Nature and origins of HIV
Thus the origin and nature of the virus primarily determined the character of the African epidemic. But it was shaped also by the multitude of circumstances in which it took place, many of them with roots far back in the past. No one of these was decisive; all must be incorporated into an explanation. The most fundamental was the demographic context. Before the twentieth century, Africa’s hostile disease environment, harsh physical and climactic conditions, and history of exploitation had made it an underpopulated continent. During the twentieth century medical and other innovations had removed many of these constraints and population had grown at increasing pace, perhaps multiplying six or seven times in the course of the century… It cannot have been entirely coincidental that HIV became epidemic at exactly the moment when demographic growth reached its peak… Later, in the 1990s, emerging areas of rural overpopulation and poverty, such as Malawi, would provide conditions for especially devastating epidemic impact. In both town and country, rapid demographic growth swelled in particular the numbers of young people who were especially vulnerable to HIV.
Even if Iliffe is wrong about demography explaining the nature of HIV’s spread in Africa, the book is a solid introduction to AIDS in Africa, and I wish I would have included it in my course on responses to AIDS in Africa.