My 10 Best Reads, Book 2

The second appearance in this space is The Origin of AIDS, by Jacques Pepin. (As I’ve posted before, I’m not rolling these books out in any particular order.)

I learned of this book via a piece written by the fantastic writer on public health issues, Donald G. McNeil Jr., in the New York Times several weeks ago. It was unfortunately buried in the Science section of the paper, and has not received wide attention elsewhere.

Editors who make decisions about which books to review may have imagined that a title like this would be too technical or that as a nominally medical  subject, a book like this wouldn’t interest a broad public. That is a pity.

This relatively slim volume is an extraordinary piece of work from any number of  angles. It’s title, of course, promises to establish the origins of the HIV virus, and hence the cause of the epidemic that by now has killed an estimated 33.2 million people worldwide and left a similar number of people infected with the disease. And it must be said that the book does a brilliant job of doing just that.

As effective as Pepin’s epidemiological sleuth work is, however,  for me this was in some ways the least interesting part of the story. What made this Origins truly special, and worthy of a much broader audience than I fear it will garner, were its rich veins of colonial and post-colonial history, especially in Central Africa, where all signs point to the disease having originated.

Pepin has eschewed the narrow, stick-to-what-my discipline-taught-me-in-grad-school approach to research that is all too common among academic writers. Or perhaps it’s just that he has taken his own field, epidemiology, to its logical limits, which has meant, in this case, becoming an avid historian and social scientist along the way.

This allows him to look probingly and to fascinating effect into such varied topics as the formation of new cities in Africa, the role of the slave trade and its displacement of populations in the propagation of disease, the complex history of the origins of commercial prostitution in West and Central Africa, and the consequent proliferation of venereal diseases.

Modern prostitution, such as we recognize it, got its start in the region from European colonial policies akin to the passbook system under apartheid in South Africa. Men were recruited into the money economy in new cities and towns where the presence of women was sharply restricted. The high male to female ratio led – as always and everywhere – to the commercialization and professionalization of sex.

Even before commercial sex became an African-driven phenomenon, though, the practice had begun to take root with Europeans acting as its principal catalyst and motor. The region’s new cities all had small European minorities whose populations were overwhelmingly male, and in one way or another, they were soon buying sex and helping spread disease.

In 1909, Pepin writes, “the medical officer in charge of the Hôpital des Blancs (the Hospital for Whites) in Leopoldville (Kinshasa) complained about the deplorable moral situation, noting that more than half of the ninety European civil servants in Léo were currently being treated for syphilis.”

Perhaps most fascinating of all the book’s many rich payoffs for me is its history of European-driven public health in Central Africa. Partly out of their desire to sustain a strong workforce, European powers early on  began making substantial investments in health care delivery. Africa became the theater of much experimentation, and in a bid to keep down the costs of empire, much corner-cutting and haste.

Pepin shows how, fighting one disease after another, European colonial health officers reused the same quickly rinsed syringes on thousands of people, spreading new diseases even as they conquered or suppressed old ones. As you’ve probably already begun to suspect AIDS, tragically, became one of them.

There are fantastic little vignettes here and there, like the story of Eugène Jamot, the French colonial doctor who led an extraordinarily single-minded crusade against sleeping sickness in what is now Cameroon. In the space of 18 months in 1917-19, we learn “Jamot examined 89,743 individuals in Oubangui-Chari, diagnosing and treating traypansomiasis cases, and did all this with only three microscopes and six syringes.”

Jamot, whose famous slogan was, “I will wake up the black race,” was ultimately ousted by his jealous or resentful military and bureaucratic rivals and peers. “A free thinker, he repeatedly and publicly said that the dramatic epidemics of trypanosomiasis in Cameroun and AEF (Afrique Equatoriale Francaise) had been triggered by European colonization and the forcible displacement of large populations. This freedom of speech did not sit well with his military status. Other conservatives did not appreciate that while remaining legally married to his French wife, who never went to Africa, Jamot lived for many years with a Fulani from north Cameroon whom he married according to tribal customs and with whom he had three children.”

There are lots of little nuggets like this throughout. But as I read this particular passage, I thought that since Hollywood insists on having Western actors as the stars and centerpieces of its films staged in Africa, how much better it would be to see movies depicting complex figures like this than the hollow white savior dreck that we are usually served?

A final, more personal thought goes to my memories of writing about AIDS and other public health issues in Africa years ago. I caught hell from Helene Gayle, then of the CDC, for this piece questioning the experimental protocols being tested on HIV-positive mothers.

The Pepin book is a powerful and timely reminder of the many things done in the name of science and health in Africa, and their unforeseen and sometimes tragic consequences. It is also a reminder that one can never ask too many questions.

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