Current tome: The Invisible Cure: Africa, The West, and the Fight Against AIDS
When I read the title of this book three questions popped into my mind.
1. Cure? Why haven’t we come up with a cure or a vaccine for AIDS?
2. Has anyone come up with the “real” explanation for the origin of AIDS?
3. Why is HIV/AIDS spreading so quickly in Africa?
Helen Epstein
And with those questions in mind I started my journey with the woman pictured. She took me from a sunny day on the New Orleans Streetcar to the forefront of a worldwide epidemic that is destroying so many lives. I hope the next few entries will teach you why you should care about what Helen Epstein and her book. Also, I hope these next few entries will help us all understand the social implications of the epidemic through the lens of this book.
Epstein, a molecular biologist, came to Uganda in the early nineties to perform an experiment involving the study of thousands of blood samples from an AIDS related project called CHIPS. She had been lured away from her research on the sexual organs of an insect by the vaccine research of a scientist named Katherine Steimer. Apparently the potential of the research moved Epstein so much that she lost her passion for insect research. She decided to join the search for the cure.
In the beginning, (let’s say 1983,) people thought it would be really easy to find a cure. We live in the age of eradication. Mass vaccination campaigns have made large strides in eliminating major scourges like smallpox, so why should HIV be any different? The difference lies in mutation. A person’s antibodies will kill most of the virus, but the rest of them will mutate and invade more cells that the overwhelm the body’s immune response. Lowered immune response exposes the body to more diseases that a healthy person would easily overcome.
The world has been fighting the AIDS epidemic for 25 years now, and the impacts have been devastating. Economically, HIV/AIDS devastates the most viable parts of communities. The fastest growing group with HIV is that of people aged 25-40. 
This demographic represents the workforce which HIV/AIDS rapidly erodes, leaving the oldest and the youngest to fend for themselves. Socially, AIDS destroys the family structure by killing parents, and infecting children. The burden of care is put on the extended family, straining the networks that have enabled care in the past. The impacts are cyclical, involving feedback loops and shocks that can be felt for generations. For 25 years we have watched the epidemic decimate individuals, their families, and communities. The disease at times seems like a great mystery, but it is, in fact totally preventable. In Uganda, Epstein is impressed by how well informed people seem to be about HIV. They know all about the disease, yet while Epstein is there, 18% of adults are 
infected with HIV. In 1993, this was the “highest national HIV rate ever recorded.”
The West has assumed for years that the speed of the epidemic in Africa was due to their being oversexed. (Those ideas still exist today in our society.) Epstein postulates that this negative and racist idea is probably what has impeded the West from making any positive strides in stopping the epidemic in Africa. Western science just plain missed the boat by being unable to identify the real reason why HIV/AIDS has continued to spread so quickly. Epstein’s answer to this conundrum is concurrency. Although this theory is in the beginning of the book For me, this is the “something new” that I was expecting to learn in grad school. So let me explain it to you before I hyperventilate.
The book uses illustrations like these to demonstrate the rate of the spread of HIV. The pictures I am using here are meant to represent concurrent relationships. Epstein’s thesis is that it is not promiscuity that leads to more prevalence of HIV, but the concurrent nature of relationships. While most Westerners practice serial monogamy, about 40% of men and 30% of women in Uganda stated that their relationships “overlapped for several months or years.” This makes a difference because of the existence of what she calls a “viremic window”. This “window” is a period in which HIV-positive people are extremely infectious. The amount of HIV present in the body, (or viral load,) is very high early in infection. Epstein presents this scenario:
“If a man with two long term partners contracts HIV- perhaps from a fling from a prostitute- he will very likely pass the virus on to both of his partners in a very short time. If any of his partners has another partner, these “partners of his partners” will very soon become infected too, along with any other partners they might have and so on.”
This creates a “superhighway” that HIV travels through, spreading it faster than what would occur if people were with one partner at a time. In a society that practiced serial monogamy, the virus would have less of a chance spread as quickly, because viral load will have decreased by the time a new relationship has started.
The theory of concurrency had a serious impact on me personally because I was so tired of hearing the same stereotypes of Africans and African Americans used to explain why HIV infection rates are so high. In the “Invisible Cure,” concurrency purports itself as the panacea to cure the false image of promiscuity given to Africans. That false image led to health officials’ belief in a high risk/low risk model of sexual behavior. This is the idea that “high risk” people’s behavior, (prostitutes, drug users, etc.) mixing with low risk people led to the rapid spread of HIV. Concurrency allows people to see that all people are affected by HIV and allows all people to learn and protect themselves instead of promoting the idea that only certain people can get HIV. When HIV programs are targeted only towards “high risk” populations, not only does everyone miss their chance to fight the disease, but stigma is slapped on all those who are infected. The people become the enemy instead of the disease.
In my opinion, concurrency has made a good argument to why this epidemic has been so indefatigable in Africa, but it is not the only answer. I think there is a lot to be said for the way poverty interacts to exacerbate the spread of HIV. Unfortunately, I have not found a lot of research on the subject except for Eileen Stillwaggon’s Ecology of Poverty, which I have not yet had the occasion to read. Part 2 will explore a specific example of how some of the power constructs in South Africa have had a detrimental effect on people suffering from HIV/AIDS…
