The Yale Journal for Humanities in Medicine

Book Review

Ethics and AIDS in Africa. The Challenge to Our Thinking.
Eds. A.A. Van Niekerk & L.M. Kopelman.
Left Coast Press, 2006.
Paper $24.95.
Reviewed by Howard Spiro (howard.spiro@yale.edu).

The pandemic of AIDS in Africa has raised a myriad of political, economic, and ethical discussions, and it is the last of these that this excellent book addresses, over and over again. In essence, it is a gloss - a long amplification really - on John Rawls’ theory of justice. But where Rawls focused largely on individual societies, the writers here raise considerations of global equity.

A compendium of 13 chapters, mainly by observers and academics from Africa, (one of the editors, Loretta Kopelman, is the Chair of Medical Humanities at East Carolina University), the book provides reasons why globalization has become such a universal issue. Everybody seems to be going for it, from the high school that sent my 16 year old grand-daughter to South Africa in a work-study program, to the university that I worked at for so long, which has set its sights on becoming a global school rather than simply an American “backwater,” an ambition true of its Ivy League rivals as well. Most college students are urged to spend a term overseas nowadays, and one hopes it will influence the career choices of our grandchildren.

“Globalization” often seems to center around money and prestige, but the essays here made me understand that it should be about altruism just as much as equalization of economic resources. In essence, readers are asked to wonder why we can be so rich and comfortable in North America and in Europe, and yet allow the tragedies of Africa -- and I include Dafur as a man-made chaos -- to escape a lot of personal attention. The pharmaceutical companies have been criticized for the pricing of AIDS drugs, and respectful attention/coercion has much improved that crisis. Another issue also involves drug-testing. Do physicians and investigators owe the countries where experimental studies are carried out, the duty to provide preferential treatment with those drugs tested and proven effective there? Since this book was written, the Gates Foundation has done much to answer these questions, but the American public certainly does not talk about Africans the way mothers in my time warned about the “starving Armenians.”

The book recounts well-known details, and it would have been great if the editors had been able to excise duplicated data. But one sympathizes with the difficulty editors have in persuading contributors to submit on time.

Nevertheless, in focusing on ethical issues in AIDS, this volume seems unique. I learned much from it and recommend it to you readers of this journal about humanities in medicine. The last chapter by Kopelman, "If HIV/AIDS is punishment, who is Bad?" should be read by all.

Published: December 6, 2006