AIDS in the Twenty-first Century. Disease and Globilization.

The recently announced failure of the world’s first vaccine against AIDS has put the AIDS/ HIV problem centre stage again. Anyone who wants to get a good understanding of the issues surrounding this condition and its impact on families and societies will find this book an excellent source of material. Barnett and Whiteside have produced an eminently readable overview of the global, social and economic impact of the AIDS/HIV epidemic. Following an introductory overview, the second chapter provides the basic science, the origin, transmission, detection, treatment, interaction with other diseases and conditions, and the epidemiology. However, the accuracy of any epidemiological data may be questionable, partly because AIDS is not a notifiable disease in many countries and partly because there may be issues surrounding the quality of the reporting and some under-reporting through lack of recognition or diagnosis of the condition. In the second section of the book the authors look at diseases and changes in disease epidemiology over time. They explore some of the issues and risk factors (social, economic and cultural) that help to explain the variation seen between populations, and discuss what might be done to reduce transmission by reducing susceptibility, improving social cohesion and changing the risk environment. They take their arguments about social cohesion and wealth forward through a series of case studies set in selected countries and a chapter devoted entirely to Africa, which is appropriate given the burden of disease in Africa, with an estimated 34.4 million with HIV/AIDS in 1999. In this chapter the authors trace the historical and economic development of countries within the African continent, the emergence of AIDS/HIV, and how this reflects upon the history and inequalities seen within each of the countries. In the third part of the book the authors examine the vulnerability of local communities to the impact of AIDS/HIV, with the changes in morbidity, mortality and life expectancy that it induces in individuals, and members of households and communities. There are four chapters providing a vivid overview of the consequences of the epidemic: the increase in numbers of dependent orphans and dependent elderly, child-headed households, the disappearance of whole families or whole generations within a family, and the loss of breadwinners. This has consequent effects upon household income, household expenditure on medication, and household consumption, as well as upon subsistence agriculture and rural livelihoods. In a further two chapters, the authors look at how HIV/AIDS affects large organizations and business markets and whether and how social and economic development can take place in the current environment, particularly for countries so overwhelmed by the disease. Chapters 12 and 13 review national government roles and the responses of governments and other agencies, which have often been slow, to this epidemic. They consider what more could and should be done to tackle the problem. Chapter 13 provides a thorough overview of possible actions to manage and contain the spread of the disease, through such actions as provision of information, advocacy, promotion of ownership and responsibility, multisectoral approaches, development of coping strategies, sustainability, and finally prevention and treatment. The material in this book is of relevance to human biologists, anthropologists, epidemiologists and health-care professionals. Chapters can be read independent of others, and the very detailed index allows readers to identify specific topics of interest. I hope that others will find this book as informative, as interesting and as thought-provoking as I have.