Our Kind of People (Link to Amazon)
by Uzodinma Iweala
In “Our Kind of People,” Uzodinma Iweala takes a hard look at current attitudes and approaches towards the African AIDS epidemic, and he identifies some disturbing truths as well as some promising approaches. It’s an important book.
According to Iweala, rather than tossing drugs and condoms at the problem or swooping in at the last minute to rescue orphaned children, we should be focusing on treating the epidemic as part of larger societal problems, especially poverty and abandonment. He argues, quite persuasively, that much of the West’s approach to African AIDS is tainted by an essentially racist (my word, not his) approach that regards Africans, and especially Africans living with HIV/AIDS, as both Other and lost.
Back when I was really keeping up with AIDS issues (it is, after all, a fascinating disease), far too many people in the back corridors of power in the fields of public health and global politics and money were whispering, “Africa is lost.” The argument generally went: (a) African sexual practices are spreading HIV/AIDS more rapidly than anywhere else in the world, (b) too many Africans are already infected, (c) even if we pour drugs into Africa for those with HIV/AIDS, the rate of infection is already so high that the rate can’t be reduced, (d) no matter how many condoms are available, most Africans won’t use them, (e) drugs are the only way to slow the rate of infection, and (f) there’s not enough time or money to save those with full-blown AIDS, let alone treat those who are only, as yet, HIV-positive.
“Our Kind of People” (from the phrase “Our kind of people don’t get AIDS”), argues that,in fact, Africa is not lost. Iweala suggests a different way of approaching the problem, one aimed at stabilizing entire communities, reducing the rate of infection through community-building and education, and focusing more than we currently are on treating those who are HIV-positive. After all, treatment for “positive people” can reduce the rate of infection by itself by reducing the individual’s viral load, thereby reducing the ability of the virus to spread.
Providing assistance to positive people, Iweala argues, helps to stabilize the community by enabling them to return to health and work. It is widely agreed that AIDS is a disease of poverty (not exclusively, but to a great extent). Therefore, getting people back to work strengthens the work force and reduces dependency on already strapped resources for support. The goal, he suggests, should be three-fold: treating those who already have full-blown AIDS, providing anti-retroviral drugs for those who are HIV-positive, and reducing the spread of infection through community action and education. In places in Nigeria (the central focus of the book) where such a three-pronged approach has been implemented, infection rates have already begun to drop, making his position hard to argue with.
Iweala’s focus on treatment for those who are HIV-positive raises some issues that some may not want to discuss: treating people who are not already ill with full-blown AIDS. As he says: “People from Nigeria and abroad don’t want to hear that their donations and aid work are going to support another person’s ability to do the things we all have to do, but this should be our goal in the struggle with HIV/AIDS: to mitigate its impact so that lives become livable again.” Those who argue against this approach explain that, after all, there is only so much money, only so many drugs, only so many doses.
Much of the difficulty the West has in dealing with the African AIDS crisis, Iweala argues, stems from centuries-old prejudices against Africans as Other. Their lives are different, their sexual practices are different and perverted, and they’re too uneducated to be able to appreciate all the wonderful things white people want to do for them. Iweala provides some excellent discussions of the world’s attitudes towards Africans, especially Westerners’ attitudes toward African sexuality. In fact, he has an entire chapter titled simply “Sex.” He references sources back to Joseph Conrad and earlier that describe African “otherness.” At the same time, at least some of the antipathy towards treating HIV-positive people stems from the kind of deer-in-the-headlights blindness caused by the extent of the suffering and death. Overwhelmed by the catastrophe, our instinct is to focus on helping the sick and dying, an approach, unfortunately, which does not focus on reducing the rate of infection or stabilizing local economies.
So where do we go from here? Iweala’s primary argument is that we need to “humanize” the epidemic in Africa. Rather than treating the continent as “lost,” we need to focus on eliminating the stigma of HIV/AIDS by, among other tactics, talking about it. Back when AIDS was considered the “gay plague,” almost no one in America wanted to talk about it. And, yes, I do remember those days. If you don’t, read Randy Shilts’s brilliant history of the first years of the epidemic, And the Band Played On: Politics, People, and the AIDS Epidemic, 20th-Anniversary Edition.* Once people started talking about the problem (especially when non-gay people realized it wasn’t just a gay disease), infection rates started to fall. Iweala’s chapter, “Speaking of AIDS,” focuses on the difficulties of getting Africans to talk about AIDS, as talking about AIDS inevitably means talking about sex, not a popular topic of polite conversation in Africa. Gosh, sort of like America in the eighties, when the “gay plague” first began to get people’s attention.
The key to humanizing the epidemic, Iweala insists, is to remove the stigma of HIV/AIDS, treat the infected as well as the sick, and integrate those living with HIV/AIDS back into their local communities: including jobs, social supports, and medical treatments. In the chapter “Healing,” he focuses on a number of programs aimed at doing just that. His examples and the testimony from “positive people” are compelling.
“Our Kind of People” is an important book. Because it is limited to Nigeria (where the infection rate is only 4%, compared to 20% in Botswana and South Africa), it’s a short book and, thanks to Mr. Iweala’s lovely style of writing, a quick read. But don’t let its brevity fool you; there are critical lessons here. So read “Our Kind of People” and then tell everyone you know to read it, as well.
*For the science wars, see Science Fictions: A Scientific Mystery, a Massive Cover-up and the Dark Legacy of Robert Gallo. Excellent analysis of big science in action.