacy of spousal faithfulness, or "zero grazing," a farming term familiar to Ugandans. …

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