Karen Grepin's Global Health Blog

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?