Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science by Johanna Taylor Crane (review)

For many, the AIDS epidemic in Africa has been tragic, but for some it has also provided great opportunity. Johanna Taylor Crane’s new book, Scrambling for Africa, illustrates the opportunistic side of AIDS in Africa in her descriptive analysis of the rise of American global health science. Her short but dense monograph captures the power dynamics of postcolonial science, from the molecular level to transnational partnerships.

The title of the book refers to a scrambling for “Africa”; however, Crane’s research in Africa draws primarily on her observations in a semi-rural HIV clinic in Uganda. Crane uses ethnographic methods, drawing on her experience working for a U.S.-funded research project collecting data in Mbarara, Uganda. Her in-depth interviews of American researchers, Ugandan researchers, Ugandan clinicians, and research staff were supplemented with participant-observation at key conferences on global health.

Scrambling for Africa has five chapters (plus an introduction and conclusion). The bulk of Crane’s research and analysis (chapters 1, 2, 3, and 5) focuses on the “scrambling for” in the book’s title: the ambitions of Western (primarily American) researchers turning toward Africa for its bounty of opportunities to study HIV, and ultimately, as a site for applying global health science more generally. The first chapters document the shift to providing antiretroviral therapy in Africa (which occurred nearly a decade after its provision in the U.S.) and interrogate the inequalities between the global North and South through an examination of the molecular politics of HIV. For example, Crane documents that though the majority of the world’s HIV-infected population lives in Africa, the science of HIV focused largely on strains of the virus predominant in North America and Europe. Such focus is problematic, considering that the same research is used to develop treatment and potential vaccines, which could have different effects on different HIV strains.

Crane characterizes American researchers as having twin motivations for conducting HIV research in Africa: “researchers’ humanitarian motivations to work in Africa were paired with scientific ambitions aimed at taking advantage of the valuable research opportunity that African countries were seen as offering at the time” (83). Opportunity was born of tragedy; the lack of treatment access in Africa during the early years of the treatment era created an opportunity of great scientific value since Africa offered a large pool of treatment-naive subjects. The new availability of cheaper drugs alongside the influx of funding from the Global Fund and PEPFAR in the early 2000s not only gave hope to Africans suffering from AIDS, but also created new opportunities for researchers studying AIDS.

Only in chapter 4 does Crane shift the focus to Africa, specifically semi-rural Uganda, in her presentation of the perspectives of Ugandan clinicians and researchers working alongside or directly for international research projects. The clinic from which Crane gets much of her data provided care to HIV-positive patients while simultaneously collecting clinical data that was later analyzed by researchers. It is in this chapter that Crane’s book provides an important cautionary lesson for Western researchers. A consistent narrative of inequality emerges from the experiences of Ugandan clinicians and researchers who are often approached as collaborators for international research projects. For example, many Ugandan physicians who become involved in research may not be included as authors in eventual publications, being “denied the professional recognition that comes with publication, despite the fact that they supplied the raw materials (samples) for research” (105). The chapter can give the broader Western research community pause to reconsider the nature of “collaborations” with scholars in Africa and the inherent inequalities structuring crosscontinental collaboration.

Crane also discusses how “Southern scientists must guard against being relegated to the position of mere ‘senders’ of blood, samples, or other raw materials” (107). It is not just educated African scientists who are often...