The African AIDS Epidemic: A History, and: AIDS in Nigeria: A Nation on the Threshold (review)

These two books are a welcome addition to the growing body of literature that draws attention to the social, cultural, political, economic, and medical forces that have made AIDS the leading cause of death in young adults globally, and more specifically in sub-Saharan Africa. The African AIDS Epidemic is a masterfully crafted piece of work that synthesizes the plethora of studies conducted from the 1980s to the present, tracing the origins and spread of AIDS throughout the continent. AIDS in Nigeria: A Nation on the Threshold is an extremely rich source of information on the AIDS epidemic as it begins to ravage one of the most populous countries on the African continent. Together these two books illustrate the complexity and the tragic consequences of the AIDS epidemic at the continental as well as at the national levels.

In The African AIDS Epidemic John Iliffe weaves together a fascinating story that attempts to explain the origins, nature, and spread of the virus from its detection in the early 1980s to its current progression throughout the continent. Without drawing himself into the controversies associated with this epidemic, Iliffe masterfully distills medical, social, economic, and geographic studies in an essay that reads like a detective story. This aspect makes the book accessible to a much wider audience than the scholarly academic community alone. Prompted by South African President Thabo Mbeki's questions on the causes of AIDS, and a concern with why Africans have borne the brunt of this epidemic in comparison to the rest of world, Iliffe's analysis offers a coherent response. He argues that the disease has affected Africa more than other continents because it was there that the virus originated, and that by the time it was recognized medically, it had already spread widely among the population. In addition, the political, cultural, social, and economic contexts, and particularly the colonial economy based on labor migration, made sub-Saharan Africa susceptible to the rapid spread of the epidemic.

In the fourteen chapters that make up this book, Iliffe examines the advance of the scourge across the African continent from its alleged origins somewhere in Western Equatorial Africa (Equatorial Guinea, Gabon, Congo, Democratic Republic of the Congo, Cameroon, and Central African Republic). He offers convincing evidence of its spread from this region to East Africa, Southern Africa, and West Africa. He then examines the specific circumstances that have made its impact so severe—among them poverty, commercial sex work, stigma, denial, and the moral and political controversies. He also carefully examines the responses to the epidemic by governments, international bodies, and NGOs. The final chapters portray the tragic consequences on individuals, households, social systems, and the economies of African countries.

Yet in spite of the tragic consequences that have been brought on the peoples of Africa by this insidious epidemic, Iliffe ends on a positive note, highlighting the growing international pressures to provide life-saving antiretroviral medications, the ongoing research on vaccines by international pharmaceutical corporations, the continuing grassroots political activism, the emergence of compassionate organizations such as The AIDS Support Organization (TASO) in Uganda and Treatment AIDS Campaign (TAC) in South Africa. He concludes that not all is lost; there is growing evidence that in some countries the epidemic has leveled, in others it is actually on the decline (e.g., Uganda), and in still others where government commitment was strong immediately after the epidemic was recognized the prevalence rates have been kept at very low levels (e.g., Senegal).

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The voluminous AIDS in Nigeria: A Nation on the Threshold provides a comprehensive overview of a single country, examining the dynamics of the epidemic through an analysis...