Intended for healthcare professionals

Reviews Book

As They See It: The Development of the African AIDS Discourse

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:783
  1. Dunstan Raphael Bishanga, final year medical student (dbishanga{at}
  1. Dar es Salaam, Tanzania

    The subject of this book is what Africans think and say about HIV and AIDS. While author Raymond Downing, a pro-African Westerner, appears to have written it for Westerners, it will interest both Africans and non-Africans with an interest in fighting the disease.

    Embedded Image

    Raymond Downing

    Adonis & Abbey Publishers, £19.95/$25, pp 179 ISBN 1 905068 07 7

    Rating: GraphicGraphicGraphicGraphic

    African voices have historically been ignored in the discourse around AIDS, which is what has prompted the author to write this book. It perhaps would have been preferable if an African had written it, but a lack of resources are a major hindrance to an African writer undertaking such a project.

    As They See It looks at AIDS from multiple African perspectives, and provides a thorough overview of the African experience, covering various countries with different socioeconomic status, different HIV prevalence, and different cultural viewpoints.

    One of the topics covered is the debate over the origin of HIV. The Western press reported that the virus originated from Africa, but some Africans question why it therefore took so long to witness the first clinical AIDS case in North America in the early 1980s. Such a discrepancy confuses African and makes them feel judged.

    Moreover, Downing indicates how HIV/AIDS statistics from Africa may be unreliable, by baseline measures or methods of statistical analysis. To illustrate this he describes how his wife received a false positive HIV diagnosis with enzyme linked immunosorbent assay (ELISA), the test mostly used in Africa. The diagnosis was later proved negative by Western blot method. Downing explains how poverty leads many Africans to live with false positives, as they cannot afford Western blot confirmation. This can destroy someone's future, as happened with one of the book's case studies, Frank, who lost a scholarship, before learning after many years that he was living with false positive HIV results.

    The book also describes how South African president Thabo Mbeki, by associating HIV and poverty, received a negative reaction from many stakeholders in Western countries. But through failing to listen to Mbeki's point and by ignoring him, appropriate ways of fighting AIDS in Africa, other than the use of antiretroviral drugs, may have been lost.

    Downing clearly illustrates how culture—such as a belief in witchcraft—is a vital component to consider when addressing HIV/AIDS. I have worked as a youth activist in Tanzania for the past five years, addressing issues on sexual health and HIV/AIDS prevention. From this, I can see how young people, for example, have their own “new culture” that is neither traditional African nor Western. In order to deal with HIV awareness, people need to understand these cultural differences and respond in consultation with local people.

    Items reviewed are rated on a 4 star scale (4=excellent)

    View Abstract