28
Stories of AIDS in Africa
By Stephanie Nolen
Knopf Canada, 408 pages, $34.95
THE INVISIBLE CURE
Africa, the West, and the Fight Against AIDS
By Helen Epstein
Farrar, Straus & Giroux,
352 pages, $26
The HIV-AIDS pandemic gnawing its way across Africa is a "great reverberator," as Saul Bellow once described the Russian Revolution, "whose echoes ... you could not choose but hear."
Authors recording these echoes find themselves nearly deafened by too much suffering, too many funerals, too many children orphaned, too many societies crippled, all of it happening on an unprecedented scale. How can books capture and relay such waste and grief?
Books such as AIDS in the World, Vols. I and II, by the late Dr. Jonathan Mann and his colleagues, are vital compendiums of epidemiological and demographic data. Scientists chart and pinpoint the dynamics of the African pandemic like astronomers attempting to outline the shape and extent of a spiralling galaxy.
At the more artful end of book-length approaches to this 26-year-old pandemic are works like Jim Wooten's We are All the Same, a slim biography of a heroic South African boy, Nkosi Johnson, who became, for a short while until his death, the world's poster child for African AIDS.
Two journalists - one American, one Canadian - document the African HIV-AIDS pandemic in books published this month. Helen Epstein, a Princeton-based scholar and contributor to The New York Times Magazine and The New York Review of Books, crosses the territory on foot, but writes from a scientific rather than humanistic perspective. Stephanie Nolen, Africa correspondent for The Globe and Mail, takes up a position like Wooten's, close to the ground, in the company of sufferers and survivors.
Nolen's 28: Stories of AIDS in Africa, takes its title from an estimate that 28 million people in sub-Saharan Africa have been infected with HIV, although she is the first to say that "this book could equally plausibly be called 26 - or 30 ..." Nolen is a gifted listener and storyteller who understands that human beings are not wired to grasp 28 million bits of information about anything, much less process news of 28 million men, women and children weakened by, strangled by, emaciated by, orphaned by, widowed by and finally killed by a runaway mutant virus. So, out of hundreds of African friends, acquaintances and subjects, won over six years of reporting on the pandemic, Nolen has chosen to profile these 28.
Her collection is so rich a portrait of humanity that it would stand up without AIDS as its buttress. It pays loving tribute to the people of Africa, as James Agee's Let Us Now Praise Famous Men respectfully evoked the world of Depression-era Southern sharecroppers. It is an anthology of nonfiction stories, a kind of modern The B ridge of San Luis Rey, Thornton Wilder's novel about the fall of a rope bridge into a gorge in 18th-century Peru, and the five strangers united only by the random moment of their deaths.
A 38-year-old widower and bereft father in Burundi, Noé Sebisaba, is especially eloquent. He has gone, in response to an urgent hospital appeal, to donate blood, but is turned away when his blood test reveals him to be HIV-positive. Shattered, he broods for days over how to tell his wife without destroying her. After three days, he approaches her: "My wife, I'm going to tell you something very dangerous and very bad. I don't know how you will cope with it." Although both husband and wife have been faithful, neither were virgins when they met, and beautiful Agrippine was gang-raped by soldiers in a raid on her village. They cling to each other in grief, secrecy and hope. But their new baby daughter fails to thrive, develops lesions and dies at 14 months, and Agrippine - Noé's "smart sparkly wife" - dies soon after at 33.
Tigist Haile Michael is a 14-year-old schoolgirl in Addis Ababa, Ethiopia, who enjoys trying out new hairstyles with her friends, painting her toenails sparkly blue and clipping movie-star photos from scavenged magazines. In bed at night, however, beside her 10-year-old brother, she worries about whether she can afford school fees and food for the two of them for the coming month.
Since their parents' deaths by AIDS, Tigist - starting at age 10 - has been not only Yohannes's big sister but the head of the household. She knows it should be her mother fussing over them instead of her; she recalls a day her mother surprised them with gifts of new pencils.
Nolen, with intrepid friendliness, and having absorbed the epidemiological big picture, visits prostitutes and truck drivers, long believed to be the highest-risk transmitters of HIV (Epstein's book will suggest otherwise); she visits war refugees, grandmothers, doctors, orphans. Although each is expected to "stand for" a million souls, or to represent, at least, The Truck Driver, The Activist, The Prostitute, The Grandmother, the richness and honesty of the book won't let that happen.
Each of her subjects is defiantly unique. You find yourself praying that the baby will live. (She doesn't.) You find yourself rooting that the loud, gregarious sex worker in the garish dress will get plenty of customers, so her family can buy food. (She does.) Although history and science are woven lightly in and around the anecdotes and photographic portraits of the 28, this is a book about human life and human nature. 28 is really not about numbers at all.
Epstein's The Secret Cure: AIDS in Africa, is harder to classify. Written in first person - with intervals during which the author complains about the inconveniences of doing scientific work in resource-poor countries - it opens like a memoir.
But the ominous notes sounded in the opening chapter - of a research project bizarrely hushed up - don't build to a relevant storyline, and the author soon drops the convention of memoir. One's uncertainty about whether this book is a layman's introduction to the science of AIDS, a serious epidemiological contribution to our AIDS library or a travelogue through a land decimated by AIDS makes the book seem a work-in-progress, perhaps awaiting its final edit. (The book will be published May 22.)
There is overlap between chapters - some were first published as magazine articles - and the anthology-like feel of the collection makes it hard to discern an overarching argument. Even book and chapter titles can be hard to grasp. What, for example, is The Secret Cure? One isn't certain until the book's conclusion that it is the wisdom inherent in African communities to find and implement their own solutions to the crisis, beginning with frank discussion that grows into grass-roots organizations.
What is the meaning of the chapter title (and the book's original title) Why Don't They Listen? I think this refers to attempts by Westerners to orchestrate good health practices from afar, often miscalculating the cultural impact such messages will have on the ground.
So there are frustrating elements, and yet the author's impatience and disorderliness also allow her to scare up counterintuitive results, to burrow deeper than the norm for information and to discover failure on the front lines of much-ballyhooed, richly funded campaigns. Perhaps The Invisible Cure might better have taken the title of Elizabeth Kolbert's Field Notes from a Catastrophe, allowing us to appreciate how much interesting information surfaces here, rather than to expect definitive answers.
We follow Epstein's growing acquaintance with the African HIV-AIDS pandemic, from the molecular to the national to the global stage. Theories and strategies are filtered through her sharp and skeptical mind, and she brings us - as close as any lay book is liable to do - to a front seat at important current disputes.
The most important of these issues, earning the book's only diagram, falls within the specialty study of sexual networks. The Western stereotype of "over-sexed Africans," guilty of the spread of AIDS through Africa faster than on other continents, is not supported by research. Africans have about the same or fewer lifetime sexual partners as people everywhere. An important difference, however, is the tendency for Westerners to engage in serial relationships, one true love at a time; and the tendency for Africans to engage in concurrent relationships, either through legal polygamy or through long-term affairs.
Serial monogamy has the effect of containing or slowing the spread of HIV-AIDS. An infected person may infect his or her partner, and there the virus stays, between the two of them, unless the relationship dissolves. By the time the relationship ends, the infected partner's viral load is diminished, as a person is most contagious soon after infection. That partner's ability to infect his or her next partner also is diminished.
Concurrency means, as an anti-AIDS slogan stated: "Everyone he's sleeping with you're sleeping with." Someone newly infected in a concurrency network may well infect his partners, who will infect their partners, who will infect theirs and so on, in rapid escalation.
Epstein does an excellent job of presenting concurrency as the guilty party in "the African earthquake," and an equally excellent job presenting the success of Uganda's "Zero Grazing" campaign, which urged people to limit their sexual contacts.
One glimpses here the misguided harm inflicted by Western governments, pouring billions of dollars into abstinence programs of the sort that don't work among evangelical youth and certainly don't work when imposed on a continent from above. The removal of condoms from the scene - designed to promote abstinence - widens the health disaster.
These are subjects of ongoing research; concurrency is intriguing, but cannot carry the weight Epstein bestows on it as a sort of Unified Theory. The empirical support is not yet there, and there is as much variation in sexual networks in Africa as among human beings elsewhere.
But I admire Epstein as an intellectual and a scientist, casting her considerable abilities into the cataclysm. She reads, she travels, she peers closer and closer, she accepts no canned responses, and she respects the issues posed by the African AIDS pandemic as dilemmas of pre-eminent importance for humankind.
Melissa Fay Greene is the author most recently of There is No Me Without You: One Woman's Odyssey to Rescue Her Country's Children.