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The Invisible Cure: Africa, the West and the Fight Against AIDS Paperback – 31 Jul 2008


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The Invisible Cure: Africa, the West and the Fight Against AIDS + HIV/AIDS: A Very Short Introduction (Very Short Introductions)
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Product details

  • Paperback: 352 pages
  • Publisher: Penguin (31 July 2008)
  • Language: English
  • ISBN-10: 014101105X
  • ISBN-13: 978-0141011059
  • Product Dimensions: 12.7 x 2.3 x 20.4 cm
  • Average Customer Review: 4.0 out of 5 stars  See all reviews (2 customer reviews)
  • Amazon Bestsellers Rank: 216,915 in Books (See Top 100 in Books)

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Review

Her subject – it soon becomes clear – is not just the nature of one virus, but of humankind (Philip Gourevitch )

Like travelling into remote and hard-to-comprehend territory with an unblinking and sure-footed guide (The New York Times )

A serious attempt to understand the epidemiology of thoughtfulness, as well as that of HIV. Epstein wants to know why clarity and honesty, as well as human lives, so often become casualties of AIDS (New Statesman )

Some of the scenes that the author describes would be hilarious were they satirical rather than real. An important contribution to the literature of AIDS (Spectator )

Practical, concrete and full of hard information ... Epstein's scientific background, lucidity of expression and habit of wide-ranging inquiry lend authority and accessibility (Hilary Mantel London Review of Books )

About the Author

Helen Epstein has conducted research on reproductive health and AIDS in Africa for the Open Society Institute, the Rockefeller Foundation and Human Rights Watch. She has a PhD in molecular biology from Cambridge University and an MSc in public health from the London School of Hygiene and Tropical Medicine. She lives in New York.

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4 of 5 people found the following review helpful By Donald Mitchell HALL OF FAMETOP 500 REVIEWERVINE VOICE on 21 July 2007
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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2 of 3 people found the following review helpful By Mr. Michael Kay on 19 Feb. 2009
Format: Paperback
Working and living with HIV I read a lot of books on the subject. This book focuses on the problems faced in tackling the pandemic on a global scale, then concentrating on the issues that Africa experience and the failings of governments in handling the situation well. Honest and interesting book, but heavy reading at times and on a similar theme to Elizabeth Pisani's book "The Wisdom Of Whores" which I preferred as it is more inciteful and has a humour that lifts the subject.
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Most Helpful Customer Reviews on Amazon.com (beta)

Amazon.com: 12 reviews
27 of 27 people found the following review helpful
An important contribution to addressing this ongoing tragedy 19 July 2007
By John Bergren - Published on Amazon.com
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.
17 of 19 people found the following review helpful
hiv prevention: now and how 6 Aug. 2007
By Daniel B. Clendenin - Published on Amazon.com
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." That is, Africans do not have more sexual partners than in other places in the world, and nowhere near as many as gay men among whom infection rates are exponentially lower; but they do have a small number of sexual partners concurrently, at the same time, rather than one at a time or sequentially. This has set the virus loose among the general population like a runaway train.

And why has prevention been so elusive? Epstein appeals to what she calls the comprehensive "social ecology" of denial, silence, shame, adverse gender roles, and stigma about HIV-AIDS. Western-initiated and donor-funded programs will always be less successful than listening to Africans themselves and their own suggestions about how to address the problem. Uganda, of course, has been the amazing success story in this regard, and the subject of bitter debates about why. In 1989 Uganda had one of the highest infection rates in the world, but from about 1992-2002 the infection rate dropped by two-thirds. The key to the success, argues Epstein, was not in the billions of dollars from the west, but from the "collective efficacy" of a "shared calamity," by people helping each other and talking openly about the scourge. In particular, "partner reduction," she says, and not the much vaunted condom use, helped Ugandans to address the cultural phenomenon of concurrent partners. Partner reduction, as one worker described it, is thus the "neglected middle child of the ABC approach" of abstinence, fidelity ("be faithful"), and condoms. Zero Grazing, as Uganda's president Yoweri Museveni called for, is thus the silent cure already available, however valuable other prescriptions.

Epstein, a molecular biologist who has written widely on public health issues, combines rigorous science and the anecdotal evidence of substantial field research. She's clearly as comfortable with and interested in meeting with a dozen African widows under a mango tree as she is in the latest results of a demographic study. Her book has received strong reviews in the New York Times and the New York Review of Books (where her mother was a co-editor before she died), and also a rebuttal of sorts on the home page of UNAIDS that was provoked by her somewhat conspiratorial stance toward research that she argues they ignored because it didn't fit their partisan ideology.
10 of 11 people found the following review helpful
A vital and important book 9 July 2007
By Ben Sonnenberg - Published on Amazon.com
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
16 of 20 people found the following review helpful
A CLASSIC WORK 16 May 2007
By Big Wind - Published on Amazon.com
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...
8 of 11 people found the following review helpful
Clear Thinking About Slowing the AIDS Epidemic in Africa 21 July 2007
By Donald Mitchell - Published on Amazon.com
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. In fact, Uganda doesn't use these good policies any more ("No Grazing") because fighting AIDS has gone from being a local activity to being a national policy.

Ms. Epstein reports in detail how local initiatives to get the correct information out can make a big difference (saving an estimated one million lives in Uganda). National and international initiatives seem to waste almost all of the money (as she points out in several examples).

By not paying attention to what works and what doesn't, country leaders and international NGO leaders run the risk of making everyone feel like everything is being done . . . when the wrong things are being done. As a result, millions will die.

It's a sad story of how everyone wants to help, but they see the problem as being like the nail in the eye of a carpenter. You hit the nail to solve the problem. Drug companies want to develop vaccines. Condom makers want to sell condoms. Churches want to preach sexual abstinence. Politicians want to ignore the frequency of rape, casual sex, and cheating among married people. Individuals want to believe they are safe because they know the people they have sex with. But most of these nails don't make much difference.

Let's start hitting the right nail!
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