I WENT TO WORK IN BOSTON, Massachusetts, in the early 1980s, and shortly after I arrived I noticed that young, gay men in my congregation had started dying of a terrible and mysterious disease. Their immune systems seemed to be packing in, exposing t
hem to ugly infections which the body normally had little difficulty repelling. Rabid evangelical preachers, with lip-smacking satisfaction, had already dubbed the mysterious condition "the gay plague", and said God was punishing homosexuals for their sins. I remember wondering out loud at the time why their God was capable of manufacturing a virus that precisely targeted sexual behaviour, while spen-ding no time at all figuring out how to zap arms manufacturers and international drugs cartels.
When I came back to Scotland in 1986 the HIV/Aids phenome-non was being thoroughly analysed by the medical community, and Edinburgh had gained the title Aids Capital of Europe. By this time the condition was targeting not only gay men but intravenous drug users. I remember being impressed by the robust, unsentimental way the problem was tackled here. The key messages were: get people to practise safe sex, and hunt for treatments that, while they may not cure the condition, might keep people alive who had it. This combined strategy turned out to be conspicuously successful. The science of the virus is now well understood, as are ways of avoiding it or treating it when it's caught, and the issue has left the front pages in Scotland and America.
Why, then, are more than 45 million people in Africa infected? Why is it that a schoolgirl in South Africa is 13 times more likely to be infected with HIV than a woman who sells sex for a living in China? Why is a civil servant in Swaziland 40 times more likely to have HIV than a junkie in Australia? In her honest and fiercely unsentimental book, Elizabeth Pisani wonders how we allowed this to happen. But her question is far from rhetorical. As far as she is concerned, there is no mystery about dealing with HIV/Aids. We know the truth, and if we acted accordingly we could contain the thing as effectively in Africa as we have in Scotland and elsewhere. Well, why haven't we? Before considering her answer, let me say something about her career, because it is as colourful and unexpected as her book.
After graduating with an Oxford degree in classical Chinese, she became a journalist for an international news agency in Indonesia, where her gift for languages was an asset. But she ditched all that in 1993 to study epidemiology at the London School of Hygiene and Tropical Medicine. With another degree on her CV, she went to work with the fledgling UNAids organisation in Geneva.
Three decades of work in the field have made her all-too familiar with the Byzantine world of Aids politics, and this book is her attempt to inject some much-needed honesty into the discussion about the international pandemic.
Having established her authority on the subject, let me now return to her $64,000 question about why Africa has landed itself with the biggest HIV/Aids catastrophe on the planet. Here's her answer: "In large part because most African politicians found it easier to watch hundreds of thousands of young adults die than to say what everyone was secretly thinking: HIV is spread by sex. Most HIV is in Africa. Ergo, Africans must have a lot of sex. There, I've said it."
She goes on to point out that, rather than challenging African leaders for their dishonest response to a disease that was ravaging their people, the officials who ran the international development agencies were so afraid of being labelled racist that they let them off the hook by trying to put the blame for Aids not on African sexual mores, but on poverty and under-development. But people don't contract Aids because they are poor; they contract it by having unprotected sex with an infected person or by sharing needles with them while injecting drugs: stop those things happening and you stop the spread of the infection.
Pisani is droll on how straightforward it really all is. She warns us that persuading people to give up sex never works very well, "so in terms of sexual transmission, our best bet is to persuade uninfected people to use condoms with any partner likely to be infected with HIV. In east and southern Africa and in many gay communities that means any new sex partner. Bombard the places people go to meet new partners with condoms and lube … Create incentives to use condoms every time sex is paid for. Use blackmail and bribery if you need to."
That's what we did in Edinburgh, and it worked. It would work in Africa too – but try telling that to Thabo Mbeki and the African bishops.
The full article contains 840 words and appears in The Scotsman newspaper.
