14 - Conclusion

Summary

This book began by suggesting that a history of the African HIV/Aids epidemic to 2005 could offer four valuable perspectives. One was an answer to President Mbeki's question why Africa had suffered the most terrible epidemic. The book has argued that the presence of the natural ancestor of HIV and the full range of viral subtypes in the western equatorial region of Africa is compelling reason to believe that the epidemic began there. The virus existed in the Kinshasa region by 1959 and began to take epidemic form there by the mid 1970s, perhaps as a result of the wide sexual networks and decayed socio-economic conditions of the city. For nearly ten years, and perhaps more, it remained a silent and unrecognised epidemic. During that period, subgroups of the virus were carried away from the epicentre to infect eastern, southern, and western Africa. Their impact on each region was shaped by its patterns of communications and mobility, its gender relationships and sexual networks, its disease environment and socio-economic arrangements. But in this first HIV/Aids epidemic, the virus initially established itself silently within the general heterosexual population before any steps were or could have been taken to check it. Africa had the worst epidemic because it had the first epidemic.

Second, this silent expansion was one way in which the unique character of the virus - mildly infectious, slow-acting, incurable, fatal - decisively shaped the epidemic and human responses to it. Those responses were slow, for HIV's long, asymptomatic incubation period and the eventual appearance of diverse opportunistic infections defied prompt action and fostered uncertainty and denial. Instead, people with Aids faced a slow and painful death while their families undertook a heavy burden of care and mourning. Care and death impoverished households and multiplied the orphans to whom young adults gave birth before they died. Yet slow incubation also gave people with HIV/Aids time to organise themselves for mutual aid and political action.

The third perspective has been to set the epidemic in the longer context of African history. When compared with earlier epidemics, HIV/Aids stands out chiefly by its uniqueness: more enduring than influenza, less environmentally dependent than sleeping sickness, more fatal than tuberculosis.