The African Aids Epidemic: A History (review)

Few topics in the history of medicine capture the interest of students and the public at large as thoroughly as the AIDS epidemic in Africa, and yet, given the sheer scale and dynamism of the epidemic, few are as complex and as hard to explain. With this book, John Iliffe—one of the most important senior historians of Africa—has given us the best, if most daunting, synthesis written to date on this history. The genius of the book lies in its structure. Iliffe tells the history of HIV/AIDS in sub-Saharan Africa in three registers: first, tracing the virus itself, including its multiple mutations and multidirectional spread; then, the political responses on local, national, and international scales; followed by, and interwoven with, the social dynamics of infection, care, and community. This framework enables him to range across all the regions of sub-Saharan Africa, highlighting their myriad internal differences and unifying factors, while developing a larger narrative.

Iliffe's approach helps to navigate through a number of complex questions that in my experience—as someone who regularly teaches a course on the AIDS pandemic—students find particularly challenging. First, the triple combination of biological, social, and political-economic histories is necessary to understand why, in global terms, Africa has borne the tremendous brunt of the epidemic to date. Second, his comprehensive approach helps to explain the paradox of poverty, wealth, and AIDS (though a sharper explication of the gender dynamics of poverty would have strengthened the case). Students (like some researchers and policy makers) who easily grasp the relationship between poverty and vulnerability to HIV/AIDS, are often puzzled as to why some of the wealthiest nations on the continent, like Botswana, have experienced the highest rates of infection. Iliffe helps the reader to understand that wealth enables some men to enter into commodified or transactional sex, even as poverty necessitates that others (women and men) do likewise. In countries where wealth and poverty exist side by side, this has proven a toxic combination indeed. The book also includes a good chapter on the role of NGOs, analyzing their unique and crucial role in the wake of structural adjustment, while revealing their tremendous unevenness of quality and efficacy. They emerge in the text as key players on the continent, but far from the universal salve or grassroots solution that many would have them be.

This concise, thoughtful, and lucid text refuses to sacrifice complexity for an overly neat narrative. But this does mean that it is very dense, weighty with details, facts, and snippets of case material. Those teaching or researching in the history of AIDS, epidemics, or African medicine and public health should buy the book for its remarkable citation base alone: the notes are very good and will be of great use to readers who are trying to locate a range of primary source material to use in their teaching about the epidemic, or to develop their own knowledge of a particular theme or phenomenon. On the other hand, the book presumes at least a basic knowledge of Africa and its history, something that many readers (especially undergraduate students) will be lacking, so it must be taught with skill, accompanied by lectures and a few key articles that flesh out the human dimensions of the story. While heavy with detail, the text is also short on the kind of synthetic paragraphs that frame the key issues, theses, and subthemes for each chapter; they are there, to be sure, but they are brief. Many students will need help in gleaning the major points here, and some will no doubt get lost in the...