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Book Review: 28: Stories of AIDS in Africa by Stephanie Nolen

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Over the past couple of years, I have often wondered how the future will judge us. How kids will read their history books and look back on their ancestors in the late 20th and early 21st centuries? As they live with the consequences and ripple effects of our actions and inactions, will they be sympathetic? Or will they be appalled? I am not optimistic that time will remember us well.

Take the African AIDS epidemic, for instance. To do this, you could ask for no better guide than Stephanie Nolen's 28: Stories of AIDS in Africa (published by Knopf Canada). Nolen, an experienced journalist, wrote the book as an examination of "the biggest story in the world."

The book is structured with one individual's story standing in for those of a million people with AIDS on the African continent. They are the stories of sex trade workers and truckers and health care professionals and grandmothers and scientists and politicians. There are stories from Zaire and South Africa, Malawai and Uganda — AIDS is experienced differently depending on where you live, after all. Nolen's twenty-eight profiles are diverse in a way that illustrates the range and variety of the face of AIDS on the continent. Some stories are hopeful, some are heart-breaking. Most are both.

Every one one of the stories is an implicit question: Why?

The scope of devastation being wrought by the AIDS epidemic hasn't gone unnoticed, after all. There probably isn't a person in the developed world — certainly not an educated person — who is oblivious to the fact that though AIDS is seen as something you live with in the West, but die from in Africa.

Through Nolen's profiles, you get an idea of just what that means. Like this:

Zomba is the poorest district in the fourth-poorest country in the world, and one of the worst hit by AIDS. Nearly twenty per cent of adults have the virus, and three-quarters of admissions to the hospital are HIV related. Zomba Central has three hundred beds, and it runs at 400 per cent occupancy: that means two or three skeletal patients in each old iron bed, and many more on the floor. It means sick babies tucked under benches and women in labour left alone in a fly-filled ward. Alice remembers all the niceties of bedside nursing she learned in college, fluffing pillows, wiping sweaty foreheads and offering encouraging words — but there's no time for any of that now: she is one of just six registered nurses in the hospital.

Or the fact that almost 1400 children with AIDS die every day, almost all in the developing world:

More than 90 per cent of all children with the virus contract it from their mothers at birth. Those infections are easily avoided: used together, a single does of nevirapine given to the mother in labour and baby at birth, a Caeserean delivery and formula feeding lower the risk of passing the virus to a baby to less than 2 per cent. Because it's so simple, fewer than three hundred children were born with HIV in all rich countries combined in 2005. But less than 10 per cent of African women get those interventions (in fact, most aren't even tested for HIV) and so 700,000 children are born infected in African each year.

How could anyone look at that kind of inequality and not be mortified? To be sure, there are complications with delivering the same kind of care in Africa as is delivered in, say, Canada. The facilities are more primitive. The poverty is crushing in many places. The values are different. But Nolen and her subjects force the re-examination of some of those assumptions. In one chapter, she talks to Christine Amisi, who assisted in the MSF's anti-retroviral trials in the Democratic Republic of Congo, a country torn apart by civil war. There is a very real risk of creating drug-resistant strains of HIV should patients not exercise compliance in treatment; this is one of the challenges often cited in treating AIDS in unstable countries like the Congo. And yet, what did MSF find?

Patients had, in the long term, a 97 per cent adherence rate—taking their pills correctly and on time — which is higher than the rate at most treatment sites in North America. Only 5 per cent of them had been "lost to follow-up," that is, stopped showing up and became untraceable — again, a number about on par with North America, and remarkable for war zone.

People, after all, are wired to want to live. If you're HIV-positive in a country with a 30% prevalance rate, your understanding of the need for treatment and the consequences of the alternative is likely to be acute. The AIDS crisis can not be blamed on HIV+ Africans. Nolen outlines the many conditions that facilitated the spread of the virus, showing us how her 28 individuals came to be affected by AIDS and giving us an idea of why Africa has been hit so hard, so unlike anywhere else in the world.

Nolen's been touched by these people; it comes through in her writing. Her profiles are respectful and unflinching. She consistently shows the frustration felt by those who are trying to survive something that threatens whole societies. Almost everyone wants to know where the help is. Whether it is Siphiwe Hlophe in Swaziland — "HIV is like the Asian tsunami: they don't say, 'There is a tsunami but you are not democratic so we are not rescuing you.' AIDS is an emergency just like that." — or Nelson Mandela — "When historians write about HIV/AIDS, when they write about this period in time, they will ask – 'Where were the leaders of Africa?'"— the question is, where is the help? The question is: Does anybody care?

If they do — and even more, perhaps, if they don't — Stephanie Nolen's book is a key piece to increasing understanding. Understanding of the scale of this crisis. Understanding of the injustices of treatment. Understanding of the humanity of the 28 million mothers, husbands, sons and sisters struggling to live with the killer in their blood. Understanding that we are them, and they are us, and this is not acceptable. The future will not be forgiving.

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