28: Stories of AIDS in Africa

The introductory maps seize your attention. "Adult prevalence of HIV /AIDS" on one page and the people represented in the "stories" on the opposite. There's a swath of dark shading across southwest Africa - that's "Over 20%". To the east, the shade is lighter - "15 - 20%", with two darker smudges labelled "Swaziland" and "Lesotho" - islands of tragedy. At the top, "5 - 15%" predominates, lower numbers hiding the intensity of conditions. Stephanie Nolen's subjects' names run across the other map - the individuals whose stories are related here. The numbers often lead to "AIDS fatigue" - too many big numbers; surpassing our ability to grasp them. The millions of people infected with HIV/AIDS seem beyond comprehension. After consulting the various estimates, Nolen surmises about 28 million for Africa, approaching the entire population of Canada. Each day, something like 5500 will die of the effects of the infection - two-thirds the population of my community. Every day. All year long. The adage runs: "One death is a tragedy, one million deaths is a statistic." Yet, that "million" represents that many "ones", and each one has a story. Nolen gives us those stories, making one person represent a million others. It's a formidable burden for the afflicted and the writer alike, but Nolen's skill effectively allows the reader to take it all in measured doses. The opening story is, appropriately, a woman. In Swaziland, women don't turn to activism. They were traditionally forbidden to wear pants until 2003 and the right to own property was only granted in 2006. The little nation has the last monarch in Africa - who has thirteen wives and a fleet of autos. Siphiwe Hlophe had borne children with a man who delayed marriage for years. The discovery that she carried the virus was devastating - it suggested she was immoral, when it was her husband who had been philandering. That situation is one of the AIDS' story social disasters. The infection carries the stigma of immorality, a view widespread throughout Africa - and the West. Traditional leaders, missionaries and even family members vilified the victims as "immoral". It was also deemed an affliction of the poor, a mistake leading to many stressful family situations. Siphiwe, transcended many of these issues by announcing her infection and launching an AIDS awareness programme. Nolen gives accounts of other activitists, including a "Miss HIV Stigma-Free". The other group most affected by the virus is children - either by being orphaned or by infection at birth. Among the former is 14-year-old Tigist Haile Michael of Addis Ababa who is the sole support for a younger brother half her age. Regine Mamba isn't an orphan. At her age, the term is meaningless. But Regine knows about orphans. When Nolen first interviewed her, Regine had 13 of them - all their parents were AIDS victims - by the book's Epilogue, the number had risen to 18. These parentless children lack education, op

Stephen Lewis, the former UN Special Envoy for AIDS in Africa, called Stephanie Nole's 28 Stories of AIDS in Africa, "the best book ever written about AIDS". I must admit that I was skeptical- how could a relatively short book of stories encapsulate this massive epidemic? By the time I'd finished the third of 28 stories, I'd changed my mind. Nolen successfully uses 28 human experiences of HIV/AIDS, gathered over years of reporting on the issue, to tackle each aspect of the pandemic: orphans, access to treatment, medical research, AIDS in conflict zones and within the military, at-risk groups such as truck drivers and sex workers, African political and international humanitarian approaches to HIV, experiences of children, women, elites, couples, families, activists, and the poorest of the poor. Her approach left me more knowledgable, and intermittently heartbroken and ready for action. The book critically examines the role of each actor in the pandemic, from international to local in the present and since the first recorded infection. It emphasizes the complexity of the crisis, most importantly its intrinsic links to poverty, as well as including a vital section on how you can help. Effectively, Nolen has written a book that provides an overview of the political, historical, cultural, and economic realities of HIV/AIDS in Africa while constantly drawing the reader back to one fundemental point: HIV/AIDS is first and foremost a human issue. She quotes Nelson Mandela (he is the main character in the 27th story), "Overcoming poverty is not a gesture of charity; it is an act of justice" (353). As someone recently embedded in the fight against HIV/AIDS (I am currently writing my undergraduate thesis on prevention programs, and have just returned from 10 months working with two grassroots HIV/AIDS organizations in Ethiopia), I would recommend this to laypeople and experts alike!

It sounds weird to say it, but I couldn't put this book down. All the stories are so compelling and so well-written. Nolen doesn't tell one story over and over, but tells many stories using very diverse people. Her courage is obvious: she hung out with a long-haul trucker, a sex worker, and people with AIDS who had only days left to live. I was especially intrigued by the stories of the infected ones who became powerful advocates. What this book left me with wasn't the sense that "these people are pathetic victims we richer folk need to help," but that these are resilient, strong, interesting human beings suffering a horrid situation with little or no resources, and we should help them help themselves. As a journalist, I'm in awe of Stephanie Nolen in every respect. As a reader, I'm compelled to respond. I highly recommend the related website, [...], where you can read about each of the 28 briefly, and see a video interview of several. The website and book both give many ideas for how you can help. Start by reading a book that could change your life.

In her book, 28 Stories of AIDS in Africa, Stephanie Nolen tells stories that stop you from totally giving up on humanity - from the tireless doctors who treat Aids patients to the campaigners who refuse to buy their own medication until it is freely available to all. In Bukavu, South Kivu, in the Democratic Republic of Congo, Christine Amisi, for example, left the safety of a UN compound to continue her work as a nurse for Doctors without Borders to ensure that her patients got supplies of drugs. Christine assisted in Doctors without Borders' anti-retroviral trials in the Democratic Republic of Congo, a country torn apart by civil war. Nolen points out that there is a very real risk of creating drug-resistant strains of HIV should patients not exercise compliance in treatment; this is one of the challenges often cited in treating AIDS in unstable countries like the Congo. And yet, what did Doctors without Borders find? Patients had, in the long term, a 97 per cent adherence rate--taking their pills correctly and on time -- which is higher than the rate at most treatment sites in North America. Only 5 per cent of them had been "lost to follow-up," that is, stopped showing up and became untraceable -- again, a number about on par with North America, and remarkable for war zone. In Bukavu Doctors without Borders provides comprehensive HIV/AIDS care with counselling, testing and treatment of opportunistic infections, as well as antiretroviral treatment (ART). Doctors without Borders has worked in the Democratic Republic of Congo since 1981. They began providing free treatment with antiretroviral drugs (ARVs) to HIV/AIDS patients in Bukavu in October 2003. In the war-afflicted east of the Democratic Republic of Congo, where people are more used to friends and relatives dying of HIV/AIDS than living with it and local health structures have no capacity to provide ARVs, this initiative marked an important step in the fight against HIV/AIDS. Dr James Orbinski, who was president of Doctors without Borders when the organisation was awarded the Nobel Peace Prize in 1999, says of Nolen's book: "Read. Weep. Rage. And above all else - like those people described in this book - find the courage to do."

There are many tragic narrative accounts of AIDS, but Stephanie Nolen's book "28: Stories of AIDS in Africa" is particularly shocking. The reader is forced to confront the real-life human consequences of: the arms trade to Africa; the patriarchal family hierarchies which deny women access to basic health care, birth control, and autonomy over their own sexuality; the unimaginable health care resource gap between the Western world and Africa; and most disturbing, the conservative fundamentalist ideology of U.S. foreign policy and faith-based charities, which prevents dissemination of live-saving accurate medical information and condoms. Nolen is effective at piercing the veil which readers inherently draw to insulate themselves from African AIDS carriers. You will meet HIV-positive mothers, grandmothers, and working parents trying to raise kids. You will meet bright, college-educated Africans who were living parallel lives and following career paths not unlike your own, until they were struck by AIDS. Some are church-going Christians, community leaders, or members of the educated elite. Readers interested in playing the 'blame game' will be hard pressed to find promiscuity or other so-called failings among most of the people depicted in the stories. Most of the victims practiced monogamy. You begin to appreciate the fact that we are HIV-negative not because we are morally or intellectually superior, but through the circumstances of fate and luck of being born in the West, which have granted us the 'privilege' of autonomy over our bodies, our sexual and reproductive health, and access to medical care and knowledge. In many ways, this book is not necessarily about AIDS, but rather about the underlying factors in Africa which facilitate its transmission and prevent its medical treatment: rape, genocide, civil war, drug patent laws, misogyny, and racism. No one can be blamed for the emergence of the HIV virus, any more than one can place blame for the emergence of killer strains of the flu. Nolen's book is a wake-up call for the role that our political, business, and church leaders have played in exacerbating the AIDS pandemic in Africa. Through our activism and lobbying, we can reduce the transmission of AIDS in Africa, and alleviate human suffering