Book Cover
Lesley Doyal, with Len Doyal

Living with HIV and Dying with AIDS: Diversity, Inequality and Human Rights in the Global Pandemic

Ashgate, UK, 2013, Paperback ISBN: 978-1-4094-3111-4, 264pp

Reviewer: Pamela Pitman Brown, PhD
Winston-Salem State University, USA
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The book
is one of the newer titles in the ‘Global Health’ book series presented by Ashgate Publishing, and edited by Nana K. Poku. The series provides global health-focused texts, which construct health issues from socio-cultural, a socio-economic, and a moral political standpoint rather than a more medically based perspective. This text is one of six offering research projects or literature reviews on HIV/AIDS, having the distinction of being the only one published within the past 3 years. As the author, Lesley Doyal writes in the introduction, the central theme of the text purports “the value of bringing social sciences into the study of HIV and AIDS, especially when that is based on interdisciplinary collaboration.” The text conveys how the HIV epidemic cannot be deliberated within a global north ideological position of personal responsibility, but offers up how the HIV epidemic is enmeshed within the larger global economic sphere, where poverty and socio-structural violence amplifies the disparity of survival between the haves and the have-nots of essential resources.

The initial chapter of the text,
Posing the Problem, references Randy Shilt’s And the Band Played On including statistics from WHO, UNAIDS, and UNICEF. Additionally, Doyal inserts a precise explanation of the biological underpinnings of the HIV epidemic, including information on the various stages and progression of the illness. This narrative is one of the most simplistic, nevertheless accurate explanations that I have encountered on the HIV epidemic. The aforementioned, along with the introduction of four created case studies, sets the tone of the text to one of teaching to and not teaching down. This is most important when instructing students at the undergraduate/graduate level who do not have the historical or biological background on the origins of the HIV epidemic; they can become enlightened and not bored with pages of incomprehensible terms.

Of particular interest to me is Chapter 2,
Mapping the Pandemic, as Doyal mentions the oft neglected group of those who are aging (over 50) with the illness, stating estimates of those cases from both a global and country specific perspective. Doyal’s dialogue on the globalised differences of transmission routes of HIV references groups such as MSM, IDU, and sex workers is enlightening, and additionally a conversation on China and their HIV epidemic is included. She also uses quite a few pages to discuss the topic of intersectionality concerning women specifically. Doyle interjects the concept of the limited, homogeneous, and summative descriptives of those with HIV, without acknowledging the usually heterogeneous and multiplicative characteristics we find as researchers for those who are HIV positive. This intersectionality within the text’s foundational framework is Doyle’s contribution to how these individuals’ who are HIV positive are renegotiating their local and/or global environment and their negotiation of daily life.

As I moved into Chapter 3 I realized how much extant knowledge of HIV would be needed during the reading for students. Additionally, it became obvious that many undergraduates would not benefit from the text, as additional sociological mastery, and more medical and global understanding (particularly for Chapter 4) was required to continue reading. Moving into Chapter 5,
Challenging Livelihoods, Doyle appears to have begun to come back to the level where undergraduates can then understand how sociological factors such as lack of paid work, gender inequalities within paid/unpaid care work, and gender roles within families who are dealing with the challenges of the HIV epidemic, influence economic and social circumstances. Additionally, Doyle addresses the tragic intergenerational responsibilities pressed upon the oldest and the youngest of the caregivers, the mothers and the children of the infected. Chapter 6, Changing Sexual Lives, will be one of the most useful tools in the text for health educators of HIV+ individuals, Doyle not only discusses abstinence policies but body dysmorphic, power differentials when one partner becomes positive, and the issues of condom use among MSM, including the lack agreement of status disclosure.

Chapter 7 discusses reproduction as HIV+ individuals and alludes to the differences between those in rich countries, who have technological means to hinder the virus from passing to the child, and those in sub-Saharan Africa. Additionally the chapter discusses the choices, intentions, and decision-making processes individuals consider for parenthood desires. Chapter 8 on
Human Rights is an excellent chapter for any student to read and understand principles and challenges of the universality and the move forward to protect others. The final chapter, Back to the Future, focuses on HIV/AIDS research issues, as well as the challenges of funding, linked to resource allocation, reminding us that HIV includes the word “human.”

I would suggest using this text within an advanced sociological course on HIV/AIDS or Medical Sociology, but would refrain from using it as a sole text, encouraging instructors to supplement with current news or journal articles, bringing in the global North’s HIV research as well.

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