|
|
Book Review
AIDS in Asia: A Continent
in Peril
Susan S. Hunter
Palgrave Macmillan, New York, 2005
ISBN: 1403967741
Pages: 288; Price: US $30.00
Suggested
citation for this article
Susan Hunter's book, AIDS in Asia: A Continent in Peril, tackles an important
subject. The subheading leaves no doubt that this volume belongs squarely
in the "next wave" school—Africa has been devastated by the
AIDS epidemic, and Asia must be next. Hunter's book paints a picture of
a continent about to be engulfed in social, economic, and political chaos,
all because of 1 small retrovirus.
Unfortunately, Hunter presents no data that support this hypothesis.
Her chapter on the epidemiology of HIV in Asia, The Looming Mushroom Clouds
of Infection, relies heavily on a single report by Nicholas Eberstadt,
a demographer and foreign policy analyst who has little experience in
the modeling of sexually transmitted and infectious disease. She draws
occasionally on advocacy reports by other international organizations
such as The Joint United Nations Programme on HIV/AIDS. The book is poorly
referenced and shows no evidence that Hunter has attempted to examine
surveillance data (much of which is in public domain) or other original
data sources. For example, she provides no source for the claim that "HIV…
typically infects 50%–90% of a developing country's sex workers."
Five years of systematic review of primary surveillance data from thousands
of sentinel sites throughout Asia has shown only 1 site with rates >50%
among sex workers, Mumbai in India. Virtually all the sex worker sites
in the Philippines, Indonesia, China, Bangladesh, Pakistan, the most populous
countries in the region other than India, report prevalence rates <5%.
The book is consistently structured. Each chapter begins with conversations
between the downtrodden victims of the HIV epidemic in Asia, persons whose
clothing, gestures, and thoughts Hunter describes in heart-rending detail,
although they are not, in fact, real persons. Next comes a homily based
on the life of Emily Pankhurst, the 19th century English feminist whose
relevance to the current HIV epidemic in Asia is uncertain. Then comes
a bit of Asian history, a nicely written précis of the Mongol advance
or the opium wars, for example, and some observations on historical and
cultural injustices of life, injustices that ultimately lead people to
have unprotected sex or share needles. Each chapter closes with an apocalyptic
statement, along the lines of "More and more countries in Asia are
teetering on the brink of a violent explosion… and the outcome may be
an epidemic the likes of which has never been seen in world history."
Hunter may perhaps be forgiven for absorbing the alarmist tone of the
advocacy reports she has read, but more attention to the facts would show
that this sort of doom mongering is contradicted by every reliable measure
of HIV prevalence and sexual behavior in Asia. These data suggest that
in Asia (as in the industrial world), HIV will largely be confined to
populations with well-defined risk of exposure to the virus. Hunter is
absolutely correct in taking Asian governments to task for not doing enough
to confront HIV. However, suggesting that HIV is an impending catastrophe
that requires turning Asian societies upside down is unhelpful and outdated.
This may be true in Africa, where Hunter has more experience, but had
she looked beyond the hype at any real data, Hunter would have found that
HIV infection does not, in fact, threaten to engulf Asia in social and
economic chaos. It is a relatively well-contained infectious disease that,
for prevention and control, requires clean needles, condoms, lubricant,
screening for sexually transmitted infections, and treatment for a small
proportion of the population. Those goals can, and should, be achieved
shortly.
Elizabeth Pisani*
*London School of Hygiene and Tropical Medicine, London, United Kingdom
Suggested citation
for this article:
Pisani E. AIDS in Asia:
a continent in peril [book review]. Emerg Infect Dis [serial on the Internet].
2006 Apr [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no04/06-0013.htm
|
