The Plague of Nations
From a review of a book by Helen Epstein
Halfway through The Invisible Cure, Helen Epstein writes about finding a long-forgotten document in a small research library in Canada. Reading through the paper, Epstein says, “I felt as though a small stick of dynamite had gone off my head.” Epstein had unearthed a rare copy of a detailed study on the sexual behaviour of Ugandans in the late 1980s and early 90s, a period that coincided with the country’s historic drop in HIV rates. In short, Epstein knew, the research done by Maxine Ankrah, an African-American academic, would give invaluable insights into what had halted the epidemic– insights that then could be applied to other countries with high rates of HIV and AIDS.
Before Epstein’s discovery, Ankrah’s research seemed destined for oblivion. A United Nations AIDS researcher had read it, failed to understand its significance or to credit it and, Epstein recounts, wrongly concluded that an increase in condom use was responsible for the decrease of the HIV rate in Uganda. In reality, according to three later analyses of Ankrah’s study, the primary reason for the decline was completely different: substantial numbers of Ugandans had ended affairs and remained faithful to one partner.
Uganda has long been a focal point in the contentious world of AIDS policy. But sometimes a bolt of clarity shoots out of the blue, as it did for Epstein when she read Ankrah’s paper – and it will for readers of this book who yearn for insights on how a deadly virus now infects an estimated 25 million Africans and has killed untold millions more. Reading The Invisible Cure is like travelling into remote and hard-to-comprehend territory with an unblinking and sure-footed guide.
After five years in Washington covering politics of AIDS and three years in Africa writing about the lives of those infected and affected, in truth, I have little patience for books on AIDS in Africa. With few exceptions, they tend to be too self-important, too polemical, too grim and too at odds with my experiences in the field. Epstein, in contrast, teaches me things I didn’t know. Her rigorous reporting unearths new findings among old, wornout issues. And the evidence she puts forward could provide a roadmap for comprehensive prevention programs that incorporate teaching abstinence, using condoms and, most critically, emphasizing fidelity.
Epstein began her work in Africa in 1993 as a scientist for a biotechnology company working in Uganda on an AIDS vaccine. Epstein often focuses on failures, including her own early search for a vaccine. “In science, failures are often as important as successes, because they tell us where the limits are”, she writes in the preface. “When it comes to fighting AIDS, our greatest mistake may have been to overlook the fact that, in spite of everything, African people often know best how to solve their own problems.” Later, she expands on this theme, criticizing many outsiders who come to Africa to work on AIDS. “Everyone seems to know what Africa needs,” she writes.
In Uganda, Epstein found a powerful example of Africans taking the lead in the fight. When scientists first reported the decline in Uganda’s HIV prevalence in 1995, Epstein says, she and others assumed it was because so many Ugandans had died from AIDS, not because they were sleeping around less. What had actually taken place, she writes, was a “very African” prevention approach. It was led by the President’s call for “zero grazing” – meaning couple should stay faithful to each other. This call inspired Ugandans to talk about AIDS more openly, which in turn erased the stigma of the disease to some degree, empowered women to divorce unfaithful husbands and cast shame on those who continued to have affairs. Hence Epstein’s title and theme – “the invisible cure.”
John Donnelly, New York Times Book Review