Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It

by Craig Timberg, Daniel Halperin

In this groundbreaking narrative, longtime Washington Post reporter Craig Timberg and award-winning AIDS researcher Daniel Halperin tell the surprising story of how Western colonial powers unwittingly sparked the AIDS epidemic and then fanned its rise. Drawing on remarkable new science, Tinderbox overturns the conventional wisdom on the origins of this deadly pandemic and the best ways to fight it today. Recent genetic studies have traced the birth of HIV to the forbidding equatorial forests of Cameroon, where chimpanzees carried the virus for millennia without causing a major outbreak in humans. During the Scramble for Africa, colonial companies blazed new routes through the jungle in search of rubber and other riches, sending African porters into remote regions rarely traveled before. It was here that humans first contracted the strain of HIV that would eventually cause 99 percent of AIDS deaths around the world. Western powers were key actors in turning a localized outbreak into a sprawling epidemic as bustling new trade routes, modern colonial cities, and the rise of prostitution sped the virus across Africa. Christian missionaries campaigned to suppress polygamy, but left in its place fractured sexual cultures that proved uncommonly vulnerable to HIV.  Equally devastating was the gradual loss of the African ritual of male circumcision, which recent studies have shown offers significant protection against infection. Timberg and Halperin argue that the same Western hubris that marked the colonial era has hamstrung the effort to fight HIV. From the United Nations AIDS program to the Bush administration's historic relief campaign, global health officials have favored well-meaning Western approaches--abstinence campaigns, condom promotion, HIV testing--that have proven ineffective in slowing the epidemic in Africa. Meanwhile they have overlooked homegrown African initiatives aimed squarely at the behaviors spreading the virus.  In a riveting narrative that stretches from colonial Leopoldville to 1980s San Francisco to South Africa today, Tinderbox reveals how human hands unleashed this epidemic and can now overcome it, if only we learn the lessons of the past.

Genres: Nonfiction, History, Science, Medicine, Medical, Africa, Health

432 pages, Paperback

First published March 1, 2012

Reviews

[Nina Cohen · Rating 1 out of 5]

The horror here is that this book is gripping, compelling, and tragically misinformed and misguided. We all want a "magic bullet" to protect the world from the spread of HIV. Condoms work brilliantly - better than anything else yet discovered or invented - when used properly. But this book champions male circumcision as an essential prophylactic in the fight against AIDS. This claim is dubious at best; even those who defend the controversial research suggesting that having a whole penis somehow renders a man more vulnerable to STD's make NO claim that amputating the foreskin does anything to directly protect the person on the RECEIVING end of the bargain, so to speak. In other words, even operating within the paradigm of the book and under the belief system of its authors, a woman who thinks that having sex with a circumcised man is safer than having sex with an intact man is WRONG. Similarly, a man who thinks it is safer to be penetrated by him because he has been circumcised is WRONG. But that won't stop men from saying it and their partners from believing it and everyone from doing it. The absence or presence of a foreskin makes absolutely NO DIFFERENCE for a woman having sex with an infected partner when it comes to HER vulnerability to contracting HIV. What makes all the difference in the world is a CONDOM. You know who is least likely to use a condom? People who believe that circumcision magically protects them from HIV. This book is as its title suggests: a tinderbox. If you feel the need to read or recommend it, please bear in mind that condoms protect against HIV, circumcision does not, and the fact that the authors suggest otherwise is wishful thinking and closer to science fiction than sound medical recommendation.

[James Loewen · Rating 1 out of 5]

There is no denying writer Craig Timberg's writing skills and Tinderbox reads like an exciting work of fiction that's chock full of the colourful adventures of our hero Halperin, out to slay AIDS.

Sometimes Halperin is depicted as an ace reporter/ cab driver, waiting outside a San Francisco bathhouse with the meter running, while his HIV wasted customer runs inside to get his rocks off. Elsewhere he's a Jewish Mother Teresa, tenderly caring for AIDS victims.

Many of these stories have the ring of the tall tale, so full of the atmospheric details that only appear in fiction.

Tinderbox also reads like a romance novel but this is no classical love story. The passion here is entirely genitally focused on the circumcision of the African male, something Halperin is extremely enthusiastic about. Every third page waxes euphorically about Halperin's not-so-secret obsession, under the strictly scientific guise, of course, of fighting HIV. When describing a mobile medical team heading out to the Kenyan countryside to provide their circumcision services Sade comes on the radio singing "Smooth Operator."

The old "C" of the ABC's of fighting HIV was "condoms" but that was so last year. The new fashion "C" is circumcision! While our book hero Halperin demures from claiming any excitement, his enthusiasm for male circumcision spills out every few pages.

The three so-called studies that claim a 60% reduction in transmission of AIDS, from women to their circumcised male partners have been soundly questioned by scholars, with the real efficacy rate of circumcision perhaps at just over 1%. Genital cutting to prevent HIV is based on junk science but such pesky details won't keep our hero from his quest.

Perhaps one day we'll see Hollywood re-imagine this story as a comedy starring Adam Sandler as Halperin. In the meantime I'm with those who would prefer a more scholarly approach to dealing with AIDS.

[Sue · Rating 5 out of 5]

I actually thought I knew something about the origins and growth of the AIDS epidemic but reading this book shattered those illusions and has taught me so much about the disease, it's probable origins in Cameroon and growth throughout Africa and then to the world. Seeing the ties to the huge changes in traditional cultures made by colonial powers just adds to the overwhelming sadness.

This is a powerful book, full of medical, social, political, public health information. It also has the words of individuals suffering from AIDS or with family members who have or had the disease. There is so much controversy over how to attack the disease and, perhaps, the major fact that I take away from this book is that Africa must be allowed to use culturally relevant means in combating the epidemic. (Of course African politics can be just as crippling as in the U.S. or anywhere else.)

For the around-the-world challenge, I chose to assign this book to Cameroon as that is hypothesized to be the origin for the disease around the turn of the 20th century, well over 100 years ago.

I do recommend this book for anyone interested in learning more about the development of this epidemic, how diseases are investigated and ultimately how they are fought, in all the messy details.


I want to thank Rebecca Huston whose excellent review inspired me to read this book.

[Jane Thayer · Rating 4 out of 5]

- Clearly, Craig Timberg, is an outstanding writer and journalist. He assimilated a lot of information and wrote a book that is easy to understand. Beginning with the history of the Simian Immunodeficiency Virus that 'no one really knows how' jumped species to Human Immunodeficiency Virus. Timberg writes about villages, the people in the villages, the big cities, the slums, HIV, AIDS, the dying, the politicians, the inept handling of antiretroviral drugs, reckless sexual encounters, and on and on and on. And ending with how - very sad it is that so many people in Africa have HIV and AIDS.

[Caroline · Rating 4 out of 5]

Well-written and thought provoking.

I used some of the ideas in this book as the foundation for a project I did in my dynamic modeling class this past semester. Specifically, I examined Timberg and Halperin's theory that the beginning of HIV/AIDS epidemic in Africa was a direct result of European immigration and colonization to the continent. It made for an interesting project topic, and because I hadn't read the entire book (only some of the articles it was based upon), I knew it would be one of the first books I tackled this summer.

It turns out, the stuff about European colonization being a prerequisite for the HIV/AIDS epidemic makes up a relatively small portion of the book itself, which I was surprised by. The rest of it focuses on the fight against HIV/AIDS and how it has been dominated by Western donors and ways of thinking. The main hypothesis of the book is that too much time, energy, and money has been spent on HIV/AIDS treatment at the expense of prevention in ways that ignore the unique cultural context of Africa nations as compared to Western ones. Specifically, Timberg and Halperin feel that in sub-Saharan Africa, attempts should be made to decrease concurrency in sexual relationships and that circumcision is an under-utilized but effect way to combat the spread of HIV/AIDS.

The book has a definite agenda, but it is also rife with citations to academic literature, which I appreciated. They present a compelling argument, but as is always the case with books like this, I would like to read a rebuttal by those who disagree (and according to the authors themselves, this includes a huge portion of most other HIV/AIDS experts).

But I think one of their overall point rings true - that the HIV/AIDS epidemic is complex and must be handled differently in different places. The culture and context of the epidemic varies the world over, and the things that work in the United States may not work in Thailand, which may not work in Senegal, which may not work in South Africa. If nothing else, this was a valuable enough takeaway to make reading the book worthwhile.

[Lisa · Rating 5 out of 5]

One of the best public health/epidemiology books I have ever read--a fascinating study of the AIDS virus and how the epidemic has spread and been fought throughout the world. The authors show strong scientific evidence that male circumcision, as well as teaching people that having multiple, concurrent sex partners is possibly fatal, are the most effective ways to stop AIDS from spreading. The widespread distribution of condoms has been helpful in reducing the transmission of AIDS to and from prostitutes, but people tend not to use them with partners they know, like spouses and girl- or boyfriends. And while anti-retrovirals have saved many AIDS patients and prevented much suffering, and are essential to preventing the spread of the disease from infected mothers to their babies, their long-term use as preventatives or in settings where the healthcare system is not well-developed is problematic. The authors demonstrate that the approach of the western world to AIDS prevention in Africa has been especially ill-informed, imposing a biomedical model where an understanding of various histories and cultures--a more anthropological approach--could have prevented hundreds of thousands of infections and deaths. Importantly, the assumption of many who have led the fight against AIDS that people can't or won't change their sexual behaviors in the face of the disease is simply not the case. And the growth of an "AIDS industry" for international prevention and treatment--and for attracting the huge sums of money available from governments and NGOs--has led to misstatements concerning the incidence of AIDS and its likely trajectory, as well as to throwing money at projects without evaluating their potential or past effectiveness. A fascinating, well-documented read.

[Clifton · Rating 4 out of 5]

This book is an important contribution to the literature of HIV/AIDS. The opening chapters about the origin of HIV, how it passed from a primate with SIV (probably a chimp) butchered by a human and then followed the paths created by colonialism from Cameroon to the Congo are fascinating. Initially the first person narrative by Craig Timberg is engaging. Eventually it becomes cloying. I found myself wishing he'd stick to the scientific/historic/political facts. (Why do we need to know how a certain person wore his/her hair or whether he/she smiled a lot? This is not a novel.)

The central facts include the necessity to target prevention efforts at the groups most responsible for the spread of HIV in their communities and, especially in Africa, to promote a reduced number of sexual partners and male circumcision, which has proved effective in reducing the number of those infected by HIV. As a person who has witnessed the epidemic in the gay community in California since the beginning, I was irked by the authors' calling people with HIV/AIDS "victims," despite their objecting to others referring to "suffering Africans [as] . . . simply victims, helpless to help themselves." A minor defect, perhaps, but one that a more careful regard for personal and political sensitivities might have caught and avoided.

[Rebecca Huston · Rating 5 out of 5]

This book will shake you up. The authors are honest, and forthright in their appraisal of how AIDS began and spread through Africa, and the various means, both good and bad, used to try and stop it. Not for the sensitive as some of the narrative is rather graphic. The story is very accessible to the lay reader. Overall this one got five stars, and the book is one that I can recommend to anyone interested in the topic.

For the longer review, please go here:
http://www.epinions.com/review/Craig_...

[Mary Kay · Rating 3 out of 5]

Eye-opening, compelling account of the origins of the HIV virus including cultural and sexual implications around colonialism. Reads like a mystery/adventure and with short chapters it is a quick read (albeit a little redundant at times). If you like this you should definitely check out Randy Shilts's comprehensive tome on the aids outbreak in the US - And the Band Played On.

Two other fascinating public health-y ethnographies are The Serpent and the Rainbow (zombies in Haiti) and The Spirit Catches You and You Fall Down (epilepsy and Hmong immigrants in US)./

[Molly · Rating 3 out of 5]

Man... this made me feel guilty. But I think they make alot of excellent points- who are we to think that we know the answers to Africa's problems more than Africa does? Why do we focus on treatment more than prevention? It's crazy and sad to me that people are still dying at such rates of an entirely preventable, slow-acting disease.

[Morgan Dhu · Rating 4 out of 5]

Craig ​Timberg's Tinderbox: ​How ​the ​West ​Sparked ​the ​AIDS ​Epidemic was, as far as I can tell from reading a few reviews, somewhat controversial when it was first published. Certainly there's a lot in this book, which looks primarily at how the AIDS epidemic started, and the conditions that both encouraged and hindered its spread in Africa, that makes one stop and think.

Timberg begins with an anti-colonialist narrative of how AIDS finally, after centuries of being confined to the simian population of Central Africa with no significant or recorded crossing of species lines, erupted into the human population. He identifies Western engagement in Africa as the catalyst, from the vast social disruptions caused by European projects intended to steal the resource wealth of the continent by forcing its people to do the work of harvesting and transporting, to the effects of both Christianisation and forced separation of families on traditional patterns of marriage, initiation rituals and sexual activity.

In particular, he points to a history of circumcision as an initiation ritual, and the tendency to have polyamorous but closed circles of sexual relationships as two traditions that might have limited the spread of AIDS throughout Africa had they not been lost in the decades of colonialist exploitation and 'modernisation.'

Timberg presents considerable evidence that the greater resistance of circumcised men to HIV infection was noted on many occasions during early research into risk factors, but never considered as a potential part of prevention education and programming.

He also notes that in those instances where African nations focused on trying to change sexual behaviour, stressing the idea of faithfulness within relationships and partner reduction in general (such as the 'zero grazing' program in Uganda) rates of infection fell significantly.

The narrative he constructs around attempt to slow the rate of infections across Africa contrasts the mostly African-based programs focused on changing sexual behaviour with programs imposed from outside along with Western aid money, which stressed condom use. He also contrasts attempts to introduce multi-faceted prevention programs, such as ABC (abstinence, be faithful, condoms), with programs focusing only on using condoms. Summarising the findings of one epidemiologist who examined the effectiveness of condom-centred prevention programs, Timberg says:

"Hearst found that condoms rarely failed when used properly by individuals, but he couldn’t find any examples of condom promotion campaigns slowing HIV’s spread in African societies with widespread epidemics. He acknowledged their role in reducing infection in epidemics such as Thailand’s, where transmission was concentrated within the sex industry. But while African men often used condoms in casual hookups or with prostitutes, few did so with their wives or girlfriends, despite years of public health campaigns encouraging the practice. He also raised the unsettling possibility, stimulated by some disturbing findings his research team had made in Uganda, that aggressive condom promotion campaigns, often featuring racy images and double entendres, may make casual sex seem more acceptable, potentially helping to spread HIV."

Condoms seemed not the be the answer for Africa, a possibility that few Westerners were willing to accept. Instead, Timberg suggests that the program ultimately championed by his collaborator in this book, David Halperin, focused on circumcision, partner reduction and changes in sexual behaviour, would be more effective in African nations: "What existed in Africa’s AIDS Belt, and in only a couple of other places on earth, was a “lethal cocktail” of extensive heterosexual networks and low circumcision rates. Changing either factor, on a broad enough level, could cause the pace of new infections to slow dramatically."

While Timberg deplores the imposition of Western ideas of how to fight the spread of the disease on African cultures, he does not ignore the mistakes made by African governments - often prompted by a desire to refute Western perceptions of Africans as promiscuous, primitive, and sexually over-active, or by resistance to conditions attached to money intended to help prevent the rising number if new infections and treat those already infected.

It is an interesting book, and one that tries to look at the ways in which Western imperialism and ignorance have affected the path of the disease in Africa. I find myself wishing, though, for a book that covers similar ground written by an African.

[Catherine · Rating 3 out of 5]

This was an interesting book choice for the current climate of quarantining at home due to the CoVid-19 virus. The whole time I was reading I was seeing parallels between the two diseases, in particular in the way easy global travel makes both so difficult to contain. Like the current pandemic, AIDS came on the scene amid a lot of uncertainty, fear and misinformation. This book illuminates the history of the AIDS epidemic (not a pandemic, since it unfolded in different places at different times) and walks the reader through the various stages of fighting the disease, from discovering how it is spread, finding ways to prevent the virus from spreading, and finally, to discovering treatments.

I thought the whole book was really informative. One fact which I found especially interesting was that researchers have concluded that AIDS has existed since the late 1800s, yet it was only able to spread globally after colonization of remote parts of Africa allowed people to travel far and wide. This is why the subtitle states that "the West sparked the AIDS epidemic"...Western countries built the roads, imported the workers, and created the environment in which the epidemic could grow and spread. Much of the book also discusses the various strategies used to prevent people from getting infected in the first place (primarily condoms, abstinence, being faithful and circumcision (which was new to me)) and how different strategies worked better in different places. I thought this insight was pretty thought-provoking - the way that something like using condoms was effective in Western cultures, the promotion of which was a great way to secure western donor money, but ultimately was not very effective at containing the virus among the people in Africa. If you want to get a new look at an old story check this book out.

[Lacye · Rating 4 out of 5]

This book provides a concise introduction to both the origins of the HIV epidemic and its ties to colonialism and the anthropology behind its proliferation in different contexts and cultural settings. The author provides a range of case studies to illustrate the extent to which HIV relies on social factors to spread and seeks to clear up several common misconceptions. He focuses mainly on the HIV epidemic in sub-saharan Africa and only briefly mentions HIV in developed nations.

Overall, I count this book as a good resource for examining why some common "best practice" techniques in HIV prevention may not be suitable everywhere. The author urges the reader to think twice before automatically prescribing the same program or process to areas where it may be unsuitable.

[Colleen · Rating 3 out of 5]

Well written and interesting, though certainly written with an agenda. The information on circumcision and continuous breast feeding was compelling, some of the other information seemed less well supported and their criticism of Peter piot is, I think, unwarranted

[Meags Wallace · Rating 2 out of 5]

The beginning was very good- compelling and informative about the impact of colonialism on southern Africa’s later struggles with HIV/AIDS - but it devolved into what I thought was a clearly biased push for vague behavioral changes over proven biomedical research.

[Jessica Cornett Allen · Rating 5 out of 5]

Engaging and informative. Journalistic style. Accessible to the layman while still being technically interesting. Perspectives you have likely not considered.

[Isra Abdulwadood · Rating 4 out of 5]

great information, but jumps around with the stories and facts. Must read multiple times to truly understand OR read the appendix at the end to get a clear idea of the points presented.

[Orlando Velazco · Rating 5 out of 5]

Had a decent review and analysis of this book but the app crashed. Whatevs. Great book of yr interested in HIV, equity, and general consequences of interventionism at its most base. Cheers.

[Marzie · Rating 5 out of 5]

A meticulously detailed account of the origins of AIDS that strikes at many of the underpinnings of colonization in Africa, some of which imposed Western or Christian values on tribal culture in a way that has resulted in broad changes in sexual culture that actually promoted spread of the disease. From SIV jumping to humans in Cameroon, to the pressure to dissolve insular polygamous relationships which led to prostitution, to the influx of sexually transmitted diseases other than AIDS that left wide swaths of infertility before the advent of antibiotics, this book will leave you both admiring the perseverance of the epidemiological and cultural detective work and horrified, in retrospect, at much of what European culture and missionary pressure wrought in Africa. It is one big socio-cultural experiment that went wrong. From taxes imposed on single women (even widows) in Congo, since they were now presumed to be earning money as prostitutes, after the ban of polygamy and forced dissolution of such families, to the practice of Victorian explorer/entrepreneurs like Stanley, dragging malnourished and overworked laborers (let's be frank, many were slaves) all over to regions in which they were exposed to diseases that they would never encounter at home, the book will leave you with a different view of the practices that makes you condemn them even more than just for their horrible violation of human rights. After first focusing on the virus itself and its jump to man from either direct bloodstream contact from slaughtered chimpanzees (or consumption of chimpanzee meat) to the slow spread across a vast tapestry of Africa, then to Haiti and to the West and Asia, the authors paint a startling picture. Much of what they describe defies everything you may think of as a firmly held belief. Condoms don't really do much to stop AIDS in Africa? Stable longterm polygamous marriages were a better social structure in cultures that put emphasis on a man producing many children? This book is a controversial one that makes meticulous arguments that may change many of your assumptions.

[Rebecca · Rating 3 out of 5]

The book is incredibly well researched and informative. I liked hearing about some of the debates that made headlines years ago, when the end of the story was hidden on page 20. Like whether circumcision helps or prevents the spread of HIV (answer: it prevents it by a huge margin). When I told my friend about that, she responded that "oh, I thought it was the other way around." That's because the studies that proved the procedure's efficacy, quite clearly and beyond a doubt, were not touted on the front page of newspapers.

However...

I've been thinking about the subtitle since about the middle of the book, and I'm not at all convinced the authors made their case successfully. For starters, even as they laid out the cause, I don't think the West is entirely responsible for the AIDS epidemic. Huge chunks of the book are dedicated to the African sexual culture (and specifically how we shouldn't treat it as taboo when discussing HIV), yet it is somehow only because of pre- and post-colonialism? Nuh uh. Hey, don't get me started on how the West totally screwed Africa. I'm just saying the subtitle of the book is misleading.

Secondly, the authors concentrate mainly on HIV in Africa. And with good reason, seeing as how that is where populations have the highest HIV concentrations, and both authors lived there for years. But their recommendations for "overcoming" the virus really only apple to that continent. Again, misleading subtitle.

But mostly, the book is terribly dry in places, unfortunately. The authors spend too much time on how the AIDS/HIV experts fought for competing paradigms, when a simple paragraph, parenthesis, or footnote would have sufficed. I had trouble getting interested enough in to pick it up every time I put it down. Tossing out a few chapters would have helped.

All in all a decent and informative read, but I give it only a 3 because it lost its focus.

[Megan Doney · Rating 5 out of 5]

I've read this book before, but I picked it up again because I've been following the news of the Ebola epidemic very closely and wondered if there were parallels between these writers' thesis and what's happening in West Africa now. These writers suggest that Western development, like deforestation for the rubber industry and road construction, and imposition of Western cultural norms, like outlawing polygamy and traditional circumcision, helped to spark the AIDS epidemic in central Africa. They argue that roads and increased river travel brought more and more people into contact with one another, thereby creating more opportunities for the disease to spread. In other circumstances, it might have simply flared up and burned itself out and we wouldn't have heard about it. Additionally, the disappearance of polygamy, which kept multiple sex partners in a relatively small, closed circle, forced patterns of sexual behavior to widen.
I wonder if similar circumstances are applicable to the current Ebola crisis, which, according to some experts on the ground whom I've heard on Democracy Now and NPR, say is more dire than the West is reporting. What are the cultural norms that the West doesn't understand, and which might be tapped into to halt this epidemic?

[Tucker · Rating 3 out of 5]

This is a really good overview of what went wrong (and is still potentially a problem) in dealing with HIV/AIDS in a manner that is economical, apolitical, and, most-importantly, humanitarian. Although the book clearly favors certain scientists and perspectives, the statistics paint a ghastly picture streaked with the impacts of misperceptions, miscalculations, and misguided intentions of the powers that be in dealing with this public health crisis that at once impacts the whole society and our most intimate relations. I especially enjoyed the history of the virus and the anthropological stories giving meaning to the statistics.

One point that bothers me in logic (but not application) is the criticism of certain behaviorally targeted campaigns (e.g., Lovelife billboards in South Africa) while at the same time supporting others (e.g., B for Be Faithful, Zerograzing, etc.) that are claimed to not be given credence because they are so qualitative. (In contrast, quantitative targets could easily garner attention with statistics on condoms, HIV tests, ARVs, baby formula etc.)

[Margaret · Rating 5 out of 5]

Well written and well researched account of the AIDS epidemic, focusing on its origin in western Africa (Belgian Congo region) and when (circa approx. 1900), and why the disease has disproportionately devastated parts of Africa. Author Craig Timberg does a masterful job of assembling history and epidemiology, and an important part of the story assembles in an easy to grasp (for this science layperson) assessment why one should personally be concerned about AIDS but, if one isn't a member of a high risk group, why one also should not let hysteria overshadow the fact that its highly unlikely that one will be infected by the disease. The accounts of misinformation (or simply sloppy information) and misses in curbing the spread of the infection, in Africa in particular (e.g., delaying circumcism campaigns), are shameful.

For more on the history of the Belgian Congo (which figures in the first part of this book), I highly recommend "King Leopold's Ghost".

[Laura · Rating 4 out of 5]

Almost everything I knew about AIDS is wrong. As it turns out, HIV is not particularly contagious (an intact vaginal lining is a largely effective barrier, and mere circumcision significantly reduces a man's risk of infection), as a white female in the US I have a very small chance of catching it (billboards about HIV testing to the contrary), and Africa's poverty has little to do with its epidemic (in fact, the kinds of sexual activity that spread HIV most effectively actually decrease when a country's economy tanks).

HIV is not uniform everywhere. It is spread by different behavior patterns and facilitated by different factors in different communities, and those differences require variations in prevention tactics. There is no one-size-fits-all solution for HIV and no shortcut other than full understanding of HIV in the particular time and place where one is attacking it.

[Rebecca · Rating 5 out of 5]

Really interesting; while Jewish people like myself have practiced circumcision (um, that sounds weird but I haven't actually circumcised anyone) for centuries, the argument the authors present in terms of the prophylactic value of circumcision regarding AIDS is hard to ignore. It will provoke a ton of controversy, for sure, but it's worthy of discussion. Also, I strongly enjoyed that the book did not portray all of sub-Saharan Africa as poor and helpless; it emphasized that many of the AIDS patients/HIV positive people are, in fact, middle or upper class. And there is enough depth to illustrate how Uganda, Kenya, Botswana, South Africa and Swaziland (among others) all differ in their ways to handle AIDS.

[Hugo · Rating 4 out of 5]

Nice review of origins of HIV, the reasoning for its spread throughout Africa and eventually out of Africa (increasing western influence causing development of roads, trains, and water passages, with enough population density to keep the virus spreading, along w/ concurrent partners (rather than just serial partners), and, in some places (the AIDS belt), lack of circumcision), and later the political involvement from the world which likely didn't help any, regardless of the amount of money (not targeting social/cultural factors like reducing concurrency, rather than spending more on condoms, which many were reluctant (as opposed to Thailand, where sex industry is leading cause of HIV spread). The last chapters are heavy on the work of Halpern and circumcision.

[Amanda · Rating 4 out of 5]

Really interesting read. I hadn't previously done a lot of reading about the African side of the epidemic, so it was interesting to learn about factors in the African world that may have contributed to viral spread in those countries. As an immunologist, my mind is naturally slanted towards the question of how we can improve on existing HIV therapeutics, however, this is the second book in a row that I've read that has suggested that what we have now in terms of anti-retrovirals is sufficient, but the more complex problem is how to enact societal changes in ways of life that have been very deeply engrained.

[Jennifer · Rating 4 out of 5]

The subtitle of this book caught my eye, and made me curious. And in fact the authors make a good argument that colonialism in Africa sparked the AIDS epidemic--as laborers were forced into the remote areas where the HIV virus first made its appearance--and then made it vastly worse by tearing apart traditional social order in African society. Fortunately, the authors also offer hope for the future. The rate of infections are generally slowing, both because of the natural progression of epidemics, and various means of changing sexual behavior. But ultimately Tinderbox is a cautionary tale, with lessons the world should bear in mind when the next epidemic strikes.

[Wilma · Rating 3 out of 5]

I read about a third of this in the fall when I was teaching the class on Polio and AIDS. It had an interesting section on colonialism in Africa, especially in the Congo, and how that influenced the development of trade and settlement patterns. Also interesting parts on how it was determined the HIV virus sprang from the mutation of a simian immunodificiency virus that jumped to man. Good section on how Haitians came to Congo to fill middle management and teaching positions after the Belgians left, and how that may have affected HIV spreading to Europe and the Western Hemisphere.

Meant to finish it after the class was over, but moved on to other books instead

[Sam Poole · Rating 3 out of 5]

People are generally missing the point in critiquing or analyzing this book. Is it informed and informative? Yes. The appendix alone is worth a star. The problems with this book and unavoidable- it has a scope that is very large with a focus that becomes diluted at points. The boundary between reporting and pontificating is crossed at times. This is not an egregious misstep but it does leave a bad taste at some points. The high points were the appendix, history at the beginning and interviews with HIV positive people. Obviously a critical topic that deserves more examination and xploration, though perhaps one that Timberg cannot fully offer.