AIDS in Africa: Rising Above the Partisan Babble

It is hard to remember when AIDS was just a simple epidemic disease. Long ago it exploded into a global rallying cry for ideologues of every stripe, politicizing the science and the social science alike. A small army of academics and consultants now stake careers — and millions of international aid dollars — on specific and often conflicting theories of how to reduce behavioral risks for acquiring and transmitting H.I.V.

Amid the partisan babble, Helen Epstein has for years generated some of the most sensible commentary around, posting dispatches from AIDS-afflicted countries in Africa to The New York Review of Books and other publications. As a scientist morphed into a journalist, Dr. Epstein combines an understanding of the biology of AIDS with a coolly impartial view of the political and social landscape of Africa. She has now assembled more than a decade’s worth of reporting into an enlightening and troubling book.

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That said, however, Dr. Epstein’s basic point is quite true: the drugs alone will never save Africa. Prevalence and transmission rates are too high, the health care infrastructure is too weak, there are too many other threatening diseases, and the costs are impossible. Instead, experts agree that hope lies in a still-distant vaccine, and in the “invisible cure” of Epstein’s title: dramatic behavioral changes to prevent new infections.

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Interrupting this perfect storm requires a clear understanding of its origins, and we still cannot fully explain why heterosexually transmitted H.I.V. exploded in Africa while remaining confined to very specific communities in the West. Theories abound, and Dr. Epstein does a nice job of reviewing them.

The fiction that Africans are more “promiscuous” than Westerners has been disproved; studies have found that Africans often have fewer sexual partners during their lifetime than Westerners do.

But accepted patterns of sexual activity seem to have ignited the tinderbox in Africa. Sex there crosses social boundaries more often than in the West, and the habit of having concurrent partners — simultaneous long-term relationships in which friendship and trust may thwart routine condom use — means a single person’s infection may spread rapidly through a group.