As nurses, few of us encounter HIV/AIDS in the routine course of our clinical lives, and yet we are so very aware of the staggering toll it exacts.  Americans have become almost numbly accustomed to images of emaciated children, flies swarming around their crusty eyes, flashing at us from the evening news.  We wonder why these conditions exist and what, if anything, we can do about them.

In sub-Saharan Africa, HIV issues a catastrophic stranglehold on familial, educational, and developmental structures.  Widespread loss of productivity and life among young and middle-aged adults cripples economic growth in countries already battling endemic disease and entrenched cycles of poverty.  Cultural safety nets which traditionally absorbed orphaned children into extended families are frayed to the point of disintegration.  Multibillionaires, celebrities, and legions of doctors, nurses, social workers, educators, and researchers have turned their attention to these issues, hoping to staunch the devastation wrought by HIV.

Why is the land mass that is home to the oldest homo sapien remains, Mount Kilimanjaro, and the Pyramids particularly vulnerable to the ever-mutating Human Immunodeficiency Virus?  Theories abound, some cultural, others biological, and still others pseudo- psychological, all attempting to explain the specifically African experience of HIV/AIDS. 

Anyone baffled by these questions should read Helen Epstein's The Invisible Cure:  Africa, the West, and the Fight against AIDS.  It is both a compelling read and a fascinating analysis. Her comprehensive discussion assumes, at turns, an epidemiological, physiological, sociological, and feminist perspective in order to comprehensively wade through the factors which complicate HIV in an African setting.

There exists a misguided belief that pervasive promiscuity drives the primarily heterosexual transmission of HIV in Africa.  Epstein devotes a healthy chunk of The Invisible Cure to debunking this myth by employing a concept she calls "concurrency".  According to Epstein's research, Africans and Westerners have equal numbers of lifetime sexual partners.  But whereas Westerners tend to engage in sequential monogamous relationships, Africans traditionally keep two or three concurrent sexual partners over the course of years or decades.  Without an understanding of concurrency, transmission prevention messages will fail.  Condom campaigns are only marginally effective in Africa because condom use is not widely accepted within committed, love-based relationships and polygamous marriages. 

Another topic subjected to Epstein's thorough treatment in The Invisible Cure is the case of HIV/AIDS in Uganda.  Uganda, a land-locked east African country made famous in the 1970s by its notoriously cruel dictator Idi Amin, grabbed headlines again when it appeared to contain and reverse its HIV crisis.  Between 1992 and 2003, Uganda's HIV rate declined by two-thirds.  It still serves as an invaluable case study of the ability of home-grown, grassroots efforts to battle HIV/AIDS.  Epstein, a microbiologist working at a Kampala lab in 1993, tells the story of a Ugandan cab driver who drilled her on the mechanism of cellular mutation and disease progression with a sophistication that shocked her.  She believes that the informed commitment of ordinary citizens in addressing HIV was fundamental to behavior change in the region. 

In a chapter entitled "When Foreign Aid Is an ATM", Epstein documents how Western-driven HIV/AIDS programs and projects often accomplish little.  Epstein argues that aid dollars are absolutely necessary, but that it is time for well-intentioned Westerners to offer their ears first.  This, she subtly suggests, is the invisible vaccine against AIDS in Africa.

In the time that I have spent, over the last several months, working in the area of HIV care in Tanzania, I have been approached by innumerable nursing colleagues.  Many of them want to know what the situation is like "in the trenches" and how the disease has managed to spiral so completely out of control here.  They want to know how their taxpayer dollars are being spent and which charities are reputable. In response, I eagerly steer them in the direction of Helen Epstein's book.

Reference:

Epstein, H. (2007).  The Invisible Cure:  Africa, the West and the Fight against AIDS. 

Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved