The epidemic of Aids among heterosexuals of which we were once warned by public health officials is now almost as forgotten as the global freezing of which the environmentalists in the 1970s also warned us. Only in Africa has Aids spread through the general population, reducing the already low life expectancies of several countries still further.
The African exception has long puzzled doctors. Why should Africa be the exception? Various theories have been put forward, from general malnutrition to the prevalence of other sexually transmitted diseases that facilitate the entry of the virus into the body and the polio immunisation experiments conducted in the 1950s in the Congo.
According to the author of this book, the main explanation lies elsewhere, in the pattern of African sexual relations. Contrary to received myths, the Africans are not particularly promiscuous, having no more sexual partners during their lifetime than people on other continents; but they do often maintain several long-term sexual relationships at the same time. This pattern is particularly propitious for the spread of the virus through the population.
The theory is supported by the experience of the first country that has had considerable success in arresting and even reversing the prevalence of the disease, Uganda. There, unlike in many other African countries, the government did not try to deny the seriousness of the situation, revealed to British and American readers by a pioneering book by Ed Hooper. The epidemic was discussed openly, and the government instituted a campaign against the very pattern of sexual relationships that the author says spread the disease.
The evidence is not conclusive, and the author, who has spent many years in the field, does not claim that it is; but the success of Uganda, with its ‘no grazing’ campaign, is nevertheless in marked contrast with the failure of other countries, notably South Africa.
There the president, Thabo Mbeki, has set his mind against the viral nature of the disease, and this has had a very harmful effect upon Aids policy. With the fervour of an autodidact, and having undergone something like a conversion experience, he has accepted the theories of Aids ‘dissidents’ who deny that HIV is the cause of Aids. It is probable that he incorporates the viral theory into his conspiratorial and resentful mindset, regarding it as yet another insult to the dignity of Africans.
At any rate, his stubborn refusal to accept the viral theory has probably resulted in as many deaths as apartheid; but it cannot be said that western efforts to help Africa have been very much better. The author shows how the large sums of money available for Aids treatment and prevention, relative to African countries’ foreign exchange receipts from other sources, have distorted the decisions of African governments on the subject. They will agree to anything the donors demand in return for the cash, a large proportion of which, of course, then goes missing. And the donors have their fashions and sudden enthusiasms.
For example, evangelical Christians demand total sexual abstinence outside marriage as the solution, while more liberal donors deny that sexual behaviour has anything whatever to do with the spread of the disease. Between the two of them they manage to develop unworkable solutions, imposed by cash on the recipient nations. Some of the schemes that the author describes would be hilarious were they satirical rather than real.
What is clear from the book is that one solution does not fit all situations. We tend to talk of Africa as if there were no variations within it, or as if all Africans had the same customs and history. Like politics, all preventive medicine is local, at least in its implementation. Unfortunately, aid organisations, even when well-meaning, are insufficiently rooted in the countries in which they find themselves to propose anything other than generic solutions. The one constant of foreign aid is four-wheel-drive vehicles painted white.
The Invisible Cure is not a well-constructed book; it meanders as if there were not quite enough material on the main theme to sustain it. There are a few factual errors; in excoriating British colonial policy, it is wrong to characterise Milton Obote merely as a thug, disastrous as a ruler as he undoubtedly was, and to do so is to miss his wider significance altogether. But this book is an important contribution not only to the literature of Aids but, by implication, to that of development economics.