On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.101 n.1 Cape Town Jan. 2011
HIV/AIDS in South Africa. 2nd ed
Edited by S S Abdool Karim and Q Abdool Karim. Pp. 608. R490.00. Cambridge University Press, South Africa. 2010. ISBN 978-0521-147-934.
Knowledge around HIV has evolved extremely rapidly over the past three decades, providing formidable challenges for the editors and writers of any reference text on the subject to remain up to date and relevant. Given such challenges, the recently published second edition of HIV/AIDS in South Africa is a remarkable achievement that serves as a broad-ranging and current overview of all aspects of the HIV/AIDS epidemic in South Africa. In addition, the book provides a historical record of the epidemic and the evolution of responses to it over the past 25 years and insights into what may be expected in the decades to come.
The book is divided into seven sections dealing with: the epidemiology; HIV virology and immunology; risk factors and prevention issues; particular focal groups in which transmission is occurring; the social, economic and other impacts of AIDS; treatment issues; and a final section on what the future holds. Each of the sections contains between 2 and 6 chapters. In all, there are 32 contributors, the majority local scientists, clinicians or public health practitioners. As such the book serves as a comprehensive overview from the basic virology of HIV replication in CD4 cells to epidemiological insights regarding what social and cultural factors drive transmission to the downstream effects on the national economy and the micro-economy of households. For any person wishing to get a thorough overview of all aspects of HIV/AIDS in South Africa this book could be read from cover to cover. It is also the most comprehensive reference text on HIV/AIDS in South Africa.
The first edition was published in 2005. In this second edition chapters have been updated and a chapter on positive prevention interventions has been added. Several chapters are of particular interest or provide novel overviews. The chapter entitled 'Cellular immunity in HIV: a synthesis of responses to preserve self ' provides a detailed overview of the immunology of HIV describing the immune response to HIV, the mechanisms leading to progressive immunodeficiency and what factors influence the variability observed between individuals with respect to these processes. I would highly recommend this chapter for any doctor needing to cover this topic for a postgraduate examination. The chapter 'Barrier methods' unpacks the issues around condoms for HIV prevention, discussing their efficacy, distribution, use and barriers to use and interventions to promote their acceptability. Quarraisha Abdool Karim's chapter entitled 'Heterosexual transmission of HIV - the importance of a gendered perspective in HIV prevention' explores how power imbalances related to gender and age as well as migrancy that is a legacy of apartheid have fuelled the epidemic and resulted in young women being disproportionately affected. Mark Heywood's chapter 'Picking up the pieces: the end of AIDS denialism and its aftermath' explores how AIDS denialism and its repercussions played a role in the downfall of the Mbeki presidency and how the new government has taken a different course in the fight against HIV/ AIDS. The chapters that cover treatment aspects of HIV provide broad overviews of the issues and are not clinical guidelines (there are many other texts that fulfil that role). In many of the chapters the challenges that we face are highlighted and strategies for reducing the spread and impact of the epidemic are discussed. These are well summarised in the final chapter, 'The future of the HIV epidemic in South Africa', that is written by the editors.
I hope there will be further editions of this book that continue to provide an updated reference on the epidemic in South Africa. As the epidemic and our response to it progress there will be issues to be expanded upon in future editions, such as the resurging epidemic among men who have sex with men, rapid HIV tests that have become the most widely used diagnostic tests in South Africa and male circumcision as a prevention measure.
Institute of Infectious Diseases and Molecular Medicine, University of Cape Town