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The Invisible Cure: Africa, the West, and the Fight Against AIDS Hardcover – May 15, 2007

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Editorial Reviews

From Publishers Weekly

Starred Review. Epstein, a public health specialist and molecular biologist who has worked on AIDS vaccine research, overturns many of our received notions about why AIDS is rampant in Africa and what to do about it. She charges that Western governments and philanthropists, though well-meaning, have been wholly misguided, and that Africans themselves, who understand their own cultures, often know best how to address HIV in their communities. Most significant is Epstein's discussion of concurrent sexual relations in Africa. Africans often engage in two or three long-term concurrent relationships—which proves more conducive to the spread of AIDS than Western-style promiscuity. Persuade Africans to forgo concurrency for monogamy, and the infection rate plummets, as it did in Uganda in the mid-1990s. On the other hand, ad campaigns focused on condom use helped imply falsely that only prostitutes and truck drivers get AIDS. In addition, Epstein examines what she calls the "African earthquake": social and economic upheaval that have also eased the spread of HIV. Epstein is a lucid writer, translating abstruse scientific concepts into language nonspecialists can easily grasp. Provocative, passionate and incisive, this may be the most important book on AIDS published this year—indeed, it may even save lives. (May)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist

Some countries in Africa report that approximately one-third of their adult populations are infected with HIV. Epstein wondered how such a state of affairs came about. Seeking answers, she contracted with a biotechnical company to go to Africa and work toward discovering an AIDS vaccine. What she subsequently learned exploded some preconceived and widely shared notions about AIDS, about how African culture all but ensures its spread, and about what might be a deceptively simple answer to the complex question of how to stem that spread. Her absorbing report reveals governmental inefficiencies and medical bureaucracies and social structures that have done nothing to slow the epidemic's pace—and may be accelerating it. Besides the epidemic's social and medical aspects, she discusses the business of AIDS, and she examines the mystery of how the HIV infection rate dropped some 70 percent between 1992 and 1997 in Uganda and the Kagera region of Tanzania; she believes that the invisible cure involved in that plunge provides clues to resolving the issue of AIDS in Africa generally. Chavez, Donna
Copyright © American Library Association. All rights reserved

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Product Details

  • Hardcover: 352 pages
  • Publisher: Farrar, Straus and Giroux; 1 edition (May 15, 2007)
  • Language: English
  • ISBN-10: 0374281521
  • ISBN-13: 978-0374281526
  • Product Dimensions: 6.2 x 1.2 x 9.6 inches
  • Shipping Weight: 1.3 pounds
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (12 customer reviews)
  • Amazon Best Sellers Rank: #863,098 in Books (See Top 100 in Books)

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26 of 26 people found the following review helpful By John Bergren on July 19, 2007
Format: Hardcover
I'm an American doctor working in rural KwaZulu-Natal, South Africa. I can attest to the substance of much of the material presented in this book and the importance of its message, specifically that norms of sexual behavior in this culture need to be discussed and changed for prevention efforts to begin to be effective. As the author aptly discusses, numerous aid organizations, flush with good intentions and funds, seem to operate on the periphery of this central issue. One of the most disturbing lessons of my time in the midst of this horrible tragedy is the realization that the stigma attached to this disease in many parts of sub-Saharan Africa remains so severe that many people prefer to die than to find out that they have AIDS, a point the author seems to get across through with many informative anecdotes. The fundamental thesis is that we need to begin to engage the leaders within these societies at a fundamental cultural level regarding relationships and sexual behavior. No small task. I would highly recommend this book as the first read for someone trying to understand why AIDS is so unbelievably prevalent in Sub-Saharan Africa. As of today, for every person we enroll in antiretroviral treatment in rural KwaZulu-Natal, five will be newly infected. It's very depressing to see so many people dying from a preventable disease--1,000 people die of it every day in South Africa alone.
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17 of 19 people found the following review helpful By Daniel B. Clendenin on August 6, 2007
Format: Hardcover
"As a woman living with HIV," says Beatrice Were of Uganda, "I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives." With a vaccine against HIV far off in the distant future (if at all), and with treatment of AIDS in the two-thirds world difficult, expensive, and limited in effect, the name of the game in HIV-AIDS is prevention. But in places like Africa, which is the focus of Helen Epstein's book, prevention is not as simple as it sounds. As she notes in her appendix, measles, syphilis, tuberculosis, and other entirely preventable diseases still kill millions of people even though they can be treated for pennies.

Why has HIV-AIDS ravaged eastern and southern Africa like no place on earth? "In 2005," she writes, "roughly 40 percent of all those infected with HIV lived in just eleven countries in this region-- home to less than 3 percent of the world's population." In some of these countries the infection rates have hit 30 percent, decimating the general population, while in the west, for example, rates hover at about 1% and are generally limited to specific demographics like gay men, intravenous drug users, and commercial sex workers." Theories abound about this discrepancy, but Epstein argues a narrow point, that Africa's problem is not profound promiscuity, or even the normal culprits of high risk groups like prostitutes or truck drivers, but instead a social phenomenon of "concurrent partners.
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9 of 10 people found the following review helpful By Ben Sonnenberg on July 9, 2007
Format: Hardcover
How rare it is to come upon an author like Helen Epstein. She not only knows her subject, with its numberless scientific and political implications; she also writes about it in a way that makes a common reader want to know more and more. She educates, she invigorates, she breaks our hearts. This is a vital and important book. -- Ben Sonnenberg, New York City
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15 of 19 people found the following review helpful By Big Wind on May 15, 2007
Format: Hardcover Verified Purchase
The most important book published on AIDS in a long time, and one of the most important books of the year. If you liked Rachel Carson's Silent Spring or And The Band Played On, you will love this book. It is readable, impassioned and brilliant, and despite its savage denunciation of the failures of the West to deal with the AIDS crisis, it is an essentially optimistic work. Publishers Weekly in a starred review said it will save lives, and that is not hyperbole. I urge anyone who is interested in the greatest medical crisis of our time; anyone who is interested in Africa; anyone who is outraged by the failure of the UN, the WHO and the Bush administration to deal with this tragedy, to buy this book and give it to your friends. It is the kind of book that will change peoples' minds and will move continents. It will be read for years to come...
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Format: Hardcover
We have been overwhelmed by bad information about what causes AIDS to be so much more prevalent in the eastern and southern parts of Africa than elsewhere in the world. Even though more money than ever is being directed to stopping this epidemic, that money is hardly ever being spent for a helpful purpose. Helen Epstein carefully describes what she learned on site in Africa about what the primary problems really are and how best to deal with those problems . . . rather than the problems that politicians and NGOs want to address. Millions of lives are at stake: Please read what Ms. Epstein has to say and share what you learn with others.

So what's different about people in eastern and southern Africa that makes AIDS so much larger a risk there?

1. Men are much less likely to be circumcised. Circumcion cuts infection risk dramatically.

2. Although the people in that part of the world have no more (and often fewer) sexual partners over a life time, these people are more likely to be active with more than one sexual partner at a time. That habit causes those who become infected to spread the disease much faster and further.

What can be done?

Uganda (once the area most affected by AIDS) provides the answer: Make sure everyone knows that AIDS risk is there for everyone who is a drug user and shares needles, or has sex with anyone who has more than one partner without using a condom. The public in general, and politicians as well, like to paint AIDS as being a problem limited to homosexuals, sex workers, and promiscuous people. But in places like eastern and southern Africa, those who monogamous can be almost equally at risk.
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