Compelling literary and scientific tale of life and death with HIV/Aids in Botswana

BOOK OF THE DAY: Saturday is for FuneralsBy Unity Dow and Max Essex. Harvard University Press. 218 pp. $19.95

UNITY DOW and Max Essex have written an unusual and compelling book about the human stories and science of HIV/Aids in Botswana. Dow is a judge and novelist from the south African state and Essex is a medical professor at Harvard.

In each chapter, Dow describes the experiences of people she knows in Botswana who are suffering from, or at risk of, HIV; Essex then reflects on what their cases tell us about the ways in which HIV is transmitted or can be combated. Through this lens the authors tackle many of the most important issues around the disease, such as diagnosis procedures or Aids in children.

Botswana is often held up as an African success, with the fastest rate of economic growth in the world from the 1970s to the 1990s, but it also suffers from a devastating HIV/Aids epidemic, which, it was once held, would eventually kill 85 per cent of males who were then teenagers.

The book is compelling because it tells us the real stories of people living with HIV/Aids and the devastating effects it has on families. There are stories of deadly sexual betrayal and bitterness, but also resilience, caring and kindness.

Through the life stories we get a sense of the fear that might arise while awaiting the outcome of a HIV test, for example.

This hook is then used to engage the reader and explain the science behind the disease in a generally accessible way. It is a work of both literature and science and works brilliantly.

The discussion of the search for a vaccine and how the biological structure of HIV makes this so difficult is particularly good.

Through its stories, the book also gives us a sense of some of the structural reasons for the severity of the epidemic in southern Africa, such as the extent of gender inequality and the prevalence of migration from rural to urban areas and family disruption as the economy has grown.

It is noted that one of the reasons the disease has spread more rapidly in southern Africa than elsewhere is that some people practise sexual concurrency – having more than one sexual relationship at a time – creating a network for the disease to spread.

However, the economic motivations behind this are not explored.

Despite appearing relatively rich when looking just at average income, Botswana is highly unequal and much of the population suffers from acute poverty. Poverty means people’s immune systems are already compromised, making them much more likely to contract HIV, and also pushes them, women in particular, to engage in risky sexual behaviours for money or gifts.

Concurrency is, partially at least, an outcome of gender power and income inequalities, and the capacity for people lacking power to engage in “behaviour change” is limited.

The other area where the book is silent is in relation to some of the controversies surrounding HIV/Aids. For example the authors note that some of the vaccine trials in Africa actually increased the likelihood of people contracting HIV. Would we tolerate such trials in Europe?

The book gets us to reflect on the fragility of life. One grandmother notes: “When you see a pregnant girl, you wonder, is she carrying death or a child?”

We learn that a single HIV can reproduce itself more than a billion times a day, in contrast to our limited ability to reproduce.

The message of the book is hopeful, though, as it shows how the government of Botswana, with external assistance, is tackling the disease with vigour and determination.

As a former president of Botswana once said, it is a fight for that country’s survival.

Pádraig Carmody teaches human geography and co-ordinates the TCD-UCD master’s in development practice at Trinity College Dublin. His book, Globalization in Africa: Recolonization or Renaissance? is published by Lynne Rienner this month.