Epstein’s Invisible Cure – Hobart and William Smith Colleges \
The HWS Update

Epstein’s Invisible Cure

It has been 30 years since the world first recognized the AIDS virus and its far reaching and devastating effects. To acknowledge the significant anniversary, the Colleges welcomed leading health and HIV expert Helen Epstein to the President’s Forum Series to discuss what the AIDS epidemic means 30 years after the first reported case.

Epstein’s work – which is a unique combination of scientific and public policy research – has had far reaching effects on efforts to rid Africa of HIV and AIDS. Her book, “The Invisible Cure: Africa, the West and the Fight against AIDS,” has generated debate within policy circles, helping to focus discussion on more practical matters. It is achievements such as this that fuel Epstein, reviving her each day as she is confronted with this tireless work.

“Helen Epstein has worked at the intersection of this important issue and is one of the best people to help us examine what is to be said – and done – 30 years later,” said President Mark D. Gearan as he introduced Epstein to the crowd that filled the Geneva Room on Tuesday night. “This talk will surely provide us, as a community and campus, with much to discuss, particularly in regards to policy issues.”

Professor of Public Policy and Political Science Craig Rimmerman, who was one of the many public policy faculty members instrumental in bringing Epstein to campus, praised Epstein’s work and book. “My students love your book,” said Rimmerman. “They praise it for its relevance, the quality of writing and the evidence you provide through social science. On this 30th anniversary of AIDS, it is an honor to have you with us.”

Epstein, who moved to Uganda in 1993 in search of a vaccine for HIV, discussed the prevalence of the AIDS epidemic in the eastern, southern rim of Africa. Although this is only a small portion of the world, the area accounts for half of the world’s HIV and AIDS cases. It is this area that we need to focus our efforts in order to decrease the disease’s presence, Epstein said.

As Epstein continued her work, she slowly began to realize the futility of such a vaccine. At the time of the initial outbreak in this part of Africa, men working in the gold mines of Johannesburg were blamed for the disease – attributed to their frequent use of the sex trade. Overtime, data began to reveal that more than half of the women afflicted with HIV did not work in the sex trade. It was this information that prompted Epstein to scour mountains of data, searching for a piece of information that might stand out as a contributing factor such an astoundingly rapid spread of the devastating illness.

“I noticed that sexual behavior in Africa was similar to many other parts of the world,” noted Epstein. However, one question seemed to stand out from among the rest: “Do you have more than one spouse or regular partner?”

Epstein noted that polygamy is part of the culture in Africa, where the practice is customary and not stigmatized. In fact, having multiple wives is an indication of wealth. “This behavior, polygamy, would merely be of cultural interest if it weren’t for HIV,” remarked Epstein. However, what this “sexual concurrency” means for Africa is the rapid spread of HIV. In the case of serial monogamy, which is common in the United States and many other countries, HIV is spread is slowly due to a social structure of limited sexual partners.”

“If concurrency is an important issue, what do we do?” asked Epstein. Although the United States has been heavily involved in the funding of HIV prevention programs, campaigns to promote condom use or abstinence have proven unsuccessful. Epstein, however, believes that there has been one highly successful campaign to date -all we must do is look to the past: to Uganda, more specifically.

The “Zero Grazing,” or Love Carefully, campaign started as a grassroots movement to prevent HIV from spreading in Uganda. The campaign stressed reducing or limiting sexual partners in order to control the spread of the disease.

“The campaign worked because it was consistent with the culture,” said Epstein, who noted the campaign was also linked with a Women’s Rights Movement, and did not alienate Ugandans as it was careful in its approach to a practice so deeply rooted in culture. “This approach was part of what I call the ‘invisible cure’ – people talking openly and pragmatically about an issue.”

Although the campaign was dismantled in the late 90s in favor of the more technical approach of promoting condoms, Uganda is hoping to revive the sentiment behind “zero grazing” with a new campaign – “Get Off the Sexual Network.” Through the use of ads featuring children, Ugandans are advised to limit the number of regular sex partners – and be mindful of those with whom they chose to become intimate.

 “What we need to realize is that the moralistic approach is not successful,” said Epstein, who also frowned on relying wholly on pharmaceutical solutions. “We have to make people see that they need to change their behavior not because one behavior is better than another, but because it is the practical, safe thing to do.”