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Aids in the Twenty-First Century 1st Edition

5 out of 5 stars 2 customer reviews
ISBN-13: 978-1403900067
ISBN-10: 140390006X
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Editorial Reviews

From The New England Journal of Medicine

In only two decades, the epidemic of human immunodeficiency virus (HIV) infection and AIDS has progressed from being a medical curiosity to its current status as a global killer, changing the family structures, economic development, and even the security of many countries in the developing world. Tony Barnett, professor of development studies at the University of East Anglia in the United Kingdom, and Alan Whiteside, director of the Health Economics and HIV-AIDS Research Division at the University of Natal in South Africa, have written a book that examines the social and economic effects of the HIV-AIDS epidemic, failures in responding to the epidemic, and what must be done to combat the epidemic. Appropriately, Barnett and Whiteside devote considerable attention to Africa, the home of most of the world's HIV-infected persons. Although disorder, social inequalities, exploitation, and poverty are common throughout sub-Saharan Africa, the authors note that the underlying risk factors for the spread of HIV in this region vary according to country. For example, they maintain that corrupt governments and war gave rise to the epidemics in Uganda and the Democratic Republic of Congo, whereas more gradual economic and social changes created a high-risk environment in Tanzania. In the Republic of South Africa, the authors trace the origins of the epidemic in large part to the legacy of apartheid. The need for black workers in mines and factories owned by white persons created a culture in which men left their families to find work and then turned to local prostitutes for sex. The authors also cite the remarkable claim that the apartheid government employed HIV-infected men for the purpose of infecting female sex workers. Beyond the sheer numbers of infections, the effects of the epidemic in the most severely affected countries can be measured by its effects on families, economies, and governments. Barnett and Whiteside give poignant examples of families consisting of children and their grandparents and households where more money is spent on funerals than on medical care. Orphaned girls are often vulnerable to sexual abuse, and orphaned boys forced to serve as soldiers. The loss of adult workers further affects the already weak economies of poor countries. The loss of farmers may lead to the sale of their lands or cultivation of crops that are easier to grow. In businesses, HIV infection increases absenteeism and health insurance costs. In addition, companies may lose their customer base and are forced to write off the debts of customers who have died. African governments may no longer be able to meet their development targets and must cope with the loss of much of their own workforce. One unfortunate irony of the epidemic is that the large numbers of deaths among children and young adults actually allow governments to save money by spending less on education and pensions. Although the large amount of demographic and economic detail provided in the book may not be of interest to most readers, some facts are particularly compelling. For example, in Botswana, the country with the world's highest prevalence of HIV infection, life expectancy for a child born in 2000 has dropped from an anticipated 70 years in the absence of AIDS to only 39 years. Botswana is a relatively wealthy African country because of its diamond industry. However, among employees of Debswana, the diamond company that accounts for a third of Botswana's gross domestic product, HIV seroprevalence is almost 29 percent. In Zambia, a country where the epidemic is almost as severe as in Botswana, the number of teachers who die annually from AIDS now exceeds the number of teachers graduating from all training colleges each year. Unfortunately, the authors note, knowledge and observation of the African HIV-AIDS epidemic have not been translated into appropriate action. They argue that effective prevention efforts will need to move beyond focusing on biomedical and behavioral interventions to changing high-risk environments. The latter goal will require political leadership and multisectoral approaches that extend beyond health agencies. The successes of Uganda in prevention are cited as goals for other countries. In their acknowledgments, the authors thank the staff of KLM Airlines because sections of the book were written on KLM flights and in the KLM lounge in Amsterdam. Unfortunately, the sorts of problems that might result are apparent in the book. These problems range from errors of fact (Pneumocystis carinii is carried by birds, and HIV infects the Sykes monkey) to simple oversights, such as the inclusion of figures that are not referenced in the text. The authors also reveal their backgrounds in economics rather than clinical medicine by failing to define terms that are unlikely to be understood by noneconomists (e.g., "Gini coefficient" and "parastatal middlemen") and making misleading statements about medicine ("Some clinicians prefer to step up the treatment gradually with single drug therapy"). The book is further marred by truisms, such as "Mortality rates crucially affect life expectancy indices" and "The further you look into the future, the less certainty there is." The reader is left wishing that the authors had spent less time on airplanes and more time consulting with a medical editor. Although AIDS in the Twenty-First Century will primarily be of value to persons interested in health economics and international development, even the most casual reader will be struck by the global tragedy of AIDS and the likelihood that the epidemic will progress from bad to worse. Harold W. Jaffe, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.


'The text is well-written, exceptionally informative, impressively clear even on complex scientific issues, and balanced in its judgements. It is written by two acknowledged experts in the field. The book is timely and important and should be published. I cannot think of two authors more suited to undertake such an ambitious and wide-ranging piece of work.' - Professor Shula Marks, School of Oriental and African Studies, University of London

'Overall, it is an impressive book, worthy of publishing. I certainly do not know of any other book that provides such a broad picture of causes and consequences. The sociology in the book on susceptibility and its causes and effects is, perhaps, the most unique aspect. It raises lots of interesting issues and provides a useful depth of information. The section on economic impacts is first rate and includes a wealth of examples that should be interesting to economists, business people and planners.' - Mr John Stover, The Futures Group International

'Overall, I find the book compelling, persuasive, very readable and informative. I feel that it will find an eager audience, including in the NGO and academic communities. I feel that it has the potential to refocus HIV/AIDS thinking and programs. I appreciated the writing style. The text flows easily, difficult concepts are explained in ways that readers will understand, and jargon is kept to a minimum or fully explained.' - Dr Bill Rau, member of the Board of Directors of the Africa Policy Information Center in the US

'AIDS in the Twenty-First Century: Disease and Globalisation is a unique and important book. It is accessible, innovative and far-sighted. This is the most important recent book to understand the unfolding longterm consequences of AIDS in Africa. But it is also about the need for a new world order.' - Peter Piot, Executive Director UNAIDS

'This is a powerful book which needs to be read by all senior African politicians and policy makers. It is honest about the scale of the pandemic and the problems we face in addressing it but there is a real message of hope. We can beat this disease.' - KY Amoako, Executive Secretary, Economic Commission for Africa

'...the book presents important ideas and presents eloquently and thoroughly the arguments of emerging thinking around the impact of the disease on society.' - African Security Review

This is an outstandingly written book with a wealth of information that makes it priority reading for policy makers, students, and anyone who is concerned about or studying the relationship between poverty, inequality, and infectious diseases. A highly recommended book for all libraries.' - H.Robert Malinowsky, AIDS Book Review Journal

'This book should be read by every businessman, not only in Africa, throughout the world - because it uncovers in new and more meaningful ways the terrifying global, social and economic impact of HIV/AIDS...[It] breaks fresh ground by offering solid reasoning why the conventional wisdom that relates wealth and poverty to the extremes of HIV/AIDS prevalence needs to be revisited.' - African Business

'The foundation text for postgraduate courses in Aids and development, Aids and politics and so on... it is also the best reference book for those who are - or should be - grappling with the implications of Aids in development planning, business and public affairs.' - Alex de Waal, London Review of Books

'...even the most casual reader will be struck by the global tragedy of AIDS...' - Harold W. Jaffe, New England Journal of Medicine

'The book is a very rich resource - a 'must read' for students, HIV/AIDS activists, social science researchers, public health experts, policy makers and programmers.' - Oluwole Odutolu, International Journal of Health Planning and Management

'Literally dozens of potential research questions emerge from almost every chapter. This book ought to be at the side of any social scientist wanting to conduct systematic work on HIV/AIDS.' - Dr. Robert Mattes, Associate Professor, Political Studies, University of Cape Town, Journal of South African Studies

'This is an important and wide-ranging book which fills a series of gaps in current understandings of the origin and impact of HIV/AIDS.' - Catherine Campbell, Social Psychology, London School of Economics and Political Science, Development in Practice

AIDS in the Twenty-First Century explains the background to the epidemic, and explores why Africa has been hit so hard and why some countries have been hit harder than others. Reading this book will shock you into an understanding of the long - perhaps century-long - impact we are all going to feel from this disease. - New Agricultuarist on-line

'AIDS in the Twenty-First Century is the single best introduction to the global pandemic and its consequences. It is clear, thorough, and authoritative. Because AIDS is transforming not just public health but whole societies around the world, this is a must-read for policy-makers, scientists, and the general public.' - Craig Calhoun, President, Social Science Research Council, USA

'Aimed at a general audience, this is a valuable and well-written addition to the literature on the HIV/AIDS epidemic, commonly dominated by biomedical and epidemiological perspectives.' - John Bongaarts and Geoffrey McNicoll, Popul

'This book provides background information about the virus and its epidemiology, as well as a detailed perspective on the impact of the disease on households, communities, economic sectors, and business.' - Development


Product Details

  • Paperback: 416 pages
  • Publisher: Palgrave Macmillan; 1st edition (June 6, 2002)
  • Language: English
  • ISBN-10: 140390006X
  • ISBN-13: 978-1403900067
  • Product Dimensions: 8.4 x 4.4 x 1 inches
  • Shipping Weight: 1.1 pounds
  • Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
  • Amazon Best Sellers Rank: #3,897,950 in Books (See Top 100 in Books)

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Top Customer Reviews

Format: Hardcover
Tony Barnett and Alan Whieside have done a fantastic job of placing the issue of HIV/AIDS within a comprehensive context. It is easy to read, well researched, thoughtful in it's analysis, and comprehensive - that is, it places the pandemic amidst the global forces that are affecting it and which must be understood if we're to successfully turn the tide. I am recommending it to many of my colleagues! It is the best book I have read to-date on the most challenging crisis facing the human family.
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Format: Hardcover
This is the only book-length exploration of the social and economic context of the the HIV/AIDS epidemics. What comes through is that the authors are not journalists who dashed off a book on AIDS, but longtime researchers, with world-ranging experience.
WHile well documented, it is readable. The next college level course I teach on contemporary issues will surely include this as required reading. My students will thank me for it.
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