Living with AIDS in Africa

For US-born journalist Nicole Itano, Athens must seem a very quiet place. When the 30-year-old moved to the Greek capital two years ago, to cover the Balkans, she had just finished a five-year stint reporting on disease and conflict in Africa. During this period, Itano observed how that huge continent has been crippled by abject poverty, political corruption and disease. But it was the devastating impact of AIDS – particularly on women – that compelled her to write a book about an epidemic that is still wreaking havoc in Africa despite years of campaigning and scientific progress. «No Place Left to Bury the Dead: Denial, Despair and Hope in the African AIDS Pandemic» – released in Greece yesterday by Atria Books – tackles a difficult subject in an engaging narrative that is truly enlightening to those whose knowledge of AIDS is limited to the impact of the disease on Western societies. Itano weaves the stories of three African women and their families with a comprehensive analysis of the political and social environment within which the AIDS pandemic has flourished. But it is the individuals behind the staggering statistics – some 25 million in Africa are HIV positive – that Itano wanted to highlight. «I wanted to get under the surface and show that the people grappling with this epidemic are real people, just like us, trying to live their lives in difficult circumstances,» Itano told Kathimerini English Edition. These personal stories unfold against a historical backdrop that explains the tribulations of three African nations in which the different families live. The book also examines the emergence and spread of AIDS and the myths that have been spun around it. And it assesses the benefits of treatment using antiretroviral (ARV) drugs (which curb the spread of the virus in the body) and the barriers to treatment that still exist in many African countries. But the most compelling aspect of the book – and that which distinguishes it from other works on the same subject – is its personal insight, drawn from the three families. The reader enters their worlds as Itano eats with them, sleeps at their homes, and accompanies them on trips to hospitals, schools and public offices. Itano relates their reactions to diagnosis, the way they break the news to their families, the physical transformation they undergo with treatment and their fear of the stigma attached to AIDS in their close-knit communities. Poverty is an ever-present problem, undermining their attempts to get well. One woman quits her medicine as she can no longer afford it. «Charlotte had to decide between food and medicine, so she stopped taking her drugs.» Another woman, Seeletso, keeps running away, leaving her severely disabled – and HIV positive – young son with her family. «The urge to escape sometimes overpowered the will to live.» The stark reality of these people’s situation, their lack of choice, is brought home to the reader who identifies with Itano as the «rich Westerner» in a world of desperate poverty. Objectivity and insight Itano remarks at many points in her narrative that she was very conscious of her role as an objective observer. But spending days at a time with these families gave her an insight into the human aspect of this disease that a purely objective analysis would lack. «I knew from the very beginning that I wasn’t going to remain entirely impartial – you can’t do that over a period of a year or more when you build relationships with people,» Itano said. Often she brought food to the families on her regular visits, sometimes small gifts, abandoning traditional journalistic arguments about impartiality which «in the context of Africa… are often weak.» A bag of candles she brought to one home elicited unanticipated joy in the youngest family member. «Tonight I can study!» the adolescent boy exclaimed. «I always brought candles after that,» she remarks. Itano also offered advice to young girls about sexual protection, aware that extreme poverty often pushes them into the arms of the very men that could put their health at risk. Perhaps because of her relative closeness in age to the women she observes, Itano draws reactions that an older, more actively impartial, writer would not elicit. But she never crosses the line, redressing the balance when she feels her «subjects» are seeking solutions she cannot offer. The book is divided into three parts. The first part is set in Lesotho, a poor landlocked state bordering South Africa; the second is in South Africa itself, where hundreds of thousands have AIDS despite the country’s wealth; and the third is in Botswana, a small, relatively prosperous African state with a pioneering AIDS program. In all these places, abject poverty exists to a greater or lesser degree. Everywhere the poorer are both more likely to contract AIDS (as education is less accessible to them) and less likely to receive treatment (due to the cost this entails). Botswana, the first African state to offer free ARV drugs, has made great progress. But ensuring that treatment programs are maintained demands steady funding and management, Itano observes. The book highlights instances of mismanagement of funds – mostly by action groups whose members were tempted by the large sums with which they were entrusted. In South Africa, the authorities’ mistrust about the impact of ARV drugs led to delays in making them readily available to AIDS sufferers, which resulted in the loss of countless lives, Itano points out. Authorities have since made progress but much still needs to be done. The book ends on a note of hope, mixed with apprehension. «Although treatment hadn’t suddenly swept away the silence and fear, it was saving lives,» Itano says after a final visit to Botswana, noting that the number of youngsters’ funerals had plummeted. Five years earlier a funeral director in Durban had told her, «There’s no place left to bury the dead.» As for the women Itano studied, the news is good: All are alive and doing well. The main fear Itano expresses in her conclusion is that cash is flowing into desperately poor communities without the infrastructure to properly absorb and manage it. Institutions are needed that will ensure treatment is distributed efficiently and protect against corruption, she says. Otherwise «all the energy, effort and money expended over recent years will be wasted.» Read an excerpt from the book and learn more about the writer at

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