IJE Advance Access originally published online on May 9, 2006
International Journal of Epidemiology 2006 35(4):1106; doi:10.1093/ije/dyl086
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Book Reviews |
HIV/AIDS in South Africa. SS Abdool Karim, Q Abdool Karim. Cambridge University Press, September 2005, £35. ISBN 0521616298
E-mail: aboulle{at}phfm.uct.ac.za
Given the disproportionate burden faced by South Africa and countries in southern Africa, in particular as a consequence of HIV, a comprehensive text written by scientists from the region, discussing the epidemic through a local lens, is to be welcomed.
HIV/AIDS in South Africa is an edited collection spanning 36 chapters divided into seven sections: The evolving HIV epidemic; The virus, the human host and their interactions; HIV risk factors and prevention strategies; Focal groups for understanding the HIV epidemic; The impact of AIDS; Treating HIV; and, What does the future hold?
Any attempt to organize material covering aspects of HIV that include epidemiology, basic sciences, clinical sciences, behavioural sciences, economics, ethics, and politics is bound to involve some compromise. The choices made in this collection are for the most part sensible and provide overall coherency. Readers with a particular disciplinary focus will, however, find themselves having to access various sections of the book.
Epidemiologists, for example, will be most interested in section 1, where chapters 3 and 4 comprehensively summarize the understanding of how the epidemic has evolved in South Africa, the range of data sources available, approaches to modelling, and estimates of prevalence and incidence. They may also find the chapter on mortality (section 4), and the one on future projections of the epidemic in South Africa (section 7), of particular interest.
The section entitled The virus, the human host and their interactions comprises 4 chapters covering the virology and immunology of HIV infection, which are clearly articulated and accessible for a general audience. The section is also appropriately focussed on understanding these issues with respect to the region and the service challenges. The chapter on diagnostics for example, considers the impact of future vaccine trials on current HIV diagnostic methods.
The third section covers risk factors and prevention strategies, and begins with a very succinct and well-formulated overview chapter and theoretical framework, followed by more in-depth chapters on specific interventions or risk factors such as promotion of barrier prevention methods, prevention of mother-to-child transmission, treatment of sexually transmitted infections, safe blood supplies, and intravenous drug use. Two important intervention areas not covered in-depth in this section, other than in the initial chapter, are voluntary counselling and testing, and information, education, and communication initiatives, which detract from the sections ability to reflect a comprehensive review of prevention interventions. The section concludes with a look to the future, with a chapter discussing vaccines, microbicides, the role of antiretrovirals in reducing transmission, treatment of herpes simplex virus, and circumcision.
The fourth section of the book deals with specific focal groups, such as women, youth, commercial sex workers, migrants, and young men. It is here that the material is the least structured and the depth most variable, as the entire gambit of risk factors and interventions apply to almost each of these groups which themselves are overlapping in places. An overarching framework for considering the epidemiological significance of these groups is absent.
The fifth section considers the impact of HIV, spanning a personal account of living with HIV through to a discussion on the impact of HIV on democracy. In between are chapters on mortality (see above), the impact of HIV on the health care system, economic impacts, and the impact on the community (including a discussion on orphans and vulnerable children, which could have presented more data). There is also a chapter on ethics termed ‘impact on ethics’. Readers with a political, ethics, or human rights interest would find chapters in this section (ethics and impact on democracy), as well as in the subsequent section on treatment, where a chapter on the political context of HIV treatment has many overlapping themes. These topics may have benefited from being grouped separately with a more explicit focus.
The section on treating HIV (section 6) mostly succeeds in discussing key clinical areas, without reproducing clinical texts or guidelines. Chapters on the prevention of opportunistic infections, nutritional interventions, antiretroviral therapy, and TB/HIV are appropriately chosen, and the authors are all well placed to reflect on the unique challenges in the context. Two chapters deal with the health system challenges, one from a general perspective covering both health system issues and clinical issues and one from a medicine management perspective.
The final section looks to the future, including the modelling discussed above and a sensitively worded contribution from the editors expressing their cautious optimism for the future of intervention efforts for HIV in South Africa, and their belief in the need for greater political and national will.
This book is a wonderful resource for anyone working in global HIV, or within the region, and testament to the wealth of experience and expertise accumulated through the course of the epidemic in South Africa. Chapters vary in quality and depth, but many are comprehensive and contained and will serve well as reference and teaching texts. It is inevitable that the early sections dealing with the evolution of the epidemic and the basic sciences are more structured than those dealing with prevention, impact, and treatment. Overall though, the collection is appropriately focussed on the major issues and interventions in the region where HIV is most devastating. Highly recommended.
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