The purpose of this volume of collected essays is to bring a novel approach to the understanding of HIV/AIDS in contemporary Africa by placing the HIV/AIDS crisis into the circumstances and debates concerning conditions that give rise to high incidence levels for many different illnesses in Africa. Too often HIV/AIDS is treated as if in a vacuum, a crisis so unique and devastating that to compare it with other illnesses seems valueless. Likewise, many scholars and activists currently stress that HIV/AIDS is primarily a behavioral problem in Africa. To improve the HIV/AIDS outlook in Africa, preventive education must succeed in...

The etiology of human ailments is of interest to those who strive to cure them, but also to those who suffer as patients, their empathizers, or their dependents. When maladies are not inflicted through physical injury, their source as well as the rationale for victim selection is frequently obscure. Some illnesses arise from within, due to malfunction or wear and tear of aging organs. Other, often more dreaded diseases encroach upon unsuspecting, appropriately situated, and susceptible individuals. External etiologic agents may be natural and artificial chemicals, which can damage organs or induce cancers, or parasitic forms of life. Just as...

In the essay “Sexual Cultures, HIV Transmission, and AIDS Prevention,” Richard Parker writes that “in little more than a decade the rapid spread of the international AIDS pandemic has profoundly changed the ways in which we live and understand the world.”¹ Although I do not wish to question the veracity of Parker’s claim, I believe an inversion of terms can also provide interesting insight: the way in which we live and understand the world has profoundly affected the AIDS pandemic and its surrounding discourses. In addition to being an important medical and scientific issue in and of itself, HIV/AIDS has...

This chapter examines the origins, dimensions, and problems associated with waterborne diseases and water supply in Makurdi, Nigeria, during the period of British colonial administration. Efforts are made as well to examine the nature of water supply during the precolonial period. The various methods used in preventing the outbreak of waterborne diseases, such as cholera, dysentery, paratyphoid fever, typhoid, giardiases, and schistosomiasis, will be discussed. During the precolonial period, the people in Makurdi continued to depend on undeveloped sources, such as rivers, streams, spring, wells, ponds, and direct rainfall, for their water supply. The water supply during this period was...

Almost two decades ago, in his seminal review article of the literature on disease and medicine in Africa, Stephen Feierman noticed that although scholars had explored the relations between colonial powers and healers in the period after colonial conquest, there were no systematic studies on the actual conquest, that is, “the battle for a medical monopoly,” including the assault on the institutions of health and the persecution of the healers.¹ A decade later, he revisited the topic, drawing on the evidence from the Great Lakes region (eastern DR Congo, northern Rwanda, and southern Uganda), and shed some light on the...

Most tropical regions of the world, including sub-Saharan Africa, South Asia, and South America, are susceptible to malaria epidemics. The West African littoral, however, branded the “fever coast” in colonial parlance, is more closely associated with malaria than other regions. As Raymond Durnett noted in a 1968 seminal essay, the peculiar climatic conditions in the areas neighboring the West African Gulf of Guinea make it one of the most dangerous environments for health. The area’s high temperature range, relative humidity, and generous monthly distribution of rainfall help breed the species of malaria parasite, Plasmodium falciparum, and its vector, Anopheles gambiae,...

Epilepsy is one of the most misunderstood diseases in most African communities. In these communities, there are beliefs that epilepsy results from possession by an evil spirit;¹ the sins committed by the diseased individual’s parents, grandparents, any older relatives; and, in some cases, by the sins of the victim himself or herself.²

It is not uncommon for very rich members of a lineage to be blamed for certain diseases—especially seizures—because excessive wealth is often viewed as having been acquired with the aid of evil spirits. Such evil spirits, if not constantly pacified, turn their anger on relatives of...

Studies on the health of Africans have increased substantially during the past couple of decades. For the most part, recent studies have concentrated on reproductive health issues, malaria, and HIV/AIDS. One health topic that is rarely addressed in African health research is disability. Not much is known about prevalence, determinants, and impact of disability among African populations. While disability is generally associated with reduced labor force participation, it also has social, cultural, and political consequences. As governments adopt policies and institute programs to ensure the full participation of the population with disability in all national activities, they often face the...

Preventive interventions were almost entirely responsible for steep declines in infectious disease in Europe and North America in the late nineteenth and early twentieth centuries. Antimicrobial agents,¹ chemical entities that kill or inhibit microorganisms, were developed late in the stage of this public health revolution. In parts of the world where potable water, sanitary housing, and sewage treatment are taken for granted, antimicrobials have, at least in the eyes of the public, displaced prevention as the primary tool for infectious disease control. In developing countries with suboptimal public health systems, antimicrobials are afforded a similar status and consequently greater expectations....

Dr. Jeffrey Sach’s recent United Nations report, “Investing in Development: A Practical Plan to Achieve the Millennium Development Goals,” has brought renewed discussion on the role of economic development in reducing poverty and improving health in the developing world.¹ While much of the public debate in developed countries has focused on the amount of aid and the implementation of this proposal, there has been limited discussion on the role economic development has already played and continues to play in the improvement of health in developing countries. Increases in the GNP (gross national product), a key indicator of economic growth, are...

Buruli ulcer (BU) is a little understood, severely debilitating skin disease caused by Mycobacterium ulcerans that has serious health and economic consequences. The slow growing environmental Mycobacterium clinically manifests as papules, nodules, plaques, edema, ulcers, and scars with or without contracture. Although its mode of transmission is not fully understood, the disease-carrying agent has been identified as belonging to the family of pathogens that cause tuberculosis and leprosy.

BU begins as a painless nodule. If not treated early, the organism gains access to the subcutaneous tissue and develops a unique toxin called mycolactane that suppresses the immune system, and invades...

Health issues in mining communities in South Africa are unique because of the nature of the mining industry. The illnesses and diseases that will be discussed in this chapter are not exclusive to the mining industry, but it is the risk factors associated with the mining environment and communities that exacerbate the incidence of these illnesses and diseases and make the subject matter burning and relevant.

The unique characteristics of the mining environment in South Africa are that mining communities are mainly isolated, originally rural with high illiteracy rates, and consequently, they become dependent on the mining companies for their...

International regulation of the West African overland pilgrimage from northern Nigeria to Mecca had its basis in concerns of British colonial officers and Saudi Arabian authorities to promote the health and well-being of itinerant Nigerian Muslims en route to Mecca in the first half of the twentieth century. Regulations enacted to control the West African pilgrimage in the period between 1919 and 1936, dubbed the Nigerian Pilgrimage Scheme, were adapted from regulations previously attempted in India, the Straits Settlement [Singapore], and Indonesia and were meant to bring the West African pilgrimage into conformity with international standards established and modified since...

Very few, if any, contemporary global issues challenge the normative boundaries of the Westphalian international system and its governance architecture as much as the HIV/AIDS pandemic.¹ In little more than a decade, global governance of the HIV/AIDS pandemic has oscillated within a tripartite multilateral governance structure:² first as a global program within the World Health Organization, second as an innovative joint venture of nine United Nations system organizations,³ and presently as the subject of a private–public sector partnership.⁴ Despite these multilateral initiatives, the multilateral, global governance of HIV/AIDS constantly challenges the orthodox structures of the Westphalian system in our...

In sub-Saharan Africa, Burkina Faso (in West Africa) is within a group of countries with low HIV prevalence,¹ but where HIV/AIDS is nonetheless considered a major problem. According to Guiard-Schmid, the first clinical case of AIDS in Burkina Faso was diagnosed at the National Hospital Yalgado Ouédraogo in Ouagadougou in 1985. Sera of patients from this center were tested in Paris, and some were declared HIV-1 positive. Serological research in 1986 attested to the presence of HIV 1 and HIV 2.² Other documents on the first case of HIV/AIDS in Burkina Faso indicate that the HIV/AIDS epidemic broke out in...

Incidents of deliberate attempts to spread HIV infection have been reported among persons living with HIV in different parts of the world. Cases of different types of deliberate HIV transmission have been recounted, including use of force,¹ attempts made by one partner in a couple having a sexual relationship,² and serial attempts made by an infected person against different persons.³ In those countries where cases of deliberate transmission of HIV infection have been reported, men with HIV/AIDS were more likely than women to be involved in performing acts consistent with deliberate attempts of spreading HIV infection.⁴ Incidents involving women have...

Despite years of struggle against the disease, UNAIDS’ Report on the Global HIV/AIDS Epidemic concluded that “the scale of the AIDS crisis now outstrips even the worst-case scenarios of a decade ago. Dozens of countries are already in the grip of serious HIV/AIDS epidemics, and many more are on the brink.”¹ If billions of dollars per year over a lengthy period of time were going into Africa as well as being spent by those on the continent for anything other than combating a sexually transmitted disease, all parties would view it as an opportunity to develop private business and advance...

This chapter reports the results of focus groups conducted with urban adults in Zimbabwe. The focus groups were designed to extract information about people’s knowledge of HIV/AIDS as well as information about people’s preventive behavior and their responses to televised HIV/AIDS public service announcements (PSAs). Premised by the Extended Parallel Process Model,¹ the focus groups produced illuminating results. In this chapter I begin by giving some background information about the HIV/AIDS situation in Zimbabwe. Next I examine the Extended Parallel Process Model (EPPM), a model that was initially designed to explain fear appeal processes in HIV/AIDS messages. Finally, I outline...

Not since the bubonic plague in the fourteenth century has there been an infectious disease as devastating as HIV/AIDS. While the epidemic is world-wide, the overwhelming majority of its impacts currently are in sub-Saharan Africa. In some of these societies, a third or more of adults in their economically active prime (age fifteen to forty-nine) are HIV positive. Contrary to beliefs held by many that this is an affliction of the destitute, HIV/AIDS in Africa is remarkably egalitarian. Indeed, in some cases infection rates are higher among highly trained workers, such as teachers, health-care workers, miners, and truckers, than in...