Out of Africa: the arrogance of an AIDS vaccine

Mourn the death of the campaign for an AIDS vaccine but also cheer it. The push for a â''silver bullet,â'' however human an impulse, reflected as much an overwhelming arrogance on the part of scientists as the inherent difficulty of engineering a preemptive technological response to a protean disease.

The field of vision should be clearer now. Pragmatic and relentless behavioral and societal adaptations are the best (and most humanistic) responses to the persistence of new cases of HIV/AIDS. As Helen Epstein wrote last year in her brilliant polemic on the disease, â''The Invisible Cure,â'' the most effective responses in Africa â'' where the disease remains an enormous public-health issue â'' are animated by mass-based social mobilizations. In Uganda, where social mobilization has perhaps gone the furthest on matter of AIDS, the results have been impressive.

After 20 years of discussing the possibility of an AIDS vaccine, the time has come to pause and let the social mobilizers hold sway in the field of prevention, unburdened by the â''noiseâ'' of well-meaning technocrats holding out the hope of a swift and easy intervention, unfettered by concerns about social organization and culture. In fighting AIDS, as in much else, social values and political mobilization, are decisive. The failure of the vaccine movement provides a convenient opportunity to remember the limits of technological innovation and the perils of engineering arrogance.

To be thrown on the social and cultural, however, is not to escape the awful dimensions of HIV/AIDS. On my visit early this month to a community of farmers in eastern Uganda, I was humbled by the capacity of human beings â'' alone and in their chosen groups â'' to deny, dissemble and even self-destruct in the face of lethal threats. In the foothills of majestic Mount Elgon, the leaders of a community Iâ''ve come to know and respect have fallen prey to new cases of HIV/AIDS. These men and women only fitfully sought treatment, and their â''prevention strategiesâ'' remain flawed.

The hollow promises of an AIDS vaccine had never reached this Ugandan village. In the homes of the stricken, there are no technocratic delusions, only evidence of flawed humanity.


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