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Sex, Disease and Society. A comparative history of sexually transmitted diseases and HIV/AIDS in Asia and the Pacific; Histories of Sexually Transmitted Diseases and HIV/AIDS in Sub-Saharan Africa ,
  1. John Richens
  1. Department of Sexually Transmitted Diseases, Mortimer Street Centre, Mortimer Market, off Capper Street, London WC1E 6AU

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    These two books provide histories of STDs and HIV in nine sub-Saharan African countries and another 11 countries in the Asia-Pacific region. The contributors are mostly historians or social scientists and the historical accounts take the reader up to 1995. Each volume is divided up into well referenced scholarly monographs on individual countries and individual chapters will be of considerable interest to anyone with an interest in sexual health in the countries studied. The number of readers of this journal who will want to read both books throughout is likely to be much less, given that these books are fairly specialist medical historical studies written mainly by historians for historians. The decision of the editors to treat each country separately has led inevitably to much repetition of certain themes. Many chapters rehearse the familiar story of how governments have responded to public pressure to regulate prostitution and the difficulty of demonstrating whether such efforts have had any real impact on STD transmission. The most interesting example in this context is the account of the attempts to eradicate prostitution and STDs in China, a subject where it is peculiarly difficult to separate the facts from the propaganda. Not only were STDs allegedly expunged from the population but they were deleted from medical textbooks too! Another theme to which contributors constantly return is the problem of differentiating non-venereal from venereal treponematosis. We are constantly reminded that syphilis reporting may be distorted by this issue but other pertinent issues such the unitarian theory of treponematosis, the lack of specificity of older serological test methods, the impossibility of determining the mode of transmission from serological results or, in many instances, from observed clinical manifestations, receive rather patchy and inconsistent coverage. A third recurring theme is the unreliability of passive reporting systems. While this is often acknowledged, contributors still feel obliged to cite whatever data they can unearth and to discuss observed trends that are unlikely to bear much relation to any true epidemiological situation.

    What is there in these books for the clinician or epidemiologist with an interest in STDs? There is no shortage of entertaining anecdote such as the expatriate doctor in Uganda who had himself publicly injected with mercury to demonstrate his faith in this treatment. The account of regular penicillin injections for prostitutes in Indonesia will interest those who are following studies of targeted periodic presumptive treatment in Africa such as the Lesedi Project. Having worked in Papua New Guinea, I was interested to see what was written about spectacular epidemic of donovanosis that affected the Marind-anim tribe in the 1920s. I felt that the account given failed to bring alive the unique nature of this epidemic and the campaign to control it. The main problem for more clinically oriented readers is the wealth of innovative approaches to STD and HIV control that have been explored in these countries since 1995 and which are too recent for inclusion in these volumes. The accounts of HIV go little further than the difficulties experienced in galvanising governments out of denial and into action. For detailed accounts of the Mwanza and Rakai trials and their impact on policy and for the discussion of more topical controversies such as the possible role of polio vaccine development in the Congo in triggering the HIV pandemic we will have to look to future historians.

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    • 1 Sex, Disease and Society. Ed by Milton Lewis, Scott Bamber and Michael Waugh. Pp 296;£ 55.95. London: Greenwood Press, 1997. ISBN 0-313-29442-9.

    • 2 Histories of Sexually Transmitted Diseases and HIV/AIDS in Sub-Saharan Africa. Ed by Philip W Setel, Milton Lewis and Maryinez Lyons. Pp 267; £59.95. London: Greenwood Publishing Group, 1999. ISBN 0-313-29715-0

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