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Don't look away

The Invisible Cure Africa, the West, and the Fight Against AIDS Helen Epstein Farrar, Straus & Giroux: 326 pp., $26

28 Stories of AIDS in Africa Stephanie Nolen Walker: 376 pp., $25.95

June 03, 2007|D.T. Max | D.T. Max is the author most recently of "The Family That Couldn't Sleep," a scientific and cultural history of mad cow, familial insomnia and other prion diseases.

ONE death is a tragedy. A million are a statistic.

Most of us live the truth of this awful adage, a buffer that enables us to go about our business. We all have our own problems, challenges, sick relatives. Who needs the burden of others' suffering?

Now come two new authors whose books about the disaster of AIDS in Africa try to break through our unresponsiveness. Helen Epstein writes often for the New York Review of Books, where parts of "The Invisible Cure" first appeared. Her book is intelligent and judicious. Stephanie Nolen, a journalist for the Toronto Globe and Mail, gives us 28 moving stories of daily life in AIDS-devastated Africa -- one for every million Africans who are HIV-positive. These stories offer astonishing glimpses of the people of a continent brought to its knees. We meet a household headed by a 14-year-old and families with grandparents who have lost most of their children and grandchildren. Cities have become ghost towns. In 2005, Nolen reports, the public health service for Malawi did not have a single pathologist. Forty children an hour die from AIDS, most of them in Africa, but a simple course of drugs at birth would save them. "AIDS is not an event, or a series of them; it's a mirror held up to the cultures and societies we build," Nolen writes.

Nolen is a pro; in the dankest wattle hut, you sense the notepad at the ready. Epstein, although her narrative is less emotional, made a personal decision to enter the drama. Before becoming interested in AIDS, she was a molecular biologist at UC Berkeley, studying a tiny aphid-like bug's even tinier sex organs. In 1992, she had a conversion moment at a lecture by a researcher who was running an AIDS vaccine trial in Africa. She came away aware of what very few Americans paid attention to: that a holocaust was going on there.

Epstein promptly left her job to work for a nonprofit doing strain testing of HIV-positive blood samples in Uganda. A Porsche repurposed as a tractor, she entered a world where nothing worked. She notes that the large amounts of nongovernmental money flowing into the country were creating two classes: fat AIDS people and thin AIDS people. Thin AIDS people were the ones who had the disease; fat AIDS people were the ones profiting from it. "The refrigerator that arrived at the lab ... was half the size of the one we had bought in the shop," she writes, adding that in Uganda, "if you said you were working on HIV, people thought you were a thief."

Epstein's strain-typing was meant to find out whether AIDS in Africa was vulnerable to a particular vaccine. Unfortunately, as has happened again and again with this sneaky virus, the answer was no: AIDS was too complex to yield to a magic bullet. After this setback, instead of returning to the cocoon of postdoc life, Epstein stayed on to investigate how the AIDS disaster in Africa happened. What she found is informative. She takes the reader through Lesotho, Swaziland, Botswana, Mozambique, South Africa, Zambia and back to Uganda as she looks into the geographic, demographic and cultural causes of the African AIDS epidemic.

How did a disease that arose primarily among gay Americans and Europeans become a huge killer of heterosexuals in Africa? Epstein makes several interesting points. First, the lethality of AIDS in Africa is related not to greater African promiscuity or the prevalence of sexually transmitted diseases there, as was once thought, but to a tradition of informal polygamy. "What may have helped spare the West a heterosexual AIDS epidemic on the scale of Africa's," Epstein notes wryly, "is the romantic belief that there is a 'perfect partner,' a 'soul mate,' to be cherished ... if not for life, then for a long time."

Nor is AIDS exclusively a disease of the poor in Africa, as most Westerners think; on the contrary, it chiefly affects the elite, who have the money and the mobility to acquire multiple partners. AIDS is also closely tied to the history of colonialism, in that it flourishes where traditional tribal loyalties have been undone.

Epstein's main point is that a solution to the tragedy of AIDS in Africa must come from the Africans, not from the "global archipelago of governmental and nongovernmental agencies [that] has emerged to channel money." She learns this lesson years after her first visit to Uganda to set up her lab. Uganda is one of the few African countries to have experienced a significant decrease in the rate of HIV infection: From 1992 to 2003, it fell by two-thirds. Uganda achieved this coup through a government-sponsored program known as Zero Grazing. In schools, churches and tribal gatherings, Zero Grazing warned of the dangers of concurrent relationships; beyond that, it encouraged Ugandans to break through their shame and talk frankly about what was going on.

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