One way or another, July is going to be a very important month in the unfolding history of the global HIV epidemic. It has now been 30 years since the HIV epidemic “officially” began. Later this month, the International AIDS Society will host its biannual meeting in Washington, DC – a very significant venue location. Tens of thousands of scientists, advocates, and program managers will descend on the capital of the world’s largest AIDS donor. While there are unlikely to be any major scientific breakthroughs announced at the upcoming conference, it will still be notable on the advocacy front due to what is at stake: the sustainability and continued expansion of a decade’s worth of donor supported AIDS programs in low income countries.
When people think about books about HIV, many will mention “And the Band Played On”, but that books is now 25 years old (into a 30 year epidemic). I think it is time for an updated reading list. It turns out; I am not the only one. Or at least that is what a number of publishers are hoping for with the release of a number of books marking the 30 anniversary of the epidemic. A number of these books have made it onto my reading list this year. So far I have managed to make it through 2.5 of the 5 books and hope to finish the rest soon. Here is my list:
Among the books I have read (fully or in part):
No Time to Lose (by Peter Piot): After leading UNAIDS for over a decade, Peter Piot spent time at the Ford Foundation reflecting upon his experiences. This book, a biographical account of his involvement in launching the global response to the HIV epidemic, is the result. I don’t know him personally, but I have seen him speak on a number of occasions. In person, I have never found Peter Piot to be particularly inspirational – I always found his style to be aggressive and he always seemed angry – but I very much enjoyed this book which described Piot’s role in the discovery of not one, but two viruses (HIV and Ebola), and the story about how a doctor and virologist from a country with little international clout (Belgium) come to lead the the UN political and bureaucratic machine against HIV. The title well describes his own mindset and perhaps explains some of the choices that he made over the years. The book introduces many of the key players in the response and how each became involved. The early chapters, I thought, were particularly interesting and detailed, describing the path that took Piot to Zaire and his involvement in the field there and throughout Africa. The latter chapters, however, seemed a little rushed and a little light (e.g. I thought the premature and violent death of Jonathan Mann, a close friend and important player in the response to the epidemic warranted a bit more than a paragraph of mention). I would have also liked a bit more thoughts on what is next for the epidemic, but overall, a highly recommended read.
The Origin of AIDS (by Jacque Pepin – no not the chef, another one): By now, it is more or less well established that the HIV virus crossed over from chimpanzees to humans at some point during the past century or so, likely in Central Africa. From there it spread across the world and infected tens of millions of people. But why did the virus spread when it did and how did is transmit to quickly? This book explores these questions and postulates some answers. The central argument that this book takes is that colonial policies and practices, in particular in Central Africa half a decade ago, are to blame. For example, Pepin argues that the migration of male, but not female, workers to capital cities to work in colonial industries generated high male to female ratios which promoted another industry: prostitution. Also, rural campaigns, whether well intentioned or not, to tackle a number of tropical diseases, led to countless inoculations and injections with unclean needles and syringes in exactly the areas where the virus was likely transmitting at low levels among rural populations. The efficient spread of the virus via contaminated blood amplified the virus in the population and led it to spread at a rapid pace. In addition, the treatment of sexually transmitted infections, in particular among the newly employed prostitutes, may have also effectively transmitted the disease. In essence, these forces lead to the rapid spread of the virus into new populations in ways that it allowed it to propagate quickly within and outside of Central Africa. Finally, the author also argues that if it was colonial practices that lead to the spread of the disease, then the now wealthier countries in the world also have an obligation to address it. This was a well-written book throughout and an entertaining read.
Republic of Therapy (Vinh-Kim Nguyen): This books makes it onto my list, even though it was published 2 years ago, because I am only now getting around to reading it. The first night I ever spent in Africa, over a decade ago, was on the patio of the house Vinh-Kim was renting in Ouagadougou, Burkina Faso while he was conducting research, some of which ended up in this book. Nguyen describes the advent of advocacy in Sub-Saharan Africa during the introduction of antiretroviral therapy in the region. He tells how Western forms of advocacy and the need for people to identify people living with HIV lead to systems that allowed outsiders to decide who lived and who died and effectively created a new form of sovereignty with outsiders holding power over the HIV infected citizens. Given how important advocacy and social movements have been in shaping the HIV epidemic you would think that there would be many good investigations of these forces, but from my perspective so much of the analysis has been on the scientific and political contributions, and this is one good exception. This book is much more academic than some of the other books on this reading list but if you are up for it, than it is a worthwhile read.
Now on to the books I have not yet read:
Tinderbox (Craig Timberg and Daniel Halperin): Similar to the Origin of AIDS, this book focuses on the reasons for the spread of the virus outside of Central Africa. I know Daniel and he is always entertaining so I suspect this book is as well, although I am not sure exactly what angle this book takes over Pepin’s book. Daniel also gets my vote for the global health expert I would most like to see on Twitter.
AIDS at 30 (Victoria Harden): Written by a historian from the NIH, this books looks at the medical history of the epidemic, including the faith that has been put into vaccines over the years. Looks like an interesting complement to the other books.
So what did I miss? What are you reading this year?Share on Facebook
With news this week (here, here, and here) that the US Government’s Global Health Initiative is being, shall we say, reorganized (closed?) many people seemed confused about the future of the US governments’s strategy on global health. It might therefore be a good time to spend some time thinking about what has come from this initiative over the years. Without a question the most visible and likely most success part of this program has been the PEPFAR program. It is therefore very timely that tomorrow, Health Affairs, the “Bible of Health Policy“, will release a themed issue that looks at the “achievements and future prospects” for the program.
I’ll be blogging more on it later this week once the journal is out (I am the author of one of the pieces in this issue) but I wanted to let you know that there will be a special briefing to disseminate the findings of this theme this week in Washington, DC. There is likely to be air conditioning at the Hyatt, so if you are in town, you might want to sign up to attend (and make sure you say hi, I’ll be the one carrying around a 7 week old). If not, there is going to be a live webcast of the event. More details on the event and an RSVP link can be found here.Share on Facebook
I frequently get asked, and myself wonder: what are the top journals in global health? This is kind of a complicated question to answer since of course “global health” is by nature a multi-disciplinary and inter-disciplinary field. As a result, you will frequently see really important papers being published in journals that might not obviously be home for such works. As well, due to the rise in this field over the past few years, we have actually seen the establishment of new journals that have attempted to fill gaps in this complicated academic field.
Andrew Harmer, who blogs at globalhealthpolicy.net, has compiled a list of what he believes to be the top academic journals in this space along with additional information each journal, including their impact factors. I mostly agree with this list – it covers nearly all of the journals I read regularly.
To help others keep up with this literature, the Global Health Hub, a very useful online aggregator of all that is going on in the field of global health, has also recently compiled an RSS feed that aggregates the feed from many of these journals. By subscribing to the feed, you can then follow along and keep up to date with these relevant journals.
Many top journals also now have Twitter accounts, so I also tend to follow many of these accounts, including the Lancet, Health Affairs, Global Health Governance, and others. I find it is also a useful way to keep up with the articles as well as other important pieces of information, such as calls for papers.Share on Facebook
As you might have observed, blogging has been low on my list of priorities for the past few months. Since I also hate those “I have been very busy” blog posts, I’ve decided not to make any excuses for my absence from cyberspace. Instead, I have decided to adopt a different tactic: I am going brag about the wonderful things that have been keeping me away from my computer.
The most wonderful thing that has happened, and the one that I am sure you can all agree I have a right to brag about, is the arrival of my second little boy – Adrien Jules Grépin – who was born just over 6 weeks ago in New York City. Like my older boy, who turned 2 just a few weeks before his little brother’s entrance into the world, he has been an easy going baby but one who has not yet figured out how to sleep more than about 4 hours in a row. Both of them have been keeping me on the go – day and night, especially between 5-8 a.m. – but a happy mom.
Luckily, Adrien held off long enough for me to finish teaching another great semester of international health economics at NYU – a course I enjoy teaching more and more each year. I have also been fortunate enough to be working on some projects that are currently launching in Kenya to evaluate the impact of mHealth technologies on health care utilization and health care savings behavior of pregnant women. I also manage to get a few projects that have been in the works for a while wrapped up, so that I can now enjoy my maternity leave a bit.
But as the exhaustion begins to fade, and my baby-brain and c-section scar continue to heal (admittedly, it took me almost a minute today to come up with the name Burundi) I have been trying to get back into work and into what has been going on in the world of global health. While I was away, I missed blogging about a lot of important issues, including the whole Millennium Villages Debacle, the launch of a new US government funded initiative to reduce maternal mortality, and the election of Jim Kim to the head of the World Bank. Fortunately, I am sure that a lot more good stuff on its way soon. Hopefully my brag worthy life events will allow me some time to write about them again.Share on Facebook