On December 1, 1969, I stood not far from Gen. Hershey at the first nationally televised draft lottery, which the government had set up to determine the order of call to military service [Lewis Blaine Hershey was a United States Army general who served as the second Director of the Selective Service System, the means by which the United States administers its military conscription. He was the longest-serving director in the history of the Selective Service System, and held the position until February 15, 1970, spanning World War II, the Korean War and the Vietnam War. He was one of only six generals in the history of the United States Army to have served as a general during three major conflicts].
There was a public exercise in which Gen, Hershey explained how names would be randomly pulled out of a large, translucent rotating drum containing plastic capsules, each containing a birth date on a slip of paper. Life-or-Death bingo.
I wore a coat and tie, and my hair was still short. No one would have suspected that an anti-war activist had slipped into this live TV event, watched by many millions. I had the impulse to take one of the 365 plastic capsules, jump in front of the live TV cameras, break open a capsule and swallow a slip of paper—which would have invalidated the whole grim lottery enterprise. I might have gotten myself on the cover of Time, Newsweek, and Rolling Stone, no matter that I’d have been fired from my job.
(later that same evening…)
Hershey was actually sympathetic to genuine religious objection to all wars; in fact, he (like Richard M. Nixon) came from a peace church background himself. I myself was something of a fraud, inasmuch as I didn’t have the conventional peace church background documentation that usually has to be in one’s Selective Service file.
So Gen. Hershey in person wasn’t such a bad guy, and I don’t just mean in the banality-of-evil sense. Despite the multi-generational difference in our ages, he seemed very affable and down-to-earth in our interview, more like a favorite uncle than the Grim Reaper. At one point he mentioned that one of his all-time favorite gospel songs was Will There Be Any Stars in My Crown? I had actually sung this song as a duet on stage, at school, and told him this. So we had a bond! As it happened, I was walking beside the general and talking with him as we both left the building after the first national lottery. Mass protests were going on right outside Selective Service Headquarters. As soon as we stepped into the open air, there in front of the crowd before us were Yippie leaders Jerry Rubin and Abbie Hoffman, brandishing a large birthday cake, poised to launch it in the face of Gen. Mars Bars. I instinctively stepped in front of the frail, old general and in that brief moment of hesitation, the cops grabbed the two Yippies. The cake was not thrown.
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(high school in Korea)
Suddenly, Mr. Hervey came charging into the room from the back door and announced that he’d caught me cheating, red-handed! I immediately put on a great show of shock and indignation. Me? How dare this wimp of a man accuse me of cheating? So I said, “If you think I’m a cheater, why don’t you and I just step outside and we can settle this like men?”
I proposed it in my most menacing voice, also probably rehearsed in front of a mirror. I somehow knew that Mr. Hervey had been a nerd back in his own school days in Nowhere, Nebraska, and was certainly not the kind of guy to get into a fistfight with the likes of me at age 16.
It seemed like no one breathed for a few minutes. I knew I had him.
Mr. Hervey ended up backing down and not really doing anything about the cheating accusation. I should have felt triumphant but I actually felt ashamed of myself, sorry about the whole situation. I sensed this might be the low point of my secondary school career.
Now we fast-forward a few weeks. We called our high school rock- ‘n-roll band The Silvertones after my cheap, brown, Sears & Roebuck, solid-bodied electric guitar, and we were performing at our first high school dance. We started off with the then-famous Champs instrumental, “Tequila.” During the break after our first set, Mr. Hervey, who I guess was there as a chaperone, came up to me and quietly asked if we could play “Tequila” a second time and this time, he could join us, because as a matter of fact, he happened to have his tenor sax in the trunk of his car.
I was surprised this man would even talk to me. I mean, what if I had said no and sneered at him? What would he have done? Big loss of face if anyone happened to hear the exchange. But I consulted the band and they thought it was a pretty cool idea, and so we performed “Tequila,” but this time with the great sax part heard on the Champs’ recording. Mr. H. knew his rock ‘n roll.
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(mental hospital adventures)
…the girl my brother was dating suggested that it would be good therapy for me to hang out with more wholesome people. He and Melissa Farley had been discussing my steady consumption of Ripple wine and were growing concerned. Melissa was a student at Mills College and one Saturday she invited me to drive up to Napa State Mental Hospital and join her group of Mills and UC Berkeley student volunteers for a project supported by the American Friends Service Committee (AFSC). These volunteers were engaged in something called recreational therapy with the mental patients. They also brought along guitar, banjo, and an autoharp and they played folk and country music on some of the wards. This seemed like a perfect fit since I loved folk music. I first heard the beautiful, earthy, haunting Carter Family songs from Melissa and the trio. With me, we became a quartet.
There was more to Melissa’s plan for improving my life. She knew another lost soul like me, a fellow Mills student and a potential girlfriend for me. So the day we first drove up to Napa was the day I met W, from an old, respectable Massachusetts family with a trust fund and a dad who had graduated from Harvard, but suffered from shell shock from World War II. She had long hair that she let cover her entire face when she wanted to retreat from the world. She seemed quite the mysterious girl. I tried to impress her with stories of my exploits in Korea and she pulled a sticker off a Chiquita banana and stuck it on my forehead, without comment. This seemed promising. So, I began to have an interest, a Purpose in my life. I began to look forward to my Saturdays at the mental hospital.
When I met Monica, she seemed almost as lost and lonely as I was... and she too felt a little out of place in the Bay Area, and California generally. She was actually engaged to a prodigy who was graduating from Harvard at the age of 19, and she was supposed to spend the summer in Cambridge with him…
We continued working at Napa and got to know a catatonic schizophrenic patient named Margie C. Margie was in her 30s, dressed as a man, sported a crew-cut , and chewed tobacco, spitting the dark, viscous cud into an ashtray. She didn't seem to think she was a woman. But she began to respond remarkably to our Carter Family country music, sung by Melissa and accompanied by our improvised string band. We learned that Margie was from Appalachia and from a very poor family. Furthermore, she had been sexually abused—probably raped—in a men's room at a Kentucky diner.
Margie slowly grew more animated and, well…sane around Monica, Melissa, and me. She told us she loved Hank Snow, Hank Williams, Hank Locklin, and just about every Hank in country music. She began to request songs and tried to sing along with us. We had never heard of music therapy, but in retrospect that is what we were providing and the results were astonishing. Nowadays music therapy is an established, allied health profession and there is even an American Music Therapy Association.
As we were witnessing her steady transformation, one day she asked Monica for one of her hand-me-down Levi skirts. Before long, Margie was beginning to look like a woman. After some months, she even attracted a boyfriend, an older, tubercular, good ole country boy named Russ. In some ways, this state hospital could have been the model for One Flew Over the Cuckoo's Nest. This was in 1962-3, not long after powerful neuroleptic drugs became available, and so patients were heavily medicated instead of being put in straightjackets and subject to other restraints and therapies that seem inhumane today. Yet a very nice thing happened. The nurses and technicians on Margie’s ward chipped in from their meager salaries and bought her an 8-bar autoharp. I gave her lessons and her progress continued.
Meanwhile, I still remember two boys on the child and adolescent ward. One was severely autistic. He lived in his private world and no stimulus could penetrate it. I could make a loud noise right next to his ear, and he’d show zero response. What he would do---his sole raison d’etre it seemed—was to very slowly loosen screws from door frames, until eventually he could get a door to fall off its hinges. Then he would go on to the next door.
The other patient I remember far better. He was a boy of about 12 named Bobby Margolis who seemed quite normal. He grew very fond of Monica and me, and we liked him. Why was he in a mental hospital? Pyromania. It seems he had predilection for burning down houses, such as that of his parents, allegedly twice. He drew lurid paintings of men and horses, both sporting super-sized penises. Melissa heard from a staff member that he had been sexually abused. He had that in common with Margie.
One Saturday about a year into my volunteer work there, the administrator of the hospital asked to see us. He informed us that Bobby Margolis had run away from the hospital. They apprehended him on the highway jogging towards Berkeley and he explained that he wanted to go and “live with Monica and Ted.” This meant we had crossed certain professional boundaries that we didn't know about because they had never been discussed. But this incident meant the suspension of our AFSC volunteer program for up to a whole year. There would be an “emotional cooling off period,” the administrator informed us, and when and if our program resumed, we were not to let patients became emotionally attached to us.
Monica and I came back after the “cooling off” period and we went at once to find Margie. We found her in a state of catatonia, about where she was when we first met her. She didn’t recognize us, or anyone. She was reduced to a state of Cerea flexibilitas, a name I later learned in an abnormal psych course. It meant keeping one’s arms, legs, and body in the last position anyone put them in.
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Fieldwork: Off to a Bad Start (1971)
My first field note reads: “This has to be the worst day in the history of ethnography. Everything I needed to get started is lost. My father drove us to the airport (Dulles, Washington, D.C.) and we had so much stuff in the trunk that I guess the trunk was not quite shut. My briefcase fell out. In it were all my key reading notes, my two letters of introduction from my professors (“Dago Dazzlers,” as they are arrogantly called at elite British universities), a letter from the Suriname Minister of Education whom I had chanced to meet on my preliminary trip, most of my cash and all my traveler’s checks, essential medications to keep us alive until we could access proper medical care, and the list goes on. So I called my parents en route to Suriname, from an airport in Curaçao. My stuff has been found! A vigilant D.C. transit bus driver found my briefcase and managed to track me down to my parents’ house. This was not as easy as it might seem. A couple of addresses he found were from my old Chicago apartment. But he managed to track me down, thanks be to Kediampo, the Creator Deity of the Matawai.
It was tongue-in-cheek, or just cheeky, that I wrote about the worst day in the history of ethnography—as if I would ever be part of that great history.
Once I reached Suriname, I faced a new setback. Before anyone thought up obstacles like Institutional or Ethics Review Boards, there was still something called getting formal permission from the host country to do research. I made my first contacts with the folks who were to become "my tribe" at Njoecombe, a low wooden building in the middle of Paramaribo, where "tribal" people from the interior could sling their hammocks, sleep, and cook during their short trips to town. On my first visit there, I met an American woman PhD linguist whose research focused on learning the language of the Maroon tribe neighboring mine, the Saramaka. She had been sitting around waiting for government approval for two years.
Yikes. I had two years for my entire research, at most.
I wasn’t sure how to avoid such paralysis. But I took steps anyway.
A worker at the hotel where Shannon, one-year-old Timmy, and our big dog Karl stayed for the first week or two told me about a guy from the Matawai tribe who was, or had been, a member of Parliament. So, I found Jarien Gadden (Shannon changed his name to “Gadfly”) and informed him of my plans to do a study of Matawai rural-urban migration. Gadden was happy to have a Bakaa (White) guy want to get to know him and his tribe. He would find me a language teacher: his uncle. But then, Gadden said he himself would be my teacher, every day for one hour. Toward end of lesson 1, I broached the subject of payment. Gadfly was embarrassed and indicated that he didn't expect anything.... "Maybe when you have a cigarette, you give me one." I persisted and he protested. When I suggested that we could talk about it later, he seemed greatly relieved. I decided that a gift would be more appropriate than money. As it turned out, Gadden lived some two kilometers from his office and had no car. Our lessons took place around 6 or 7 p.m., so I could drive him home after his day's work and converse in an easy, casual way.
I had lessons in both Matawai and Taki-Taki, the informal name for Sranan Tongo, the English-Dutch-based creole. It was the lingua franca for Suriname and all the diverse ethnic groups could speak it. Months later, I would visit a Carib Amerindian village and it was very gratifying to be able to speak with the village chief in Taki-Taki. After about 2 months, I felt I knew enough Matawai, and Taki-Taki to fall back on if needed.
So, one fine day we all simply showed up in the Matawai village of Niewkonde, courtesy of a small, medical missionary plane. We set down on a landing strip at the edge of the village, which consisted of thatched huts clustered around a semi-secret shrine to ancestor spirits, the faaka pau. This was not the village of the Gaanman, the Paramount Chief, but our plan was to move upriver to his village, as courtesy dictated. When we did, he cordially assigned us one of the huts, that of his maternal nephew, who was away. I began doing fieldwork and waited to hear from the government about permission to do what I was already doing.
REVIEWS OF PREVIOUS PUBLICATIONS BY EDWARD C. GREEN
Far from being the province of magic, witchcraft, and sorcery, indigenous understanding of contagious disease in Africa and elsewhere in the developing world very often parallels western concepts of germ theory, according to the author. Labeling this 'indigenous contagion theory (ICT),' Green synthesizes the voluminous ethnographic work on tropical diseases and remedies as well as 20 years of his own studies and interventions on sexually transmitted diseases, AIDS, and traditional healers in southern Africa to demonstrate how indigenous peoples generally conceive of contagious diseases as having naturalistic causes. His groundbreaking work suggests how western medical practitioners can incorporate ICT to better help native peoples control contagious diseases.
REVIEWS
Anthropologist Edward Green offers here a highly readable contribution to medical and applied anthropology. Based on over twenty-five years of fieldwork and development assistance in Africa, Southeast Asia and other regions, the author of the authoritative sourcebook STD and AIDS in Africa deepens his examination of indigenous healing and disease prevention strategies. ....Anthropologists and other readers interested in the evolutionary and other bio-cultural underpinnings of indigenous systems ofcontagious illness will find the book's theoretical reflections, summarized in the final chapter, especially thought-provoking... -- Daniel T. Halperin, Community Health Systems Department, University of California, San Francisco ― Social Science & Medicine, (2000) Edward C. Green, experienced anthropologist and prolific writer, offers what can only be described as an engaging comprehensive account of ICT (indigenous Contagion Theories).... Overall, this book appears to be geared towards those who have little or no knowledge of social explanations of illnesses or of "layman" beliefs. The author does manage to convey quite successfully the details of indigenous medical explanations in a language that is easily accessible. This book is a good introduction to the area for undergraduate social scientists, health professionals and the general public. -- Catherine Heffernan, (University of Oxford) ― Medical Sociology Online, Vol 26.2, June 2002 This important new book paves the way for effective working relationships between indigenous healers and the providers of biomedical health services, and for more effective health promotion and disease prevention across the world.... I would recommend Indigenous Theories of Contagious Disease to medical anthropologists and the others who are interested in the bio-socio-cultural and historical underpinnings of ICTs, as well as to anyone with a concern for indigenous knowledge and development. -- Mirjam J.E. van Ewijk, European Research Centre of Migration and Ethnic Relations ― Indigenous Knowledge and Development Monitor, Vol. 8, Issue 1 Anthropologist Edward Green offers here a highly readable contribution to medical and applied anthropology. Based on over twenty-five years of fieldwork and development assistance in Africa, Southeast Asia and other regions, the author of the authoritative sourcebook STD and AIDS in Africa deepens his examination of indigenous healing and disease prevention strategies.....Anthropologists and other readers interested in the evolutionary and other bio-cultural underpinnings of indigenous systems of contagious illness will find the book's theoretical reflections, summarized in the final chapter, especially thought-provoking. -- Daniel T. Halperin, Community Health Systems Department, University of California, San Francisco ― Social Science & Medicine, (2000)
This is not another book about how AIDS is out of control in Africa and Third World nations, or one complaining about the inadequacy of secured funds to fight the pandemic. The author looks objectively at countries that have succeeded in reducing HIV infection rates…along with a worrisome flip side to the progress. The largely medical solutions funded by major donors have had little impact in Africa, the continent hardest hit by AIDS. Instead, relatively simple, low-cost behavioral change programs―stressing increased monogamy and delayed sexual activity for young people―have made the greatest headway in fighting or preventing the disease's spread. Ugandans pioneered these simple, sustainable interventions and achieved significant results. As National Review journalist Rod Dreher put it, rather than pay for clinics, gadgets and medical procedures―especially in the important earlier years of its response to the epidemic―Uganda mobilized human resources. In a New York Times interview, Green cited evidence that partner reduction, promoted as mutual faithfulness, is the single most effective way of reducing the spread of AIDS.
That deceptively simple solution is not merely about medical advances or condom use. It is about the ABC model: Abstain, Be faithful, and use Condoms if A and B are impossible. Yet deeply rooted Western biases have obstructed the effectiveness of AIDS prevention. Many Western scientists have attacked the ABC approach as impossible and moralistic. Some Western activists and HIV carriers have been outraged, thinking the approach passes moral judgment on their behaviors. But there is also a troubling suspicion among a growing number of scientists who support the ABC model that certain opponents may simply be AIDS profiteers, more interested in protecting their incomes than battling the disease. This book is a bellwether in the escalating controversy, offering persuasive evidence in support of the ABC approach and exposing the fallacies and motivations of its opponents.
Ideological blinders have led to millions of preventable AIDS deaths in Africa. Dr. Edward C. Green, former director of the Harvard AIDS Prevention Project, describes how Western AIDS “experts” stubbornly pursued ineffective remedies and sabotaged the most successful AIDS prevention program on that ravaged continent. Drawing on 30 years of conducting research in Africa, Southeast Asia, and other parts of the world in international health, Green offers a set of evidence-based and experience-rich solutions to the AIDS crisis. He calls for new emphasis on promoting sexual fidelity, the only strategy shown by research to work. Controversial but important findings for health researchers, international development specialists, and policy makers.
"Broken Promises combines a remarkable Present at the Creation' perspective with historical and scientific data to tell a riveting story of how AIDS prevention in Africa went so terribly wrong. You may agree or disagree with Green, but you will never be bored. The lessons go beyond AIDS and even foreign aid' to the very process of how consensus is formed in our supposedly modern scientific world." Norman Hearst, Professor, University of California, San Francisco "Dr. Edward Green is a pioneer of the approach currently gaining favor for African HIV epidemics: discouraging multiple and concurrent partners and encouraging male circumcision. Broken Promises argues for an approach to AIDS that is more African as well as more evidence based." Cedza Diamini, Ubuntu Institute, South Africa "Condoms used consistently and correctly do work effectively for couples in some countries, but condom marketing in Africa encourages earlier, riskier sex with more partners, increasing AIDS. Broken Promises explains that difficult but very important distinction." Nick Danforth, Resident Scholar, Women's Studies Research Center, Brandeis University
AIDS, Behavior, and Culture presents a bold challenge to the prevailing wisdom of “the global AIDS industry” and offers an alternative framework for understanding what works in HIV prevention. Arguing for a behavior-based approach, Green and Ruark make the case that the most effective programs are those that encourage fundamental behavioral changes such as abstinence, delay of sex, faithfulness, and cessation of injection drug use. Successful programs are locally based, low cost, low tech, innovative, and built on existing cultural structures. In contrast, they argue that anthropologists and public health practitioners focus on counseling, testing, condoms, and treatment, and impose their Western values, culture, and political ideologies in an attempt to “liberate” non-Western people from sexual repression and homophobia. This provocative book is essential reading for anyone working in HIV/AIDS prevention, and a stimulating introduction to the key controversies and approaches in global health and medical anthropology for students and general readers.
Top reviews from the United States
Reviewed in the United States on July 11, 2011
With two-thirds of the people who need treatment for HIV & AIDS not receiving it and with funding going flat, a major reassessment of prevailing approaches to prevention is in order. Sifting through a plethora of data pertaining to the AIDS pandemic and the international AIDS establishment's response to it, Green and Ruark and members of the AIDS Prevention Research Project (supported by the John Templeton Foundation at the Harvard Center for Population and Development) identify and clarify what is working and what is not working. In the course of their analysis a number of myths and misassumptions emerge - not so much within African indigenous communities, as one might suspect, but within the ranks of those charged with conducting a strategic international response. Here are a few examples:
Most married or cohabiting women who are HIV infected have been infected by their current partner.
The belief that one can be cured of AIDS by having sex with a virgin is a significant cause of child abuse and the spread of AIDS in Africa.
Gender-based violence is a significant cause of AIDS acquisition among women.
Scores of lives have been lost because the US had to uphold their ideological ideal of prevention.
Counseling and testing lead to a significant reduction in risky sexual behavior, particularly among those who test negative.
Condoms are highly effective in combating the spread of AIDS in generalized epidemics. All of these statements are essentially false. Yet Green and Ruark point out how misconceptions--some of which have been perpetuated by influential and allegedly "authoritative" reports--have dulled and even sidetracked the efforts that major donors have funded to combat the spread of HIV and AIDS. Their book examines how the global response - the creation of a western driven approach not well suited to generalized epidemics--has repeatedly erupted in a clash of values between Western AIDS programs and the societies in which they operate, and how this continues to hamper effective prevention. The chapters present the reader with anthropological insights, cultural analysis, case studies of successful prevention efforts and the best epidemiological data to guide evidenced-based prevention. In the words of the authors, "It is time we begin admitting what has not worked, recognize what has, and allow for a major realignment of prevention priorities (and dollars) toward behavioral solutions." Green and Ruark's book makes an important contribution toward advancing this process.
5.0 out of 5 stars Urgent need for attention to Biblical teachings to avert suffering by AIDS victims in sub-Saharan Africa
Reviewed in the United States on September 17, 2014
Green and Ruark blow the whistle on AIDS extortion. In house disputes between bigoted Westerners set the agenda of global AIDS prevention on ideological grounds regardless of outcomes on the ground, according to Green and Ruark. The outcome is use of vast amounts of 'global' resources to distract people from the 'real' and most helpful means of countering a deadly scourge the cost of which in human life continues to be enormous. 33 million people are currently infected with HIV globally. The people in the majorly affected populations, classically sub-Saharan Africa, should have a voice in designing preventative strategies, we are told. This message falls on deaf ears. Attempts at injecting sense into anti-AIDS strategies by anthropologists have consistently been upstaged by a pro-technology anti-values pro-gay agenda. The sexual revolution, itself on very dodgy foundations, has been guiding AIDS prevention among populations who have no time for it. Any opposition to sexual liberalism in favour of restraint is battered. Political activism and technological advocacy have been free-riders on the anti-AIDS agenda, at the cost of the sufferers on the ground. Means to curtail the spread of AIDS arising from its comprehension in communities including sufferers are consistently belittled and ignored, according to our authors. Anything that does not fit hand in glove with the narrow modern liberal poorly informed ideologies of rapacious directors of heavily funded AIDS programs is splatted. The foundations for AIDS prevention was set by gay men and family-planning advocates. Homophobia is as a result blamed for the spread of AIDS, while epidemiological truths are lost in the smokescreen. From the beginning the dominant view has been that people's sexual urges are insatiable and unstoppable. Instead of advocating avoidance of dangerous contexts of viral exposure, grossly unproven protective strategies have been given pride of place. Defense of human rights has been given priority over consideration of the wider Christian Scriptures from which they have been derived. Meanwhile, in pursuance of a morally-neutral stance, brothel owners practicing trafficking and forcing prostitution on young captive girls have been held in cozy relationship. 'General epidemics' such as in Africa are for good reason a greater apparent concern to our authors than infected minorities – such as drug users and prostitutes. "Widespread patterns of overlapping and concurrent sexual relationships" (133) are repeatedly and consistently confirmed as underlying the vast spread of AIDS in Southern Africa and beyond. While this evidence shouts out for behavioural change, especially fidelity and pre-marriage abstinence, powerful voices controlling enormous amounts of funds for AIDS prevention much prefer to occupy themselves with condoms. Reducing poverty aggravates rates of infection with AIDS in Africa, our authors emphasize. Those who have flagrantly suggested that the institution of marriage increases spread of AIDS are akin to liars promoting ideas that can have murderous homicidal outcomes. All of this seems to be done as a means of defending presupposed and unquestionable tenets of sexual liberalism. Our authors advocate promoting behaviour change towards abstinence outside of marriage, and faithfulness in marriage. Even they seem to be embarrassed by and inclined to ignore the fact that this is not a 'new' approach. It is one that has been going on and it appears that its undermining by the 'professionals' whose actions are laid bare in this book has caused vast human suffering and death. "We must address sexual behaviour head-on", something that Africans and church leaders have been saying for centuries. Meanwhile, the empty hot air about condoms and risk-reduction technologies is still causing enormous suffering. Green and Ruark should be heard and action is needed. (The author of this review lives in East Africa, cares for victims of AIDS. He has personally observed numerous disasters arising from the very things that Green and Ruark here condemn. He has been advocating abstinence pre-marriage and fidelity within marriage in Africa for the last twenty-six years.)
Reviewed in the United States on March 22, 2011
This is an extremely well researched and compellingly argued book. It makes a convincing case that the Western response to the AIDS epidemic in Africa has often been informed more by Western cultural values and social agendas than by an appreciation for solutions that are respectful of African cultural ways and traditions, and which are at the same time more cost effective and have better prospects for long-term success. While the book's tone is passionate and committed, the authors are not contentious. The perspective of the book is summarized well in a quotation it offers from President Yoweri Museveni of Uganda (p. 100): "AIDS is a 'good' disease. We know the few ways it is transmitted and it is in our control. You have a choice! You can decide not to get it. How can you stop it? You can abstain from sex. Or you can stay with one partner. Be faithful to survive. You can decide not to get it." The book demonstrates how this "ABC" approach (Abstain, Be faithful, use a Condom as a last-line strategy, not a first-line one) is harmonious with African culture and has led to some of the most notable reductions in infection rates. The issue is of course complex, but this book hopefully will put an important and promising approach on the table where it can receive serious attention and consideration. (I am personally acquainted with one of the authors, Ms. Ruark.)