Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science

Expertise: Cultures and Technologies of Knowledge

by Johanna Tayloe Crane

Anthropologist Crane (Univ. of Washington-Bothell) presents a solidly documented and well-reasoned discussion of AIDS and its far-reaching effects. An excellent overview deals with resistance to treatment.. Recommended. Graduate students, faculty, professionals. ― Choice A work of outstanding interdisciplinary scholarship, Scrambling for Africa will be of interest to audiences in anthropology, science and technology studies, African studies, and the medical humanities. Countries in sub-Saharan Africa were once dismissed by Western experts as being too poor and chaotic to benefit from the antiretroviral drugs that transformed the AIDS epidemic in the United States and Europe. Today, however, the region is courted by some of the most prestigious research universities in the world as they search for "resource-poor" hospitals in which to base their international HIV research and global health programs. In Scrambling for Africa , Johanna Tayloe Crane reveals how, in the space of merely a decade, Africa went from being a continent largely excluded from advancements in HIV medicine to an area of central concern and knowledge production within the increasingly popular field of global health science. Drawing on research conducted in the U.S. and Uganda during the mid-2000s, Crane provides a fascinating ethnographic account of the transnational flow of knowledge, politics, and research money—as well as blood samples, viruses, and drugs. She takes readers to underfunded Ugandan HIV clinics as well as to laboratories and conference rooms in wealthy American cities like San Francisco and Seattle where American and Ugandan experts struggle to forge shared knowledge about the AIDS epidemic. The resulting uncomfortable mix of preventable suffering, humanitarian sentiment, and scientific ambition shows how global health research partnerships may paradoxically benefit from the very inequalities they aspire to redress.

Genres: Health, Medicine, Nonfiction, Anthropology, Africa

224 pages, Paperback

First published August 20, 2013

Reviews

[Audrey Nixon · Rating 4 out of 5]

Very well written, and informative about the nuances of global health in a post colonial environment

[Scott Pearson · Rating 5 out of 5]

The prevalence of HIV and AIDS in Africa was a looming problem at the turn of the millennium, but heavy American investment in treatment for Africans under George W. Bush’s PEPFAR program addressed the acute symptoms. However, like much in life, smaller, no-less-significant problems exploded soon afterwards, particularly in the vein of post-colonialism.

Was this a scientific partnership of equals or was it a contribution from a superior to an inferior? Does PEPFAR create a health culture of collaboration? Crane’s book addresses these issues at length by performing an ethnology, a cultural analysis around research based on interviews in the field. Her findings relevantly address the future of such aid in the trending field of global health.

I generally find medical anthropologies difficult to read because they discuss inequities that surround my field of work. However, I welcome these challenges because they force me to think about uncomfortable issues. Does global aid truly help the African culture advance and flourish? If not, how can it achieve these aims better? These are not easy issues because few Americans – myself included – have never travelled to this great continent.

Yet there exists so much human potential there. How many intellects the size of Marie Curie or Albert Einstein exist on this so-called “dark continent,” unused because they are uneducated – or because their research interests are unfunded? Again and again, Crane brings out that most Africans in the field just long to be treated like scientific equals in grants and publishing. This simple wish is not extreme or unreasonable, but Western pride after centuries of colonial oppression context seems to neglect this desire.

Medical anthropologists will celebrate this work, but the people who need to read it most are the medical students and researchers involved in global health. These groups make up the cultural structure explored and critiqued here. Like any ethnography, this book is an act of scientific exploration, not an opinion piece driven by an agenda. Will science respond appropriately to such data-filled critiques or continue in ignorance? Will global health science by the Americans become public health science for the Africans?

[KT · Rating 5 out of 5]

Informative and constructive critique of global health based on qualitative research.
The book began by explaining the complexities of AIDS and HIV to a layperson such as myself with little prior knowledge of how the disease operates.
I particularly enjoyed the fourth chapter in which the author delved in to the postcolonial activity of global health, in particular the impact of the US AIDS research community on Ugandan healthcare and research sectors.
The author made a convincing case that health research and development are in conflict, if not incompatible when aspiring for equitable scientific collaborations. For example developmental donations and handouts are inherently unequal and often lack meaningful participation and inclusion.

[Lora · Rating 5 out of 5]

This is a shorter ethnography, but Johanna Crane still fills it with an enormous amount of information. The book was well organized, with each chapter focusing and diving into a topic. I also felt that the chapters progressed smoothly and in an easy to follow way, the ethnographic knowledge and research building on one another. After reading it, I have a much better understanding of the rise of HIV treatment in Africa, the creation of “global health”, and the inequalities and problems within the “global health” system. This is a great read for anyone interested in development projects in Africa.

[Oksana · Rating 3 out of 5]

Read this for school. As an ethnographic dissection of the "savior"/user complex wealthy countries have it's excellent. They do an excellent job if exploring the way African patients are used as fodder for research for global health scientists. As a book to purely enjoy to read...it was definitely dry and the flow was stunted at many points of the text. Glad I have read, but wouldn't have if it weren't for school.

[Niru · Rating 4 out of 5]

Everyone should read this - it’s dense but incredible

[Zach · Rating 3 out of 5]

Read before going abroad - I expect it would be more interesting if you had little to no baseline knowledge.

[Sara Salem · Rating 5 out of 5]

Brilliant book that shows the politics involved in global health research into HIV/AIDS and how inequalities between researchers in the Global North and those in the Global South negatively affect the research process. Neocolonial relationships continue to linger and Africans continue to be framed as victims who need to be saved by western doctors and institutions. The author also shows how assumptions about Africans have had a major impact, for example by delaying the availability of ARVs to Africans for at least a decade because western doctors were sure Africans wouldn't take the medicine on time.
She also demonstrates the role of pharmaceutical companies and the money they bring which inevitably influences the research being done. This means most research is based on HIV strains found in Europe and the US. It is also the reason why ARVs come in multiple pills: because each one is produced by a different company.
At the heart of the issue is also the question of intellectual property and the patent that prevents the cheap reproduction of ARVs apart from in a handful of countries.
Devastating but necessary book.

[Sydney Bender · Rating 4 out of 5]

This book is accessible to the non-scientist while delving deeply into the scientific and social issues of HIV/AIDS research. Commendably, the author constantly qualifies her critique and reassures readers that she seeks not to condemn current global health science but to highlight the "friction" within the field such that it may be lessened in future years. This is a great book for those interested in postcolonial relations, particularly those pertaining to medicine and HIV/AIDS treatment and research.

[Tracy Cable · Rating 4 out of 5]

This book takes a nuanced view of a history of HIV research in Africa, both as a means of value extraction and capacity building. It makes you think about what Global Health means, really. What local researchers get out of research relationships, and what how researchers abroad extract value and data. I was shocked to learn that HIV subtype B (nearly all North American cases) is overly represented in research, representing only 12% of worldwide cases.