The AIDS Pandemic in Latin America (review)

This book results from the ambitious project of covering the patterns of AIDS in the entire continent of Latin America, including the Caribbean. The author uses a critical and socially informed approach that draws from a variety of sources: epidemiological and public health data, political history, sociological analyses, anthropological monographs, interviews with locally engaged social actors, and fieldwork in selected places. It is no minor endeavor to bring together in a common frame of analysis a variety of AIDS situations that are as different as—to mention just a few—Haiti, with its devastating figures and its tight embedding in external economies; Cuba, with its early quarantine policies, its sanatoria, and the intriguing self-injection with HIV movement; and Brazil, with its celebrated official support for AIDS prevention and its free distribution of antiviral therapies in the public health care system. Smallman is up to the challenge and leads the reader through the entire continent, providing a comprehensive portrait of AIDS across Latin America that accounts for commonalities, patterns, differences, and fractures.

As some previous authors working in the field have suggested, AIDS in Latin America may be depicted as a mosaic of epidemics—and subepidemics, the author adds. This notion helps to avoid the pressures to generalize and the traps that such pressure creates. Although HIV and the clinical patterns related to AIDS emerge in similar ways across latitudes, nationalities, class, race and gender, there are very different local combinations of incidence, ways of transmission, evolution, social responses, and policies. It becomes apparent that there is no single "Latin American" AIDS, nor an Andean, Central American, or Caribbean one. Paths of HIV transmission interweave with one another in different historical, political, and public health situations that bring each local and national epidemic into a unique shape. Naturally, the analysis is not exempt from a tension between the use of nationality as a traditional reference and the stated understanding that the flows and variables that influence the epidemic articulate the local and the global in ways that transcend the national unit. The author is aware of that tension and makes reasonable choices, providing both the approach to the regional and national settings and an account of the multitude of transnational flows influencing the epidemic patterns. Those factors include displacement, migration, war, tourism, industry, drug traffic, blood surveillance, injection practices, sexual encounters, domestic arrangements, economic dependency, development flows, research protocols, pharmaceutical initiatives, prevention initiatives, shared ideologies, and other factors, which in many health reports come sometimes amalgamated and obscured as either residual, cultural, or irrational. Smallman is able to pay attention to each of those factors and provides the reader with a useful guide to the actual face and history of AIDS for every country and macro-region in Latin America: the Caribbean, accounting for its internal diversity; Central America, with a separate analysis for Mexico; Brazil; and Spanish South America, with the Andean and Southern cone sub-regions. In the process, the author also provides a quick compact guide to the history and society of each Latin American region, a component that adds value to a sourcebook that no student of health and illness in the Americas should miss.