A Continent's Challenge, A Country's Hope
Harper: 228 pp., $24.99
About halfway through "Our Kind of People: A Continent's Challenge, A Country's Hope," a stunning inquiry into the AIDS crisis in sub-Saharan Africa, Uzodinma Iweala makes the thrust of his investigation clear.
"I found his words interesting," he writes of a Nigerian politician who blames the disease's spread on long-distance truckers and rest-stop sex workers, "because they seemed to externalize both the epidemic and its primary means of transmission — sex. By focusing on these groups of people that Nigerians traditionally consider promiscuous or of lax morality, he seemed to suggest that normal people with normal monogamous sexual relationships exist outside the reach of the virus. Or, as one woman I interviewed, who had recently graduated from college, put it: 'Everybody wants to believe that they're very good and they're too clean for all of that; that people that die of AIDS or have HIV are dirty people, people that sleep around or do rubbish and stuff, not our kind of people.'"
There you have it, not just the source of Iweala's title, but also the challenge that AIDS provokes. From the start, it has come with an agenda, "understood," to borrow a phrase from Susan Sontag, "as a disease not only of sexual excess but of perversity." For Iweala, Sontag's observation offers a vivid lens on AIDS as both medical and cultural condition, a source of physical and spiritual despair.
"The disease," he notes, "is … seen as a commentary on a person's moral standing. As one doctor I spoke with briefly about HIV put it, 'Whenever people see you, they say, "Oh! Here is a sinner — somebody must have gone and done something really bad." ' "
And later: "If to be open about one's status is to don a set of scarlet letters that says 'not one of us,' not human, then it is understandable why so many would remain silent about or ignorant of their status. The more the virus spreads, the more people die, and the stronger the stigma grows."
That's an important point because, for all that medical advances have helped make AIDS something of a chronic condition for some in the West, it remains a killer in Africa.
"[W]hat does it mean to say," Iweala asks, "that 33.4 million people in the world are HIV positive and 28.2 million of those in sub-Saharan Africa? What does it mean to say that 1.8 million people in Africa died last year as a result of the virus and its effects?" This is more than just a health-care issue, he goes on to argue, but one with implications for the economy and social polity.
"Countries affected by HIV/AIDS deaths," he writes, "face a declining workforce, which can translate into a drastic drop in productive capacity. Household incomes drop dramatically when working members of a family die from HIV/AIDS. Most alarmingly, when adults die from HIV/AIDS, they leave behind children, orphans, who will likely have decreased access to nutrition, educational opportunities, and other economic advantages that would make them productive members of society.… Death from HIV/AIDS comes to mean a loss of opportunity, not just for those who die, but for those they leave behind."
What Iweala evokes is the human cost of AIDS, and this is where "Our Kind of People" excels. A fiction writer as well as a physician — his novel "Beasts of No Nation" won a 2005 Los Angeles Times Book Prize — he is adept at making the numbers personal through a series of character portraits, primarily from his native Nigeria, where 3 million people live with the disease. This is a key idea, that of living with the disease, especially in a country where religious and cultural pressures have made AIDS difficult to talk about.
In that sense, Iweala's focus on narrative, on sharing the voices and experiences of his subjects, becomes an act of redemption, a way to dignify the struggle of activists and survivors, not to mention those who have died. "You know this story," he writes in the first chapter. "You have heard it many times. This is the story of HIV/AIDS in Africa.… Or is it?" The point is that only through stories will we ever understand or, more essentially, question our preconceptions about AIDS and what it means.
That brings us back to the Nigerian politician and his argument that AIDS is a disease of truckers and sex workers when in fact it affects everyone. It also allows Iweala to address certain stereotypes that give us permission in his view to explain away the disease. "For some both on and off the continent, the presence of HIV/AIDS in Africa confirms that there is indeed something untoward about the way Africans approach sex," he reflects, before recalling an encounter with a woman who asked, "Isn't HIV the disease that started because someone in Africa had sex with a monkey?"
It's a ridiculous question, but Iweala pushes us to reckon with its ramifications, citing a report by medical anthropologist Daniel Hrdy that compares "promiscuity as a risk factor" in African society with the "promiscuous behavior" of (yes) a species of monkeys known as vervets. "We are left to conclude," Iweala suggests, with no small trace of irony, "that even if HIV/AIDS isn't the result of some African having sex with a monkey, it has certainly spread because Africans were having sex like monkeys."
Such pointed commentary appears throughout "Our Kind of People," infusing the book with an insider's edge. Yet Iweala is also clear about his status as an outsider — as much because of his privilege as because he does not have HIV. These parallel strands come together when he visits a brothel to interview a pair of female sex workers. "How many men do you see in a day?" he asks, only to be brought up short when one of the women responds, "Why do you ask?… There is no need of that." Her reaction provokes an act of soul-searching as compelling as it is unexpected, as Iweala is driven to question his assumptions about the disease.
"Why did I ask?" he wonders. "[I]f I am honest … [i]t is the same sentiment that caused the politician to associate HIV/AIDS with the sexual practices of prostitutes and truck drivers. It is the same sentiment that initially led some to look at the scope of the HIV/AIDS epidemic in Africa and suggest that … Africans must be more promiscuous and perverse than the general population." Here, Iweala turns the tables on himself by highlighting his complicity in the crisis — a complicity that can't help but implicate all of us as well.