Epstein is especially good on the two questions that have bedeviled others who have grappled with the topic. Why did AIDS begin in Africa? And why has the disease hit eastern and southern Africa so much harder than virtually everywhere else in the world?
Her answer to the first question is succinct: HIV/AIDS jumped from chimpanzees to hunters in central and eastern Africa, as the latest research proves. Why, Epstein asks, if "Africans have been killing and eating monkeys for at least 50,000 years," did doctors not spot anything like AIDS there until the 1960s? Much like the great historian of Africa, John Iliffe, in his excellent 2006 book, "The African AIDS Epidemic: A History," Epstein convincingly presents "the possibility that new medical technologies introduced into Africa in the early 20th century [notably the widespread use and reuse of needles to deliver vaccinations in inoculation campaigns] sparked the global AIDS pandemic."
Epstein's discussion of why AIDS is so severe in eastern and southern Africa is also illuminating. She cites strong evidence that Africans are "not more promiscuous than heterosexual people in other world regions." Instead, Africans in these two subregions tend to have "concurrent" relations with a small number of people. The pattern gave rise, Epstein writes, "to a stable interlocking sexual network that served as a 'superhighway' for HIV." In Uganda, widespread encouragement of "zero grazing" (no sex outside a single partner) proved crucial in rolling back the disease, providing evidence for one of Epstein's central propositions: "When it comes to fighting AIDS, our greatest mistake may have been to overlook the fact that, in spite of everything, African people often know best how to solve their own problems."
As method or rhetoric, zero grazing never gained favor with international AIDS experts -- who instead put their weight behind campaigns for condom use, abstinence and frequent testing -- and the failure of this African concept to carry the day illustrates a wider failure to understand AIDS in African terms.
In the end, Epstein's subject is not just a scary disease but sexual and social relations between men and women in Africa. And her final indictment remains troubling and still all too accurate: Outside experts fail to grasp the social web in which the disease lives and thus continue to fail in their efforts to roll back AIDS.
The closest Epstein comes to identifying a single solution is in her section on the growing awareness that circumcised men are much less likely to contract HIV than are uncircumcised men. The popularity of circumcision among west African men may explain the relatively low rate of HIV in this subregion. In asking whether male circumcision is "a magic bullet after all," Epstein underscores another paradox: that a low-tech social tradition provides more protection against AIDS than high-tech, high-cost and imported medicine.
Epstein offers scant other solutions beyond urging outsiders to make more space for responses crafted by Africans themselves. Her advice is worth noting, especially since spending on AIDS in Africa, as Laurie Garrett recently highlighted in an article in Foreign Affairs, is soaring. Increased funding for AIDS will only compound past mistakes, Garrett argues. Epstein is similarly concerned that in the coming explosion of international funding to fight HIV/AIDS in Africa, past errors will replicated as foreign donors mistake the size of the checks they write for their potential to help ordinary Africans.
Ultimately, "The Invisible Cure" concludes that success in the war on AIDS in Africa "depends critically on a sense of commitment and will" on the part of Africans. Epstein is right, once again. Yet her conclusion is sobering for those rooting for a quick end to suffering in sub-Saharan Africa. In a timely warning to foreign do-gooders with fat checkbooks, Epstein suggests that an African commitment to fight AIDS effectively "cannot be bought." Instead, victory must flow out of a rebirth of African self-reliance. Yet if outsiders cannot supply a quick fix to what ails Africa, and Africans themselves must shoulder the heaviest burden, the spectacle of AIDS devastation is likely to persist for years to come.
About the writer
G. Pascal Zachary edits the africaworksgpz.com blog and writes often on African affairs.
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