- AIDS in the 21ST Century: disease and globalisation
A poor household sells its animals, its implements and then the thatch from its roof in the hopeless quest for treatment. They then cease to farm or to herd and go to the city. When those individual changes become communal and then social, history's trajectory has been irreversibly altered. . . (but) it is hard to measure things - quality of life, quality of relationships, pain of loss - for which measures are partial or non-existent. If it is hard to see these things, it is all the easier to deny them. (7)
Barnett and Whiteside have constructed a monumental book that attempts to provide a philosophical context in which to understand the social and economic impact of HIV/AIDS, 'the first epidemic of globalisation'. It wrestles with complex moral dilemmas such as how we define our responsibilities to others, as well as providing a wealth of informative graphs and tables that nail down the statistics and trends behind HIV/AIDS.
The authors argue that health and well-being need to be seen as public issues rather than as individual states of being. A 'medieval approach' to HIV/AIDS, in which those with the disease are placed in quarantine, is not possible. Much as wealthier nations may try to contain the infectious diseases of 'the poor' by excluding the sick and the poor, the global world is too flexible and porous for this to happen. Instead, HIV/AIDS should 'wake us up to the emergency of global public health' and galvanise a global approach that addresses people's social and economic circumstances.
However, while the wealthy burghers may also get infected by HIV, access to anti-retroviral drugs defines who gets saved and who is left to die, thus drawing deeper boundaries between those who can buy their health and [End Page 164] those 'wretched of the earth' who cannot. 'Will we build just and cohesive societies both within and beyond national borders? Or will we continue to isolate and defend ourselves in islands of prosperity… while remaining surrounded by an increasingly hostile, desperate and suspicious world?' ask the authors.
While parts of the book grapple with how the globalised world should deal with HIV/AIDS, large parts simply provide information about the disease in accessible bite-sized sections broken up by information boxes. It briefly explores theories around the origins of HIV/AIDS, as well as how the virus is spread and what the virus does once it enters the body. While the medical and scientific explanations are brief, they provide the reader with an adequate basic explanation of the workings of the virus.
The bulk of AIDS in the 21st century is devoted to defining who is most vulnerable to HIV/AIDS, and what the impact of the epidemic is on individuals, households and communities.
Measuring impact internationally has generally been inadequate, based on small samples and failed to address complexity. 'This means that we understand impact very poorly. In particular, much impact is unmeasured', argue the authors.
A key concept when considering impact is vulnerability, which is defined as identifying the features of a society, institution or process that makes it more or less likely to be negatively affected by the sickness and death associated with HIV/AIDS. Some groups of people are more vulnerable than others are, and I feel the book pays inadequate attention to the fact that girls and women are most vulnerable to HIV/AIDS.
Despite this drawback, the book is a very valuable resource. Stylistically easy to read, it provides clear, sharp and incisive commentary on the unfolding epidemic. It can be used as a reference book for both novices in the HIV/AIDS field and those who need quick access to a range of studies and statistics.
Barnett is development studies professor at the University of East Anglia and Whiteside is the director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal. The book is the fruit of 10 years' worth of global...