Medicine And Books

One New Humanity: the Challenge of AIDS

BMJ 1996; 313 doi: (Published 07 December 1996) Cite this as: BMJ 1996;313:1495
  1. Kenneth M Boyd

    Anne Bayley SPCK, £9.99, pp 330 ISBN 0 281 04923 8

    “How does a society with a history of violence, buckling under the pressure of poverty and land scarcity, react to the news that an unknown third of its members carry the virus?” In Rwanda, with a population prevalence of HIV among the highest in the world, a survey in 1992 in a military camp found that 70% of the soldiers were more afraid of HIV and AIDS than of being at war. The cumulative incidence of HIV infections in Africa (over 11 million) and increasingly in Asia (over 3 million) is far more disturbing than Western perspectives often admit.

    We may be incapable of taking on board the sheer weight of human misery—soon, for example, a new generation of orphans will lack not only parents but also grandparents. But in an increasingly interdependent world, the destabilising effects of AIDS on the economies and societies of developing countries, like the renewed threat of tuberculosis, are deeply worrying.

    Anne Bayley is a surgeon who knows about AIDS in Africa. She was there when cases began to appear, but the accumulating consequences have exceeded her worst expectations. Her book is a reasoned argument against the “dishonest mood of denial” in which communities and governments all too often shelter against the facts. But Bayley is not a prophet of doom and knows that people need something to hope for if they are to respond effectively to a crisis of these proportions. In the challenge of AIDS she glimpses possibilities beyond scientific optimism's failure to deliver a meaningful existence to most people. Because she believes in it, the language she uses to talk about this is theological. (Bayley is also an Anglican priest and her book is written as a study guide for theological students and church groups.) But the possibilities she perceives are (unlike resurgent fundamentalism) inclusive, generous, and practical.

    Much of the book is a series of accounts of how Africans have responded to the pressures of the pandemic, for example by rethinking the role of women and by small scale socioeconomic projects to recreate devastated communities. Whether this will achieve the larger goal of changing social norms and sexual behaviour sufficiently to limit the spread of HIV remains to be seen. Bailey's chaos theory hope is that “small events start chain reactions which have unpredictable and large consequences,” although these need to be helped by enlightened Western self interest, particularly in terms of debt reduction. AIDS in turn, she adds, “is helping to restore a human face to Western medical care….Doctors who reach the end of their stock of useful drugs must either walk out of the clinic in despair, or else stay and talk to their patients.”—KENNETH M BOYD, research director, Institute of Medical Ethics, Royal Infirmary, Edinburgh


    Ingenuity of design and increasing versatility in use are amply shown in Endoluminal Stenting edited by Ulrich Sigwart (Saunders, £45, ISBN 0 7020 2046 X), most of which is devoted to technology and clinical applications in vascular disease. The illustration shows a variety of coronary stents.

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