E3W Literature | University of Texas

Toyin Falola and Matthew M. Heaton, Eds.
HIV/AIDS, Illness and African Well-Being
University of Rochester Press, 2006
400 pages
$75

Reviewed by Neville Hoad

The HIV/AIDS pandemic in sub-Saharan Africa is variously represented as the greatest humanitarian crisis of the last ten years, as another instance of the failure of postcolonial governance, as part of the ongoing legacy of colonialism, and as part of a representational system in the Western imaginary that would have Africa continue as an atrocity exhibition. The title of this anthology—HIV/AIDS, Illness and African Well-Being—alone well suggests how all these modes for making sense of the pandemic are complicated and contested within it. The most important claims the title makes are that HIV/AIDS cannot be understood removed from the wider contexts of public health in Africa and that questions of African illness must be framed by commitments to African well-being. Through its careful organization and through the subject matter of its various essays, the anthology itself make good on these claims.

Growing out of a conference on African Health and Illness held at the University of Texas at Austin from March 25 to 27, 2005, the anthology contains perspectives from many different countries, academic disciplines and health practices. The editors write that “by providing multiple perspectives and disciplinary approaches to understanding the relationship of HIV/AIDS to other illnesses in Africa, both historically and contemporaneously, as well as by drawing attention to the economic and environmental circumstances that affect Africans’ ability to respond to HIV/AIDS and other illnesses, this book provides a more comprehensive view of the AIDS pandemic than is currently available in sources that focus specifically on HIV/AIDS or on a single aspect of the overall disease environment in which Africans struggle to live long, healthy and happy lives.” Their introduction provides useful summaries of the articles to follow, bringing out the stakes of the anthology and insisting on the importance of historical context for any understanding of disease in Africa. The essays are divided into four sections: Part I: Context; Part II: Illness Case Studies; Part III: Globalization; Development and Health, and Part IV: HIV/AIDS.

Part I sets out the deep history of the key terms for understanding disease in the African context. Iruka N. Okele’s excellent “The Evolution of Disease in Africa” provides an account of the relationship between African ethnomedicine and Western allopathic medicine within and through the legacies of the long colonial encounter. Noting that “Africans inhabited the infectious continent even though they had no appreciation of germ theory in the western scientific sense,” Okele points to how “enough Africans reached reproductive adulthood to maintain societies on the continent as well as to seed the global workforce conscripted during the slave-trade.” This article sustainedly reminds readers that no comfortable developmental story about medical advances can be made, that modernity brings up new epidemiological crises, and the pathogens that cultural and environmental practices kept under control often begin to flourish under the pressures of urbanization and underdevelopment. Sophie Westheimer’s contribution to this section, “The Infectious Continent: Africa, Disease and the Western Imagination,” reveals the interaction of long-standing discursive histories with the more material ones presented in the previous essay. Tracing the ways that “multiple layers of racial and racist stereotyping collided and intertwined, further contributing to the construction of the black “infectious other,” Westheimer suggests that media representations of African HIV/AIDS in the present “West” will continue this mode of representation. Part I thus offers a framework in which to make sense of the case studies of the rest of the volume.

Part II, “Illness Case Studies,” considers a variety of illnesses, ranging from a history of waterborne diseases in urban Nigeria in the thirty years before independence to an ethnographic study of the perceptions of epilepsy in an Akan family’s experiences in Ghana. The essays here illustrate the variety of disciplinary approaches necessary for elucidating the heterogenous medical, economic, affective and religious experiences that a focus on illness must constellate, and reveal the inadequacies of an allopathic biomedical model for explaining health and health-seeking behavior in contexts where the underlying assumptions of this model make little cultural sense. In a fascinating essay on “Smallpox and Social Control in Colonial Saint-Louis de Senegal 1860-1916,” Khala Ngalamulume uses a Gramscian approach to illustrate how “the battle for a medical monopoly” is bound up with both the implementation of colonial governance in colonial French West Africa and with indigenous resistance to such governance. The final essay in this section is an important quantitative study of disability in Nigeria—a health topic rarely addressed in studies of the health of Africans, which have focused on infectious diseases (for reasons that the essays in Part I of this volume make abundantly clear).

The essays in Part III, on “Globalization, Development and Health,” do important intellectual labor by synthesizing the problems raised in Part II’s specific case studies with the broader economic, political and discursive histories of Part I, with one exception moving these concerns closer to the present time. As Falola and Heaton poignantly observe in their introduction, “To say that sub-Saharan Africa has been left behind by global economic processes is unremarkable.” The essays in this section elaborate on the health implications for the way this part of the world is embedded in global economic systems and processes. Kathryn H. Jacobsen and Melissa K. Van Dyke track the mechanisms for the emergence of development-related diseases arguing that “the unintentional consequences that may arise from development programs call for holistic approaches to understanding potential disease risk by bringing together experts from different specialties.” Matthew Heaton’s “Globalization, Health and the Hajj: The West African Pilgrimage Scheme, 1919-38” revisits an earlier time and program in order to represent “a potential starting point for scholars to begin reconceptualizing the effects of globalization on African health and the effects of health knowledge on the globalization of Africa.” Heaton suggests that neglect is not an inevitability for African subjects under conditions of globalization, and that the Nigerian pilgrimage scheme offered and offers an important instance in which the relationship between the health of Africans and globalization “has not been completely dominated by western policy,” despite the colonial origins of the scheme.

Part IV, on “HIV/AIDS,” builds on the three preceding parts to offer scrupulously contextualized discussions of the HIV/AIDS pandemic in terms of the long and difficult histories already established and in relation to the book’s broader political and ethical concerns with African well-being. Obijiofor Aginam frames the pandemic in terms of a crisis of global health governance. Yacouba Banhoro shifts the frame to consider HIV/AIDS on the scale of national policy, in this case in Burkino Faso. Two more ethnographically focused studies, one, on the emotionally charged topic of deliberate infection, undertaken in rural Tanzania, and another on the diverse emotional responses to HIV infection in urban Zimbabwe, suggest the necessity of multiple scales of analysis for both making sense of the pandemic and imagining and implementing effective strategies to fight it. The book concludes with an essay by an economist, Richard Beilock, on how to analyze the economic growth effects of the pandemic on sub-Saharan Africa given the difficulties of obtaining accurate data on the extent of the disease in the affected countries.

Taken as a whole, HIV/AIDS, Illness and African Well-Being represents a remarkable contribution to a range of scholarly enterprises. With its impressive diversity of topics and disciplinary and interdisciplinary approaches, it very easily could have become an incoherent collection of valuable essays. Instead, the editors, through their careful framing introduction and skillful grouping and sequencing of the essays, have produced a book that reveals the ongoing historical determinants of the current crisis and its interlocking geographies, while performing a principled resistance to the Afropessimism that characterizes so much writing on the HIV/AIDS pandemic in Africa. While there are many excellent anthologies on the HIV/AIDS pandemic in Africa—the standard bearer for me is HIV/AIDS in Africa: Beyond Epidemiology (Kalipeni et al. eds., 2003)—none that I know of holds the pandemic in dialogue with discussions of African health more generally and fruitfully than the book under review here. While most readers may struggle with the unfamiliarity of the disciplinary procedures of one or another of these essays, that should only remind us that both understanding the pandemic and fighting against it are tasks that can only succeed if they are profoundly collaborative.