Today, December 1st, is World AIDS Day. This year's slogan is Stop AIDS. Keep the promise. Fully 60% of those living with HIV/AIDS do so in Sub-Saharan Africa. In Zimbabwe, one in five pregnant women test positive for HIV infection. The vast majority of Africans living with AIDS do so without the medical care that has changed the meaning of the disease in the developed world; antiretrovirals are available often to as few as 10% of those who need them. It seems like an appropriate day, then, to review Susan Hunter's Black Death: AIDS in Africa.
Hunter's book focuses on drawing parallels between previous epidemics and endemics and the AIDS crisis, specifically in Africa. The book weaves together three illustrative threads in each chapter. One explores the lives of three fictional African women as they work to cope with AIDS in their villages. The second looks at Charles Darwin's experiences, and how his evolutionary theories are essential to understanding disease cycles and emerging diseases. Finally, the latter part of each chapter looks at facts and figures for the section's theme. Chapter topics range from a global overview of AIDS to the rules of epidemics to the role of evolution in managing the crisis.
Early in the book, Hunter traces the political path that lead to Africa's precarious position: slavery, use in colonial military services, resource exploitation, crushing debts. Poverty and exploitation are contributing to factors to the region's AIDS crisis. When populations of indigenous peoples in the New World were decimated by disease, some would argue that despair helped to make them susceptible to its impact. Amid abuse and poverty, people may have lost their will to fight, or failed to provide adequate care to those who were suffering. What does that mean to Africa, where:
the average... household today consumes 20 percent less than it did twenty-five years ago. Sub-Saharan Africa has the largest proportion of people in poverty, 220 million people living without the resources needed to eat a diet sufficient to sustain productive life. In many countries in the subcontinent, close to half of all children and a sizeable minority of adults are malnourished, leaving them highly susceptible to diseases of all types, including HIV/AIDS.
Meanwhile, these countries are staggering under enormous debts. (Remember Live 8?) These debts affect the ability of nations to provide medical care, sanitation, nutrition and education that could help to fight the disease. Some have tried to negotiate with their creditors:
Since 2000 only six countries have been able to swing agreements with the IMF and World Bank to swap "debt for AIDS" — commit their savings from debt forgiveness to HIV prevention and care. At their 2002 board meetings, the IMF and World Bank announced they were tightening the screws on five of those countries.
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