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on 21 January 2008
Graça Machel, wife of former South African President Nelson Mandela and, with him, long time activist in the fight against HIV/AIDS, said: "... we can't fill all the spaces that are left." Five and a half thousand people die in Africa every day of AIDS and related diseases, with an estimated 28 million people infected by the HIV virus. These figures are too overwhelming to comprehend and Stephanie Nolen's book opens an evocative window for us into the struggle, the suffering and the hope of ordinary Africans through 28 portraits. From her diverse and multi-year experience and research into the pandemic in a number of sub-Saharan Africa countries, she focuses on the individuals, their families and their circumstances, resulting in an intimate, sometimes heart wrenching, sometimes uplifting, yet always deeply moving and inspiring account of what HIV/AIDS has done and continues to do to Africans: to individuals, relations, communities and countries.
Each chapter starts with a photograph of the primary individual as she or he reveals the tragedy of their lives. Some of them Nolen met only a couple of times, others have become close friends. Her ability to convey their stories vividly and with great empathy brings us as reader not only close to the unique aspects of each "case", but assists our better appreciation of cultural and political traditions and realities in African societies. The critical components of the HIV/AIDS crisis unique to African countries are addressed within the narrative without losing the personal and emotional primacy of the subject matter.
For close to ten years, Nolen, a Canadian journalist for the Globe & Mail, based in South Africa, has been following the HIV/AIDS crisis all over the continent. She has visited families, health clinics, scientists, care centres for AIDS orphans, and activists' organizations. She has walked with health care providers among remote rural communities lacking any medicines, yet trying their best to comfort and help the sick. Stigmas still attached to the infection have meant that misconceptions flourish: those identified with it have been shunned, thrown out of their family's house and left to die. For a long time, testing positive for the virus was perceived by people as an automatic death sentence, resulting too often in changing behaviour patterns. Without any concrete knowledge of this "disease of many names" it robbed families of one young woman or man after another and villages in despair with the ever increasing number of orphans left behind.
Contrary to the long-held prevalent view in Africa as elsewhere - that HIV/AIDS is a disease of minorities and of the poor - Nolen demonstrates the fallacy of this perception that has cost many their lives needlessly. Poverty remains an important factor where nutrition is inadequate, education non-existent, and money for treatment and care is not available. Nolen discusses how traditional societal norms of behaviour still contribute to the persistence of high infection rates, in particular among women. Abstinence, promoted by international, in particular US, aid agencies as a primary method to reduce infections, is only rarely an acceptable option, Nolen contends. Anita in Mozambique stands for many: "None of it" she said, "was up to me". On the other side, there are young professionals, like Lydia in Uganda or Ibrahim in Nigeria, fully aware of their condition, that are still caring for others, lobbying and fighting for access to life prolonging ARVs (antiretroviral medication). What shines through all the stories, is determination and hope despite the odds, the courage, resolve and perseverance that the individuals show in the face of unimaginable obstacles.
A substantial number of books are available on HIV/AIDS and its devastating impact on African societies and demonstrating the need for cheap medicines and vaccines. The human costs in countries where the HIV infection rate may be as high as 30 or more percent is unimaginable in its devastation for generations to come. As Machel put it: "I don't think I comprehend the dimensions of the havoc, disruption, discontinuity". Nolen's book stands out for her insightful descriptions of the human costs as well as the its fluid integration into the stories of aspects of socio-economic conditions and up-to-date science research surrounding the pandemic. Yet, she never loses the focus on the human beings who she got to know and who candidly shared with her their life's story. If you think you can only cope with one book on this subject, read this one. [Friederike Knabe]
The introductory maps seize your attention. "Adult prevalence of HIV /AIDS" on one page and the people represented in the "stories" on the opposite. There's a swath of dark shading across southwest Africa - that's "Over 20%". To the east, the shade is lighter - "15 - 20%", with two darker smudges labelled "Swaziland" and "Lesotho" - islands of tragedy. At the top, "5 - 15%" predominates, lower numbers hiding the intensity of conditions. Stephanie Nolen's subjects' names run across the other map - the individuals whose stories are related here.
The numbers often lead to "AIDS fatigue" - too many big numbers; surpassing our ability to grasp them. The millions of people infected with HIV/AIDS seem beyond comprehension. After consulting the various estimates, Nolen surmises about 28 million for Africa, approaching the entire population of Canada. Each day, something like 5500 will die of the effects of the infection - two-thirds the population of my community. Every day. All year long. The adage runs: "One death is a tragedy, one million deaths is a statistic." Yet, that "million" represents that many "ones", and each one has a story. Nolen gives us those stories, making one person represent a million others. It's a formidable burden for the afflicted and the writer alike, but Nolen's skill effectively allows the reader to take it all in measured doses.
The opening story is, appropriately, a woman. In Swaziland, women don't turn to activism. They were traditionally forbidden to wear pants until 2003 and the right to own property was only granted in 2006. The little nation has the last monarch in Africa - who has thirteen wives and a fleet of autos. Siphiwe Hlophe had borne children with a man who delayed marriage for years. The discovery that she carried the virus was devastating - it suggested she was immoral, when it was her husband who had been philandering. That situation is one of the AIDS' story social disasters. The infection carries the stigma of immorality, a view widespread throughout Africa - and the West. Traditional leaders, missionaries and even family members vilified the victims as "immoral". It was also deemed an affliction of the poor, a mistake leading to many stressful family situations. Siphiwe, transcended many of these issues by announcing her infection and launching an AIDS awareness programme. Nolen gives accounts of other activitists, including a "Miss HIV Stigma-Free".
The other group most affected by the virus is children - either by being orphaned or by infection at birth. Among the former is 14-year-old Tigist Haile Michael of Addis Ababa who is the sole support for a younger brother half her age. Regine Mamba isn't an orphan. At her age, the term is meaningless. But Regine knows about orphans. When Nolen first interviewed her, Regine had 13 of them - all their parents were AIDS victims - by the book's Epilogue, the number had risen to 18. These parentless children lack education, opportunity and exist on a bare subsistence level lacking any skills to provide for themselves or siblings. Across Africa the number of such children is estimated to have reached 14 million today. What is their future? One path, of course, is always open - at least to the girls.
Is it entirely disaster and is amelioration impossible? There are signs of hope for researchers, but one of those will likely raise a few eyebrows. Agnes Munyiva has three children who live across town from where she works. Seeing up to a dozen clients per day, her job makes her a high risk for HIV infection, but that's not the part she keeps from her children. She's a sex worker in a Nairobi suburb, and she's very special. Agnes is HIV immune, a physiological trait that has many, especially AIDS researchers, scratching their heads, but see her condition as a means leading to prevention. The number of immune sex workers is small, and conditions providing immunity vary. Can enough be studied carefully to derive some answers? Does Alice truly fit the "one in a million" status? In what may seem a departure from the theme, Nolen relates the sad story of Western pharmaceutical firms keeping the price of Anti-Retroviral Drugs [ARVs] out of reach of those needing them. Compounding this tragedy of corporate greed is the role of Western financial institutions such as the World Bank and International Monetary Fund to cripple the social services. Through Strategic Adjustment Plans [SAPs - one of the few truly indicative acronyms], Western investors demanded "downsizing" of government employees - read "teachers" and "nurses" - to pay off international debts, thousands were deprived of jobs. Lacking land and the skills to work it, those unemployed quickly became destitute. Add those to the young orphan girls and Alice readily becomes "one in a million". One of those will assuredly displace her from her hard mattress and mud-walled hut.
If the foundation of Alice's immunity, shared with a small number of Africa's prostitutes, can be unravelled, the chance of a vaccine increases. That's the quest of Uganda's Pontiano Kaleebu, who's been seeking that preventive step for years. Nolen's chapter on Pontiano is one of the most compelling of the collection. In it, Nolen explains how HIV/AIDS operates in the body, and why both prevention and cure are so difficult to achieve. While the vaccine remains elusive, the "cure" has made hesitant progress. But the drugs work only for a time, then a new form and schedule is required. That means testing, analysis, prescription, scheduling and instruction by health-care workers - many of whom were laid off. The drugs have to be available where and when needed at a price that people can afford. Not easily achieved in Sub-Saharan Africa.
As a Canadian in Africa, reporter for the Toronto Globe & Mail, Nolen is aware of how that nation prides itself on helping those in need. Accordingly, she offers a list of organizations providing that support for the suffering. Those 28 million are still living - minus today's 5500 - and their lives can be extended by ARV compounds. Nolen explains how you can help and what your help can achieve. [stephen a. haines - Ottawa, Canada