Sexually Transmitted Diseases:
Muula, Adamson S. MB BS, MPH
Department of Community Health; University of Malawi, College of Medicine; Blantyre, Malawi; Department of Epidemiology; School of Public Health; University of North Carolina at Chapel Hill; Chapel Hill, North Carolina
Ethics & AIDS in Africa
Von Niekerk, Anton, and Kopelman, Lorreta M. (2005) Walnut Creek (CA): Left Coast Press. 232 pp. $24.95.
Ethics & AIDS in Africa, a book edited by Anton Van Niekerk and Loretta M. Kopelman, presents many of the ethical challenges associated with HIV in diverse settings in Africa and globally. Unlike other multiauthored books that pull in different directions so as to leave the reader eventually confused, the editors of Ethics & AIDS in Africa did a commendable job producing a coherent book. The reader does not have to read several chapters before understanding clearly that 1) HIV is a global problem, 2) Africa has been severely hit, 3) inequities fuel the epidemic by facilitating transmission and denying people care and support, 4) reducing the incidence of infection is a global responsibility, and that 5) a biomedical approach is inadequate to reduce the spread of HIV and deal with its consequences.
In chapter 6, Van Nierkerk discusses the Rawlsian theory of justice and argued how the Law of Peoples could be used to better understand the ethical complexities involved in dealing with HIV. The author does not just refer to the Law of Peoples, but also identifies their shortcomings and suggests modifications. This certainly comes in handy because the HIV pandemic can hardly be dealt with successfully without emphasizing the responsibility of all humankind.
Chapter 11 is an interesting presentation in which the “Western approach” to problem-solving is contrasted to the “African approach.” Although the extent to which this “African approach” can be said to be pan-African or not, it is of interest that the author suggests that in traditional African society, traditional healthcare services are or were not for commercial gain. This may have shaped the discourse on antiretroviral therapy in which activists, especially in Africa, have challenged multinational pharmaceutical firms that hold patent rights to life-serving medications. The book, however, does not take a naïve outlook by suggesting that “big pharma” is the adversary, but rather suggests that humankind, including pharma, African and the global stakeholders, should all work together to contain the HIV problem.
The editors have presented an assessment of mainly South Africa, less so of southern Africa, very little of West Africa, and almost nothing about North Africa. Much of the data are from South Africa, and the solution of compulsory licensing to ameliorate antiretroviral shortages will probably directly work for a few (middle-income) African countries. In the short to medium term, most African countries may rather have parallel importation of drugs because the capacity to manufacture their own high-quality medicines does not exist.
There are some instances in which the editors overlooked a few things. Figures and tables are not always as informative as a result of labeling and choice of colors e.g., Figure 1. In chapter I, a factual error occurs when the authors wrote, “HIV is unique in that it is the only disease where prevalence is given as a percentage rather than a rate.” These minor issues aside, the book is a worthwhile read.
The ethics in global trade regimes, vaccine development, vertical HIV transmission, responsibilities of states and communities both in Africa and outside, and intellectual property rights are important situations which the book calls for reexamination with an “ethics lens.”
Adamson S. Muula, MB BS, MPH
Department of Community Health
University of Malawi, College of Medicine
Department of Epidemiology
School of Public Health
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina