You'd be hard-pressed, this past decade, to come up with a single book concerning HIV/Aids in the West that has had any impact or visibility at all. That vacancy misrepresents the seismic effect of the epidemic on Western citizens and societies. Still, until recently, it was rivalled by an eerie silence in respect of the "other" plague – in the Third World, and sub-Saharan Africa in particular.
Several factors – political discretion, cultural nervousness, personal indifference – meant that, while the astonishing infection rates soared further, it was near-impossible to read anything much about the lives (and deaths) behind the headlines. That has all changed. Two fine studies, both by sceptical epidemiologists – Helen Epstein's The Invisible Cure and Elizabeth Pisani's The Wisdom of Whores – have skewered many of the aims and claims of Western-generated health campaigns, with their emphasis on abstinence, celibacy and monogamy. Stephanie Nolen's 28: Stories of Aids in Africa, meanwhile, humanised the pandemic by narrating as diverse a set of encounters with HIV/Aids as she could find.
Now Jonny Steinberg, a South African journalist, has come up with a compelling account of the impact (and non-impact) of anti-retroviral distribution campaigns in the poor rural hinterland of his country. Struck by stories of sick fellow-countrymen refusing to test for HIV, or declining the very pills that might restore their health, Steinberg took off to the Transkei, befriending a young shop-owner called Sizwe. He witnesses, translates, yet also embodies the concerns and confusions of his community. Those confusions have hardly been helped by the Mbeki administration's shameful tolerance of shamanism and ignorance.
The book's US title – Sizwe's Test – personalises Steinberg's learning curve. But it unhelpfully worries away at one individual's responsibilities, rather as Randy Shilts's And the Band Played On obsessed over the irrelevant figure of "Patient Zero". Steinberg's account of the roles played by shame, superstition, faith in traditional healing, bureaucratic indifference, incompetence and fear of the (usually) white doctor-interloper with his needle, is jaw-dropping and unforgettable. He shows how each South African life today is predicated on the playing out of the tragedy wrought by Aids – not only in the country's hospitals, cities and cabinet rooms, but in its less visible subjects and recesses.