Black death: AIDS in Africa

Susan S. Hunter. Black death: AIDS in Africa. 2003. Palgrave Macmillan New York, New York, USA. 247 pp. $29.95. ISBN: 1-4039-6244-8 (hardcover).

Twenty years after the discovery of HIV-1, the virus that causes AIDS, many educated people in the developed world still do not fully understand the tragedy that is unfolding in Africa. We sometimes become distracted by other infectious diseases and by bioterrorism. At a time when highly active antiretroviral therapy (HAART) is changing the natural history of HIV-1 infection in the developed world but having only minimal effects on the rampaging pandemic in the developing world, Susan Hunter’s short but very interesting and well-researched book is welcome.

Black Death: AIDS in Africa is a forceful and compelling work that outlines the African AIDS epidemic in a way that experts in the field as well as educated lay people can understand and appreciate. Hunter brings together various strands of a story to make the book more comprehensive and engaging. While teaching us about epidemics in general, and the African AIDS epidemic in particular, she also develops a story of how Africans are beginning to fight back at the grass-roots level against AIDS, highlighting several dedicated women and their struggle against the tragedy in their villages in Uganda.

Hunter uses the life and ideas of Charles Darwin to demonstrate how natural selection and evolution have affected both the pathogens and the people involved in major epidemics. Being a personal fan of Charles Darwin, I found this particularly effective. Her approach of bringing science into the study of epidemics shows how much we still owe to Darwin, who, a century after his death, has much to teach us about how to view host/pathogen interactions on both an individual and a global scale.

The book traces several major epidemics of the past, showing how they dramatically and directly affected human history. Whether it is Pericles’ death by plague in ancient Athens and its effect on the Peloponnesian War, or the ravaging of the Amerindians of Mesoamerica by smallpox brought by Spanish explorers, the book demonstrates that AIDS in Africa has historical precedents but at the same time is unique in its devastation of developing countries in a now “globalized” world.

One of Hunter’s major accomplishments is to educate lay people while still offering something to medical scientists. Though the book’s brevity keeps her from deeply exploring any one subject, she avoids oversimplifying or glossing over important issues. Readers will wish that certain sections had been expanded, but Hunter achieves her goal of highlighting the devastation that has occurred and the horrors that will continue in Africa if the pandemic is not brought under control. She weaves together Darwinian studies, retrovirology, epidemiology, colonial history, and accounts of day-to-day suffering from AIDS into a fairly seamless narrative. The human tragedies outlined here, sometimes of a very personal nature, bring the statistics into perspective: thousands of Africans die of this plague every day.

Hunter’s tone is, at times, somewhat preachy, but this seems appropriate enough in light of what has been allowed to progress in Africa, with minimal input or care from the developed world and from drug companies that could provide antiretroviral drugs at low cost. Whether AIDS remains the first true “disease of globalization” will be based on the response of the world community in the next few years.

I strongly recommend Black Death: AIDS in Africa to anyone interested in what is quickly becoming the worst epidemic in human history. As the book suggests, in the near future the AIDS epidemic, especially but not only in Africa, will surpass all other epidemics. Whether the spread of geopolitical problems that allowed HIV-1 to flourish relatively unabated in much of sub-Saharan Africa was due to 19th-century Western colonialism or to other factors is important to understand but may be seen largely as “water under the bridge.” Today, as Hunter points out, it is a moral imperative for the world to approach AIDS as a true threat to global stability and security. It is suggested in the Talmud that to save one life is to save the entire world. Black Death demonstrates that, if we adopt an activist approach, we have the opportunity not only to save individual lives in Africa from the horrors of untreated HIV-1 infection, but also, in a real sense, to affect the whole world and possibly the future course of modernity.