Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It

by Craig Timberg, Daniel Halperin

Overview

In this groundbreaking narrative, longtime Washington Post reporter Craig Timberg and award-winning AIDS researcher Daniel Halperin tell the surprising story of how Western colonial powers unwittingly sparked the AIDS epidemic and then fanned its rise. Drawing on remarkable new science, Tinderbox overturns the conventional wisdom on the origins of this deadly pandemic and the best ways to fight it today.

Recent genetic studies have traced the birth of HIV to the forbidding equatorial forests of Cameroon, where chimpanzees carried the virus for millennia without causing a major outbreak in humans. During the Scramble for Africa, colonial companies blazed new routes through the jungle in search of rubber and other riches, sending African porters into remote regions rarely traveled before. It was here that humans first contracted the strain of HIV that would eventually cause 99 percent of AIDS deaths around the world.

Western powers were key actors in turning a localized outbreak into a sprawling epidemic as bustling new trade routes, modern colonial cities, and the rise of prostitution sped the virus across Africa. Christian missionaries campaigned to suppress polygamy, but left in its place fractured sexual cultures that proved uncommonly vulnerable to HIV.  Equally devastating was the gradual loss of the African ritual of male circumcision, which recent studies have shown offers significant protection against infection.

Timberg and Halperin argue that the same Western hubris that marked the colonial era has hamstrung the effort to fight HIV. From the United Nations AIDS program to the Bush administration's historic relief campaign, global health officials have favored well-meaning Western approaches--abstinence campaigns, condom promotion, HIV testing--that have proven ineffective in slowing the epidemic in Africa. Meanwhile they have overlooked homegrown African initiatives aimed squarely at the behaviors spreading the virus. 

In a riveting narrative that stretches from colonial Leopoldville to 1980s San Francisco to South Africa today, Tinderbox reveals how human hands unleashed this epidemic and can now overcome it, if only we learn the lessons of the past.

Product Details

ISBN-13:	9781101560617
Publisher:	Penguin Publishing Group
Publication date:	03/01/2012
Sold by:	Penguin Group
Format:	eBook
Pages:	432
File size:	3 MB

About the Author

Craig Timberg is the former Johannesburg bureau chief for The Washington Post. From his position, he visited twenty-three African nations  and penned dozens of major stories about AIDS. He is now The Washington Post's deputy national security editor.
Daniel Halperin, PhD, is an epidemiologist and medical anthropologist at the University of North Carolina, Chapel Hill and has taught at Harvard and the University of California, Berkeley. He was a top technical adviser in the US government's PEPFAR program to combat AIDS.

Table of Contents

Prologue 1

Book I Silent Spread

1 Francistown 13

2 Searching for the Beginning 23

3 One Tiny Speck of Truth 30

4 A Tale of Two Viruses 37

5 The Lion and Dr. Livingstone 42

6 Femmes Vivant Théoriquement Seules 53

7 The Gift 61

8 The Big Bang 67

Book II An Epidemic of Politics

9 Americanizing AIDS 77

10 It Can't Be Here Already! 85

11 Attention na SIDA 92

12 You Won't Believe 100

13 Fear Worked 109

14 Born in Africa 119

15 The Condom Code 126

16 The Beat-up 136

17 Things Just Fell Apart 152

Book III The Humbling

18 X Factor 169

19 The Interests of the ANC 181

20 Poverty Trap 192

21 A, B, and C 198

22 On the Jericho Road 206

23 Gordon and Thandi 213

24 A Marshall Plan for Botswana 224

25 What Shall We Do? 234

26 Raymond the Great 243

27 Makhwapheni Uyabulala 256

28 The Flood 263

29 Mother and Son 272

30 What Shall We Do? Part II 280

Epilogue 297

Appendix: How the AIDS Epidemic Can Be Overcome 305

Acknowledgments 318

Notes 321

References to the Appendix 388

Additional Suggested Readings 403

Index 406

What People are Saying About This

From the Publisher

"A remarkable volume. With rare clarity, Tinderbox lays bare the origins of the AIDS virus, and then reveals the often hapless and delinquent responses of the international community. It's a fascinating read: relentlessly honest, sometimes scathing, alway principled."
    —Stephen Lewis, Founder/Director of AIDS-Free World, Former UN Special Envoy on AIDS in Africa

"Remarkable...reads like a detective novel."—The New Yorker

“Gripping … buy the book.”—The Nation

"A strong warning to those who would disregard the cultural specificities of those one is trying to serve."—The New York Times (EDITORS CHOICE)

"Tinderbox will help readers understand...why the period ahead is so critical in fighting the epidemic. Millions of lives depend on the effort."—The Washington Post

“In addition to a useful history of the disease, Timberg and Halperin examine how to confront it and develop more effective ways to fight it…[Timberg and Halpern] present a forceful case with which future students of HIV and AIDS will have to reckon.”—Kirkus (STARRED REVIEW)

“Insightful.”—Salon

 “Essential for understanding a relentlessly urgent issue.”—Library Journal

“An essential and engrossing read, Timberg and Halperin’s sweeping work covers AIDS from its origins…to its impact on the world today…Extensively researched, eminently readable and accessible, Timberg and Halperin’s work is a notable and invaluable addition to the AIDS canon.”—Booklist (STARRED REVIEW)

"Tinderbox is an unusually compelling and informative account of how the AIDS epidemic has affected the world, particularly the peoples of Africa. In a compassionate and engaging manner, Timberg and Halperin bring to life the story from its beginnings to the most recent evidence on how to effectively prevent further tragedy."
—Jay Levy, M.D., director, Laboratory for Tumor and AIDS Virus Research, University of California, San Francisco

"Craig Timberg and Daniel Halperin have written a searing book about the AIDS epidemic. Tinderbox is an indictment of Western ineptitude and meddling and lost opportunities to prevent millions of infections and deaths. But it also contains valuable prescriptions for making changemdash;and it's an important read for anyone who cares about Africa."
—Stephanie Nolen, author of 28: Stories of AIDS in Africa

"Timberg and Halperin have been challenging conventional wisdom (and behavior change skeptics like me) for years. Their book is entertaining, thought-provoking, human, and in the end, hopeful for a continent that craves some answers after two decades of HIV prevention failures."
—Francois Venter, M.D., president, Southern African HIV Clinicians Society

"Randy Shilts's And the Band Played On was the first—and for decades the best—book on AIDS. Craig Timberg and Daniel Halperin's Tinderbox is every bit as good, revealing the same denial, the same story of politics trumping science, and the same tragedy. This time, it is about the whole world, not just San Francisco. Read it!"
—Malcolm Potts, M.D., author of The AIDS Reader and Ever Since Adam and Eve

"The sometimes glorious, often tragic constellation of science, politics, and personalities in the fight against AIDS comes to life in the masterful storytelling of an energetic journalist and a passionate scientist."
—Arthur Allen, author of Vaccine: The Controversial Story of Medicine's Greatest Lifesaver

"An excellent read. Tinderbox brilliantly outlines the successes, failures, and missed opportunities in the battle of HIV prevention over the last thirty years."
—Elly Katabira, M.D., president, International AIDS Society

Editorial Reviews

This absorbing interdisciplinary study of HIV/AIDS explores how the West inadvertently unleashed the AIDS epidemic and then failed to combat it effectively, especially in the most vulnerable regions in Africa. Drawing on the latest genetic research, Washington Post reporter Timberg and Harvard epidemiologist and medical anthropologist Halperin trace the disease’s origins in the Cameroonian jungle, where HIV’s transmission from chimps to humans coincided with the rapacious period of colonial expansion as the quest for rubber sap and ivory created new transportation networks (porter paths, steamship lines, airstrips, and highways), along which the disease traveled, and a large, hectic colonial city (Leopoldville; now Kinshasa in the Democratic Republic of the Congo). Africa’s susceptibility, the authors suggest, was partly due to changing social customs. For example, Christian missionaries discouraged rituals such as male circumcision, now known to significantly reduce the spread of HIV. As the Western powers (namely the U.N. AIDS program and President George W. Bush’s initiative) poured money into combating the spread of AIDS, they favored biomedical approaches (shots, pills, HIV testing, condom promotion) and ignored potentially life-saving African initiatives, such as modifying sexual behavior and male circumcision. Highlighting the politics of AIDS, where there were powerful incentives to work within the conventional wisdom to win lucrative government contracts, this timely exposé advocates practical solutions to a seemingly intractable problem. (Mar.)

Publishers Weekly

"A remarkable volume. With rare clarity, Tinderbox lays bare the origins of the AIDS virus, and then reveals the often hapless and delinquent responses of the international community. It's a fascinating read: relentlessly honest, sometimes scathing, alway principled."
    —Stephen Lewis, Founder/Director of AIDS-Free World, Former UN Special Envoy on AIDS in Africa

"Remarkable...reads like a detective novel."—The New Yorker

“Gripping … buy the book.”—The Nation

"A strong warning to those who would disregard the cultural specificities of those one is trying to serve."—The New York Times (EDITORS CHOICE)

"Tinderbox will help readers understand...why the period ahead is so critical in fighting the epidemic. Millions of lives depend on the effort."—The Washington Post

“In addition to a useful history of the disease, Timberg and Halperin examine how to confront it and develop more effective ways to fight it…[Timberg and Halpern] present a forceful case with which future students of HIV and AIDS will have to reckon.”—Kirkus (STARRED REVIEW)

“Insightful.”—Salon

 “Essential for understanding a relentlessly urgent issue.”—Library Journal

“An essential and engrossing read, Timberg and Halperin’s sweeping work covers AIDS from its origins…to its impact on the world today…Extensively researched, eminently readable and accessible, Timberg and Halperin’s work is a notable and invaluable addition to the AIDS canon.”—Booklist (STARRED REVIEW)

"Tinderbox is an unusually compelling and informative account of how the AIDS epidemic has affected the world, particularly the peoples of Africa. In a compassionate and engaging manner, Timberg and Halperin bring to life the story from its beginnings to the most recent evidence on how to effectively prevent further tragedy."
—Jay Levy, M.D., director, Laboratory for Tumor and AIDS Virus Research, University of California, San Francisco

"Craig Timberg and Daniel Halperin have written a searing book about the AIDS epidemic. Tinderbox is an indictment of Western ineptitude and meddling and lost opportunities to prevent millions of infections and deaths. But it also contains valuable prescriptions for making changemdash;and it's an important read for anyone who cares about Africa."
—Stephanie Nolen, author of 28: Stories of AIDS in Africa

"Timberg and Halperin have been challenging conventional wisdom (and behavior change skeptics like me) for years. Their book is entertaining, thought-provoking, human, and in the end, hopeful for a continent that craves some answers after two decades of HIV prevention failures."
—Francois Venter, M.D., president, Southern African HIV Clinicians Society

"Randy Shilts's And the Band Played On was the first—and for decades the best—book on AIDS. Craig Timberg and Daniel Halperin's Tinderbox is every bit as good, revealing the same denial, the same story of politics trumping science, and the same tragedy. This time, it is about the whole world, not just San Francisco. Read it!"
—Malcolm Potts, M.D., author of The AIDS Reader and Ever Since Adam and Eve

"The sometimes glorious, often tragic constellation of science, politics, and personalities in the fight against AIDS comes to life in the masterful storytelling of an energetic journalist and a passionate scientist."
—Arthur Allen, author of Vaccine: The Controversial Story of Medicine's Greatest Lifesaver

"An excellent read. Tinderbox brilliantly outlines the successes, failures, and missed opportunities in the battle of HIV prevention over the last thirty years."
—Elly Katabira, M.D., president, International AIDS Society

From the Publisher

An essential and engrossing read, Timberg and Halperin’s sweeping work covers AIDS from its origins . . . to its impact on the world today. . . . Extensively researched, eminently readable and accessible, Timberg and Halperin’s work is a notable and invaluable addition to the AIDS canon.

Booklist

Careful scientific detective work.

The Nation

An insightful new book from a journalist and an AIDS researcher, tells the story of the epidemic from its birth in colonial Africa . . . to its status today as the object of a global public health war.

Salon.com

"Remarkable . . . well-written and thoughtful, and sometimes reads like a detective novel. The authors have clearly done important research and have brought together amazing stories, bits of history, and scientific perspectives.

The New Yorker

Remarkable...well written and thoughtful, and sometimes reads like a detective novel. The authors have clearly done important research and have brought together amazing stories, bits of history, and scientific perspectives.

New Yorker

Journalist Timberg (deputy national security editor & former Johannesburg bureau chief, Washington Post) and epidemiologist and medical anthropologist Halperin (health behavior & health education, Univ. of North Carolina, Chapel Hill) have written a first-person account of the horrific AIDS epidemic in southern Africa. Their narrative is a compassionate and persuasive argument for new approaches to AIDS prevention. The social and economic legacies of colonialism, they argue, are at the root of southern Africa's uniquely high AIDS infection rates. Christian missionaries and colonial officials discouraged indigenous polygamous and circumcision practices. The hidden heritage of polygamy results in high rates of sex outside of marriage, and areas where circumcision isn't routinely performed have AIDS rates 50 percent higher than areas where it is. Timberg and Halperin argue that dealing frankly but sensitively with these cultural issues is the key to developing workable strategies to lower the rate of new AIDS cases, which remain disturbingly high in spite of the widespread use of life-saving drugs to treat existing infections. VERDICT A compelling account of the ravages of the southern African AIDS epidemic and its heroes, villains, and missed opportunities. General readers, social scientists, and public health experts will find much to ponder.—Kathy Arsenault, St. Petersburg, FL

Library Journal

Timberg, the former Johannesburg bureau chief for the Washington Post and current deputy national security editor, and Halperin, an epidemiologist and AIDS expert at Harvard, trace the history, growth and spread of HIV and present what will in the minds of many be a controversial approach to addressing the disease. Although the subtitle sounds vaguely conspiratorial, the authors crisply chronicle the origins of AIDS from chimpanzees in West Africa and follow the perhaps shockingly slow spread of HIV across the African continent and to the rest of the world. The key factor in the spread of the disease was the expansion of European colonialism in Africa, which took a virus that otherwise may well have died off and instead created the conditions by which, decades later, it would become a scourge in many parts of the world. But European colonial-era malfeasance is not the only issue at work in this book. In addition to a useful history of the disease, Timberg and Halperin examine how to confront it and develop more effective ways to fight it. If Western imperialism is to blame for the initial proliferation of HIV/AIDS, Western arrogance and the unintended consequences of good intentions may well have prevented adequate treatment. While Western health advocates have supported abstinence campaigns and condom use, the authors argue that homegrown initiatives hold more promise than many Westerners have been willing to acknowledge, and that new research on the importance of sexual behavior and male circumcision is central to developing a coherent approach going forward. Timberg and Halperin may ruffle feathers with some of their unorthodox views, but they present a forceful case with which future students of HIV and AIDS will have to reckon.

Kirkus Reviews