In this article I will briefly review Edward Green’s book, Broken Promises, How the AIDS Establishment has Betrayed the Developing World, which details his experience researching the HIV/AIDS epidemic in Uganda, the US response to the pandemic, and the paradigm shift in the explanation for why HIV/AIDS is rampant in some African countries-and more importantly-what can be done about it.
Notwithstanding the title of the book, which sounds like a fringe conspiracy theory, Dr. Green is actually an established expert on HIV/AIDS and provides a unique point of view as a medical anthropologist with an keen eye for scientific truth above ideological orientation. He has spent a number of years in countries hard hit by HIV/AIDS, and describes himself as a liberal, though his research findings have often put him at odds with both democrats and republicans.
The overall message of the book is that concurrent sexual partnerships (or the practice of having more than one long term sexual partner), is driving the HIV/AIDS epidemic in many African countries. This idea has been explored elsewhere, such as in Helen Epstein’s excellent book, The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa, and is increasingly becoming more accepted among academicians. To tackle the problem, Green advocates for the furtherance of grass roots fidelity based prevention programs, male circumcision, and the use of antiretroviral medication for the prevention of mother to child transmission of HIV (something which he only touches on briefly in the book).
Specifically, the book discusses why the Ugandan government’s campaign against HIV/AIDS was initially successful, and why it later failed as the public health message changed under increasing western influence. While some may react with disbelief, and even anger, to Green’s conclusions, you can’t help but conclude that he has a firm grasp of the issue-and that public health campaigns which focus on decreasing multiple concurrent sexual relationships are desperately needed in certain countries.
Rather than viewing the HIV/AIDS pandemic as the natural result of a combination of sociological problems, Green explores how the everyday reality of the pandemic is hidden in a cloak of extreme liberal and conservative ideology and pervasive misinformation. Good intentions and billions of dollars are wielded by rich , yet uniformed, western donors who at times do more harm than good. He attributes this, in part, due to a lack of evidence based research on the real world effectiveness of the billions of dollars pumped into HIV/AIDS programs, and a “top to bottom” approach of administering these programs.
This book might change how you view the HIV/AIDS pandemic, and the global response, as Green argues (quite effectively) that promoting fidelity, instead of condom usage, is more effective in Uganda. While condom usage has helped stem the tide of new HIV infections among sex workers in Thailand and Cambodia, Green exposes the lack of evidence for promotion of condom usage in Africa among the general population.
Green also explains, from a scholarly anthropological vista, how misconceptions and stereotypes of cultures in Africa have negatively impacted the western approach to the pandemic on the continent.
Overall, the book was a great read and it provides some of the gritty details concerning UNAIDS, other HIV/AIDS organizations and players, and even Harvard University, which shows how the politics of the HIV/AIDS pandemic effects almost every institution involved with preventing the spread of HIV, while the science behind understanding the pandemic is often times ignored or simply unknown.
My only criticism would be that the book doesn’t specifically address the feasibility of using “test and treat”, and “treatment as prevention” approaches in Africa, but rather only briefly concludes that the use of treatment programs, before prevention programs were completely scaled up, as not being good public health practice. He postulates that the current economic recession will lead to a round of a massive number of deaths in Africa as funds for antiretroviral therapy for new patients dries up.
Overall a great read, and a must for anybody who really wants to know what is happening behind the scenes concerning the science of preventing HIV infection in Africa.
Broken Promises: How the AIDS Establishment Has Betrayed the Developing World
Edward C. Green