BOOK REVIEW: Tinderbox

Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome it
By Craig TImberg and Daniel Halperin. Penguin Press (2012).

HIV-AIDS, as it is commonly referred to in my mother’s motherland of Uganda, has certain uniform characteristics, in terms of both where it is entrenched and the behaviors and circumstances of the virus’ victims.

However, a number of those similarities are often reduced to stereotypes, rooted in aspects of human history readily ignored by the winners who have recorded that history.

Veteran Washington Post reporter, it is how author Craig Timberg connected with Daniel Halperin, former Senior HIV Prevention and Behavior Change advisor to the U.S. Agency for International Development to write this book.  Halperin himself has worn many hats as a former epidemiological and ethnographic researcher with a doctorate in medical and cultural anthropology, who still works with UNICEF, WHO and the Gates Foundation, to name a few. The pair has linked a chain of overlapping narratives that are the meat of Tinderbox, juxtaposed with the hard science that informs prevention and treatment on an international level and within the “industrial AIDS complex.”

The 2012 book details “a series of epidemics” and analyzes the role of the West in spreading AIDS, and  both the treatment and prevention of AIDS, with a special focus on sub-Saharan Africa, that part of the world hit hardest by the disease.

Timberg and Halperin discuss numerous strategies employed throughout the 30-plus year war on AIDS, specifically, a tendency to address the “epidemic as biomedical challenge” while ignoring the roles of “sex, culture, or the complex realities” the author found in Africa. The authors assert that AIDS is “not equally serious everywhere and among all communities” for numerous reasons. As such, they argue, a multitude of proven approaches must be implemented to halt its spread.

Despite the weight and the scale of the subject matter, Tinderbox is a smooth read. The book is broken up into three parts, with roughly a dozen chapters a piece that outline the umbrella narrative: “Silent Spread,” “An Epidemic of Politics,” and “The Humbling.” The reader is granted new insights into the roles of scientists from a broad spectrum of disciplines, with a new and revealing emphasis placed on the role of social scientists.

This is a work of investigative journalism, deep research, and reflective of an ample amount of footwork. The clarity of the writing is what makes the content so accessible. From the ABC-debate (Abstinence, Be Faithful, Condoms), the introduction of anti-retroviral treatments, and a disastrous attempt to prevent HIV transmission from mother to child, the story spans two hemispheres and focuses on six countries: Botswana, Kenya, Uganda, South Africa, Swaziland and Zimbabwe. In every instance, the social-political and economic consequences of AIDS are drawn in a stark, new light.

Readers will see the roles of colonialism and slavery in the global spread of AIDS, which took root in and moved outward from King Leopold’s Congo, one of the most heinous examples of rampant white supremacy in the history of the world. The impact of these two factors in dismantling the social structures, gender relationships and shifting lifestyle choices on Africans since that time is subsequently detailed. What is also noted is that, like so many things in Africa, no one cares until it becomes a problem domestically:

“The rash of new discoveries in the early 1980s” that followed the stirrings of AIDS in the U.S. “gave the illusion of an explosive new epidemic, but it was in fact medical science discovering an outbreak already decades old and now entering an aggressive new phase,” writes Timberg.

[pullquote]“The rash of new discoveries in the early 1980s” that followed the stirrings of AIDS in the U.S. “gave the illusion of an explosive new epidemic, but it was in fact medical science discovering an outbreak already decades old and now entering an aggressive new phase,” writes Timberg[/pullquote].

This is a subject area that might lose a lot of readers. Tinderbox operates on an ambitious scope, which is fully realized and up to date.

But every success, every breakthrough and every debate is likewise detailed: The major factors in what Halperin describes as the “lethal cocktail” in the African AIDS belt, “extensive sexual networks and low circumcision rates,” are called out. For example, Ugandan President Yoweri Museveni’s “zero-grazing” and the Swazi “makhwapheni uyabulala” campaigns are each given an entire chapter. Meanwhile, the western-sponsored LoveLife efforts and other questionable attempts to encourage condom use, above or instead of the A or B strategies, are revealed as utter failures. Others examples involve inaction; research supporting male circumcision, which can reduce the likelihood of HIV infection by up to 60 percent, went unheeded by the international community for almost a decade.

We see the disproportionate impact of ARV’s in the West, the roles of economics, race, paternalism and infantilism. We see Africans working to solve problems they didn’t necessarily create and continue to pay the price for, as detailed in the tragic and disturbing tale of President Mbeki and the Vicocene peddlers.  In this, we see an upstart African pharmaceutical company approach the South African government to test potentially toxic anti-retro-viral treatments called Vicocene on humans. Despite the large investment of the state, the peddlers used Mbeki’s desire to see his people triumph without the Western powers. The situation degraded into a pork-barrel scandal that hurt him politically, and burned bridges with a slew of organizations and individuals working to treat and arrest the spread of AIDS.

The authors make clear that progress comes slowly, over time,  as ideas shift, money changes hands and institutional cultures are slowly but surely altered from within. As it is with each individual, so it is with the science we create and utilize as tools to shape policy, generate profit, and/or save lives.

Tinderbox is one of those rare books that give the reader everything without taking anything away and without taking the reader for granted. I am astonished by how effectively Timberg followed the money. He examined the political self-interest of the powerbrokers, made it a point to contextualize the lifestyles and decisions of the stakeholders. He already understood how to write about other countries for Western audiences and even took a few lines to casually and earnestly address his own white privilege and “first world problems.”

Clearly, the authors would not, or could not divorce themselves or otherwise presume to stand apart from their work.

That more, so than anything else, is what makes Tinderbox so compelling; it is ultimately pan-humanist, aspirational without being altruistic and informative without being condescending.