Craig Timberg's Tinderbox: How the West Sparked the AIDS Epidemic was, as far as I can tell from reading a few reviews, somewhat controversial when it was first published. Certainly there's a lot in this book, which looks primarily at how the AIDS epidemic started, and the conditions that both encouraged and hindered its spread in Africa, that makes one stop and think.
Timberg begins with an anti-colonialist narrative of how AIDS finally, after centuries of being confined to the simian population of Central Africa with no significant or recorded crossing of species lines, erupted into the human population. He identifies Western engagement in Africa as the catalyst, from the vast social disruptions caused by European projects intended to steal the resource wealth of the continent by forcing its people to do the work of harvesting and transporting, to the effects of both Christianisation and forced separation of families on traditional patterns of marriage, initiation rituals and sexual activity.
In particular, he points to a history of circumcision as an initiation ritual, and the tendency to have polyamorous but closed circles of sexual relationships as two traditions that might have limited the spread of AIDS throughout Africa had they not been lost in the decades of colonialist exploitation and ' modernisation.'
Timberg presents considerable evidence that the greater resistance of circumcised men to HIV infection was noted on many occasions during early research into risk factors, but never considered as a potential part of prevention education and programming.
He also notes that in those instances where African nations focused on trying to change sexual behaviour, stressing the idea of faithfulness within relationships and partner reduction in general (such as the 'zero grazing' program in Uganda) rates of infection fell significantly.
The narrative he constructs around attempt to slow the rate of infections across Africa contrasts the mostly African-based programs focused on changing sexual behaviour with programs imposed from outside along with Western aid money, which stressed condom use. He also contrasts attempts to introduce multi-faceted prevention programs, such as ABC (abstinence, be faithful, condoms), with programs focusing only on using condoms. Summarising the findings of one epidemiologist who examined the effectiveness of condom-centred prevention programs, Timberg says:
"Hearst found that condoms rarely failed when used properly by individuals, but he couldn’t find any examples of condom promotion campaigns slowing HIV’s spread in African societies with widespread epidemics. He acknowledged their role in reducing infection in epidemics such as Thailand’s, where transmission was concentrated within the sex industry. But while African men often used condoms in casual hookups or with prostitutes, few did so with their wives or girlfriends, despite years of public health campaigns encouraging the practice. He also raised the unsettling possibility, stimulated by some disturbing findings his research team had made in Uganda, that aggressive condom promotion campaigns, often featuring racy images and double entendres, may make casual sex seem more acceptable, potentially helping to spread HIV."
Condoms seemed not the be the answer for Africa, a possibility that few Westerners were willing to accept. Instead, Timberg suggests that the program ultimately championed by his collaborator in this book, David Halperin, focused on circumcision, partner reduction and changes in sexual behaviour, would be more effective in African nations: "What existed in Africa’s AIDS Belt, and in only a couple of other places on earth, was a “lethal cocktail” of extensive heterosexual networks and low circumcision rates. Changing either factor, on a broad enough level, could cause the pace of new infections to slow dramatically."
While Timberg deplores the imposition of Western ideas of how to fight the spread of the disease on African cultures, he does not ignore the mistakes made by African governments - often prompted by a desire to refute Western perceptions of Africans as promiscuous, primitive, and sexually over-active, or by resistance to conditions attached to money intended to help prevent the rising number if new infections and treat those already infected.
It is an interesting book, and one that tries to look at the ways in which Western imperialism and ignorance have affected the path of the disease in Africa. I find myself wishing, though, for a book that covers similar ground written by an African.