The African AIDS Epidemic: A History (review)

In September 1985, the Director-General of the World Health Organization, Halfdan Mahler, told reporters in what was then Zambia that African countries should not make AIDS their top priority: "AIDS is not spreading like a bush fire in Africa," Mahler concluded. "It is malaria and other tropical diseases that are killing millions of children every day" (68). Just over one year later, Mahler again stood before reporters to discuss global AIDS, but by now his perspective had changed: "We stand nakedly in front of a very serious pandemic as mortal as any pandemic there ever has been," he told his audience. "I don't know of any greater killer than AIDS" (Lawrence K. Altman, "Global Program Aims to Combat AIDS 'Disaster,'" The New York Times, 21 November 1986, A1). What had sparked this about face was, ironically, evidence coming out of Africa that the epidemic was indeed "spreading like a bush fire" on that continent. Since that time, it has become clear that sub-Saharan Africa has borne the brunt of the global AIDS pandemic: according to UNAIDS, in 2008, sub-Saharan Africa accounted for 67 percent of HIV infections, 68 percent of new HIV infections among adults, 91 percent of new HIV infections among children, and 72 percent of AIDS-related deaths worldwide ("AIDS Epidemic Update: December 2009," Geneva: Joint United Nations Programme on HIV/AIDS [UNAIDS] and World Health Organization [WHO], 2009, 21). Such devastation has prompted numerous observers to ask why, in the words of the former South African President Thabo Mbeki, Africans have had "to deal with this uniquely African catastrophe." Observers have posited several explanations for African versions of the epidemic: poverty and exploitation in Africa; difference in African sexual practices; the legacies of colonialism and the ravages of postcolonial instability. In his book, The African AIDS Epidemic: A History, eminent African historian John Iliffe provides a more simple yet complex answer: time and historical sequence. "Africa had the worst AIDS epidemic," Iliffe writes, "because it had the first epidemic established in the general population before anyone knew the disease existed" (1).

Iliffe is eminently qualified to tackle such a topic. A professor of African history at Cambridge University, Iliffe has devoted his career to the modern history of sub-Saharan Africa, particularly eastern and central Africa. This short work on AIDS in Africa adds to some of his recent work on medicine in East Africa (East African Doctors: A History of the Modern Profession, New York: Cambridge, 1998). In The African AIDS Epidemic, Iliffe is not trying to excavate the pandemic in excruciating detail; rather his work has a more modest aim: "This is not a book of research," he explains in the opening pages. "This book is intended as an introduction, for students and other readers." As an introduction to the AIDS epidemic in sub-Saharan Africa, Iliffe succeeds.

Iliffe divides his work into three informal sections. Chapters 2 through 7 describe the origins of HIV and its spread across the various sub-Saharan regions. Chapter 2 is probably the best summary of the origins of HIV I have read, and any instructors who address the history of AIDS in their classes will want to include it in their reading packets regardless of whether Africa is their main pedagogical concern. Chapter 7 also does a very nice job synthesizing the various ideas around "causation." Chapters 3 through 6 are densely packed epidemiological overviews, and readers unfamiliar with African geography will want to keep bookmarks in the map sections to help them understand the geographic spread Iliffe details. The next informal section, in Chapters 8 through 11, provides insight into the experience of AIDS in various population groups. Iliffe devotes each chapter in this section to a different perspective on and experience of the epidemic (from "above," from "below," from families, and from activists and care providers). These chapters are necessarily brief, but provide an excellent overview that instructors may want to supplement with readings from...