AIDS and men: taking risks or taking responsibility.

Books & Electronic Media AIDS and men: taking risks or taking responsibility edited by Martin Foreman. Published by Zed Books, London and New York in association with the Panos Institute, London, 1999, 238 pages, price £12.95 (US$ 19.95). AIDS and men: taking risks or taking responsi- bility, a compilation of reports by journalists, addresses the role that men play in the acquired immunodeficiency syndrome (AIDS) epidemic and the implication of this for prevention efforts. It also attempts to put a human face on the epidemic, by portraying the people who continue to be infected and who may infect others in the eleven countries covered (from the Americas, Africa, Asia, and Eastern Europe). Many of the pieces have been or will be published in the home countries of the journalists, in the hope that they will stimulate the type of dialogue about men and AIDS that is required before real change can take place. The book begins with some context- setting chapters by Martin Foreman, the editor of the volume. He presents a clear picture of the difference between ‘‘risk’’ and ‘‘vulnerability’’. Women, he points out, have been the focus of many prevention efforts because they are very vulnerable to infection by human immunodeficiency virus (HIV). Unfortunately, they often have little control over the risks they face, as these are the results of their male partners’ behaviours. In his chapters, Foreman argues for real social change through dialogue and a reassessment of men’s behaviour, their roles in society and the HIV prevention efforts that have largely failed to address these issues directly. Unfortunately, the types of social change Foreman rightly calls for will require considerable time and effort. Attention spans in AIDS prevention have grown short, as donors and others have grown impatient or generally more accepting of the reality of AIDS. The hope for a ‘‘magic bullet’’, the simple solution to prevent HIV transmission, still diverts attention from the reality that many learned long ago: real AIDS prevention requires time, diligence, creativity and a multiplicity of approaches. In the chapters written by journalists in developing countries, the multiplicities of social and behavioural problems associated with AIDS are all represented, ranging from domestic violence to living with AIDS. Most of these chapters fulfil their promise of giving a human face to the otherwise dry statistics and facts about AIDS. We meet women who live with abusive husbands in Mexico and middle-aged men who live double lives in Kenya, pretending to be heterosexual while concealing their homosexual activities. We meet the people who must live with HIV/ AIDS and begin to understand the chal- lenges, not only to health but also to society, that it poses in many developing countries. Along the way, we come away with a clearer picture of the types of social change needed. Many of these chapters are preceded by an introduction from the editor, primarily to set the context for what is to follow. In some, however, Foreman has written more context than the chapter delivers. In the chapter Men, the military and HIV/AIDS in Malawi by Kaulanda Nkosi, the journalist describes the result of Malawian intervention in Mozam- bique to protect a key railway line from rebel attack. Malawian soldiers, away from home and with money available to spend, quickly became involved with Mozambican women. The result of all the sexual networking that took place is now apparent with AIDS reportedly devastating the Malawian soldiers and former soldiers. In the foreword to this chapter, Foreman highlights sexual activity between men in the military, though this is not featured in the journalistic report. My main criticism of this book is the presentation of men and maleness. While women are portrayed as vulnerable as a result of the roles and expectations that society places on them, men are portrayed as risk- takers who exercise choice over their behaviour. In fact, men are also inculcated to societally determined roles; machismo is a good example of such a role. It is a rare individual who has the insight and the determination to behave in ways different from those dictated by society. In fairness, some of the chapters do touch on this issue, in their treatment of sex education or attempts to offer alternatives to the pre- dominant sex roles offered to men. The main argument of the book, however, does not sufficiently recognize that both men and women live with societally determined con- straints on their behaviour. Clearly, women suffer more from this problem and are vulnerable. However, men also suffer and, by and large, are not capable of changing themselves and the risks they take without assistance. As Foreman and the journalists who have contributed to this volume show us, the most effective way of reducing the risks associated with HIV/AIDS is to introduce societal level changes that affect how boys and girls are raised. The challenge for many will be to maintain the commitment and determination to make this long-range goal achievable. n Kevin O’Reilly Reproductive Health and Research World Health Organization 1211 Geneva 27 Switzerland Fasciolosis edited by J.P. Dalton. Published by CABI Publishing, Wallingford, Oxfordshire, England, 1999, 244 pages, price £85.00 ($US 160.00). The simplicity of the title elegantly captures the very complete knowledge base on fasciolosis assembled in this book. It also underscores this condition as a parasitic disease of domestic livestock rather than of humans; humans are an accidental host in whom the disease is traditionally (and still) called fascioliasis. The focus of the book is therefore on Fasciola hepatica and its interac- tion with its animal hosts. All the expected aspects of this devastating fluke infection are presented with particular detail — from the molecular level to that of the population — and from taxonomic to epidemiological issues. Recent advances in approaches to prevention and control, such as the devel- opment of molecular vaccines and the applications of geographical information systems (GIS), are included. The illustration of GIS with regional, country and district- specific examples demonstrates not only its usefulness in predicting outbreaks of fascio- losis but provides insight into its potential application in other diseases as well. The section on the economic impact of fasciolosis on the livestock industry is surprisingly brief and, with cited references dating from the 1970s, dramatically emphasizes a critical need for modern research in this area. While the chapters are multi-authored, they have been crafted to read as if written by 782 # World Health Organization 1999 Bulletin of the World Health Organization, 1999, 77 (9) a single individual. Care has been taken to standardize terms and units for easy reading. A glossary and a list of acronyms, however, are notable omissions. All chapters are meticulously referenced with a balanced mix of primary and review publications. The last chapter is devoted entirely to the tropical parasite Fasciola gigantica, which is also covered at appropriate places in other chapters. Unfortunately, human infection with Fasciola spp. and the resulting diseases are considered in only one chapter, though a separate chapter on immunodiagnosis also covers diagnosis in humans. None the less, for readers who are more interested in the human aspects of the disease, several epidemiological discoveries such as atypical environmental habitats and atypical animal reservoirs are mentioned which serve to pique our curiosity and leave us with the hope that a subsequent volume might address the human infection more comprehensively. Certainly, with its increasing public health importance and recognition that there is still much that is not known about the human– Fasciola interaction, this area requires renewed attention. The book also has some unexpected treasures. The historical introduction is fascinating, the black-and-white drawings are exceptionally clear, and the colour plates on pages 192 and 193 provide a fitting touch. This book contributes a much-needed state- of-the-art synthesis of scientific evidence on fasciolosis and points out several avenues for future research. It will be an essential reference text for all students of parasitology and related sciences. n Theresa W. Gyorkos Associate Professor Department of Epidemiology and Biostatistics McGill University; Associate Director The Montreal General Hospital 1650 Cedar Avenue Montreal, Quebec Canada H3G IA4 e-mail: mdgt@musica.mcgill.ca 783Bulletin of the World Health Organization, 1999, 77 (9) # World Health Organization 1999 Books & Electronic Media