Uzodinma Iweala is originally from Nigeria, and is an American-trained physician who routinely commutes between the two countries. He has written an important book on the HIV/AIDS epidemic in his native country, and, to some degree, by extension, the rest of Africa. He says that approximately 4% of Nigeria's population of 150 million, over 3 million people are HIV positive. Although he states this is the 3rd largest group of HIV positives, by country, in the world (p. 27), I did a fact check, and it seems that it is in a grim second place, only behind South Africa, and substantially ahead of India.
He starts with a case history, of Jerome, who became HIV positive, which led to not only his death, but that of his wife, and one of his children. Throughout the book, there are several more case histories of individuals who contracted the disease, and died, or, thanks to improved anti-viral medications that were developed in the `90's, have learned to live with the disease. Iweala travels throughout Nigeria, meets and talks with various other individuals, many of whom are HIV positive, and have become "activists," forming small groups that fight both the transmission of the disease, as well as provide support groups that demonstrate how one can live with it, with the help of medication.
There are many other strengths to Iweala's book. Via case histories, he details the stigma and isolation that many HIV positives incur... something akin to society's reaction to disease carriers in the Middle Ages. In terms of education, much effort has been expended on campaigns to overcome the know-nothing concept that AIDS means "American Intervention to Discourage Sex," and that AIDS really is a sexually transmitted disease. The death, from AIDS, of the famous Nigerian musician, Fela Kuti, in the late `90's, did much to convince the population that AIDS is REAL. His primary focus in on local Nigerian groups, which utilize peer group pressure, and the social media, to raise awareness of the disease and modify behavior. He almost never mentions the work of various Western NGO's, as well as governmental organizations, such as WHO and the CDC. The sole exception is the NGO, "Partner's in Health." Another most worthwhile aspect is Iweala's depiction of the continued negative and often racist stereotyping of the African continent. He quotes medical anthropologist Daniel Hardy (p.97-98) who clearly implies that Africans have sex like monkeys. And he is quite critical of CNN's 2006 documentary by Christiane Amanpour, "Where Have All the Parents Gone?" As some others have, like Achebe, he even tackles the inherent racism in Joseph Conrad's
Heart of Darkness. Yet Iweala is also "equal opportunity" in his critiques, taking on, most surprisingly, the "sense of entitlement" that some African HIV positive patients have developed.
But Iweala seems to succumb to the same type of negative stereotyping. There is a very real question that needs to be addressed: why is some 80% of the world's HIV positive population located in sub-Sahara Africa? Without any rigorous scientific evidence, and based primarily on one anecdote concerning a guy with eight girlfriends, he makes the following sweeping generalization: "Patterns of sexual interaction matter tremendously in the spread of the disease. In the West, people tend to engage in sequentially monogamous relationships. In other words, each person has one partner an any one time, with very little overlap between relationships... In sub-Saharan Africa- Nigeria included- more emphasis has been placed on the idea of concurrent partnerships, sexual relationships that overlap in time." But is this distinction really true? In terms of reportage, people are notoriously less than forthright in terms of admitting the true nature and frequency of their sexual relations. Given the number of lives involved, the question of "Why Africa" deserves a far more rigorous answer.
Iweala concludes with an important and vital point that is often overlooked. He references the introduction ceremony to his medical school, which was conducted by writer and physician Abraham Verghese. He emphasized that in addition to the straightforward treatment of illnesses, there must be a major component of "healing," which he describes: "Healing requires compassion, `a shared sense of humanity,' and the ability to see another's pain as `the kind of thing that could happen to anyone, including oneself insofar as one is a human being.'"
Noble words, that need to truly be practiced. 4-stars.
