AIDS in the Twenty-First Century: Disease and Globalization (review)

With approximately 39.4 million people living with HIV/AIDS worldwide in 2004, and with 21.8 million total deaths from the time the epidemic began through 2004, the HIV/AIDS pandemic is a phenomenon with far-reaching consequences affecting agricultural production, socialization of the next generation, economic development, and governance, especially in east and southern Africa, where HIV prevalence is highest. The authors succeed in their goals of describing what is known about the social and economic impact of the AIDS epidemic and of explaining the importance of understanding social, political, and economic contexts that can facilitate or retard the spread of disease.

Contemporary historians of all fields—not just of medicine—will find this book to be an indispensable reference, enabling them to study comprehensively the epidemic's impact using micro- to macro-level approaches. Given the importance of this epidemic, the book's biggest surprise is the paucity of evidence gathered to date that examines the impact of HIV/AIDS. The book, therefore, serves as more of a call to arms for social scientists and historians to undertake this important research rather than as a conclusive assessment of the epidemic's impact thus far.

The first two chapters provide an excellent introduction to the biology, epidemiology, and public health issues of HIV/AIDS, making the book accessible to a wide audience. Chapter 3, "Epidemic Roots," is a useful analysis of how prevention efforts have focused on individuals rather than on the larger economic, social, and political processes that create "risk environments" and render some people more susceptible to infection than others. Although Barnett and Whiteside, both economists, emphasize the importance of studying historical context and of how epidemics unfold over time, they are less adept at applying those ideas to specific examples. Their discussion of how, for example, the Philippines has avoided a major epidemic while other countries, such as Uganda and Ukraine, have not relies on static concepts of social cohesion and wealth that do not capture the complexities involved. Chapter 5, which addresses why sub-Saharan Africa suffers from the world's most severe epidemic, is more conceptually rich and useful, especially in handling the continent's diversity of responses, with detailed case studies of Uganda, the Democratic Republic of Congo, and South Africa. For the book's future editions, the authors will need to take account of John Iliffe's The African AIDS Epidemic: A History (2006), which offers a more satisfying explanation of how the African epidemic unfolded. The two books could serve as useful companions in a graduate course, since each book's strengths complement the other's weaknesses.

The heart of the book consists of seven chapters devoted exclusively to the epidemic's impact, providing a primer on how to develop a research agenda as well as how to interpret existing data. Because AIDS deaths occur primarily among adults of reproductive age, their deaths impact household income, agricultural productivity, and the care of both children and the elderly. HIV/AIDS creates long-term changes in farming practices and agricultural productivity, as households reduce their involvement in labor-intensive practices, slowly allowing farmland to return to bush, with subsequent environmental changes.

The authors are sharply critical of the idea that communities are "coping" with the epidemic, arguing that in fact households have dissolved and family members dispersed, with orphans less likely to attend school and have adequate nutrition and health care. In addition, the children of families who accept orphans into their households also suffer because of increased demands on scarce resources. The word "coping" masks the suffering associated with HIV/AIDS. Few studies have examined the epidemic's impact on the private sector, the economy, or government in any country. Because of the importance of the HIV/AIDS pandemic to societies and economies globally, Barnett and Whiteside's book deserves...