I read The Invisible Cure, by Helen Epstein, at least ten years ago when I was on a particularly fevered quest to learn as much as I could about HIV. I was so impressed by her work that I later went to a talk that she gave about her work.
Epstein moved to Uganda in 1993 to work on an HIV vaccine. She worked across sectors, with politicians, activists, researchers, doctors, economists, and so on.
She challenged the prevailing orthodoxy and the struggled to understand how politics and greed can infect and corrupt even the most honorably motivated humanitarian projects. For me, I am always impressed by stories, like those told in The Invisible Cure, about the power and potential of grassroots community organizing as the most effective solution to community problems. She offers insight into the thoughts of the Ugandans with whom she is working:
“As a woman living with HIV,” says Beatrice Were of Uganda, “I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives.”
The story that is told is one that focuses on the Ugandan solution to the Ugandan Problem. The story takes place in the Bush era (so prepared to be fired up about major failings due to political ideologies!) and focuses on the successful reduction of new infections that stem from, Epstein argues, not the billions of dollars from the West, but from the “collective efficacy” of a “shared calamity,” where people helped each other and talked openly about sex, sexuality, and HIV. The reduction of HIV incidence in Uganda focuses on the “B” of the old ABC prevention methods (abstinence, be faithful, condomize). The “A” was problematic as a huge portion of infections were happening in marriages. The “C” was problematic because there simply were not enough condoms to go around at that time. So, Uganda focused on the “B”. President Yoweri Museveni called for “Zero Grazing” as a means of limiting the numbers of concurrent partners that Ugandans (and other groups, too) had. And it worked. Dramatically. Before there were millions in funding for HIV prevention.
In reflecting on the ten years that have lapsed since I read this book…all I can think is “thank goodness”! Thank goodness that we have more in our HIV toolkit than A, B and C. Thank goodness treatment is now much more widely available. Thank goodness we have gotten from a place of encouraging “Zero Grazing” as national policy to a place where we are aiming for 90% of those taking drugs to be virologically suppressed—an HIV prevention tactic I was longing for in the 90s and early 2000s.
Of course, the dark lessons, of the bumbling western influence into the affairs of other countries continues. “Everyone seems to know what Africa needs, but sometimes I think our minds are not really on it,” she writes. “Most of us see only Africa’s contours, and we use them to map out problems of our own. Africa is a career move, an adventure, an experiment. It fades into an idea. We aren’t really looking.”
Those lessons around the neo-colonization that is funding, aid, and imperialism are still ever present. While times have changed, I still recommend this book for you public health junkies out there. It offers a compelling look back and lessons around the importance of community involvement, questioning what we think we know, and challenging the status quo.