Preface

History is replete with stories of European colonizers attempting to “civilize” nations and societies they considered less developed than their own. Those European countries that participated in the “Scramble for Africa” in the 19th century had a profound and not always positive effect on the continent. Over the course of nearly 100 years, virtually every country in Africa was colonized, and as the Europeans attempted to transform the tribal cultures into societies more closely resembling those in the West, the way Africans lived changed immensely. This was especially true in the geographically immense area of sub-Saharan Africa, defined by its location south of the Sahara Desert and by its ethnic, cultural, and political differences from North Africa. Unfortunately, once these sub-Saharan countries began to achieve their independence after World War II, they were virtually abandoned by the international community and left without the proper structures to continue life as it had been. A return to traditional culture at this point was impossible, and governing and caring for themselves under the foreign structures imposed by Europeans made for a difficult transition.

One of the most affected areas of African society was the health care system. During the colonial period, cultures that had once depended on traditional healers like the Sangomas of South Africa were placed under the care of the church and state. However, as these countries gained their independence, it became necessary to instill a more relative system that varied according to each culture. This process could not be completed overnight, and consequently a resurgence of disease resulted due to lack of education, deficient health care systems, and cultural taboos that interfered with procuring proper care.

HIV/AIDS has been one of the most devastating diseases to affect sub-Saharan Africa. Although most of the early cases were detected in the United States, scientists have since suggested that the first documented case of AIDS was likely identified in the Congo in the late 1950s. In the past 15 years, HIV/AIDS infections have skyrocketed in Africa. At one point, it was reported that as many as one in four South Africans were afflicted with the disease. Chapter 1 presents a variety of articles that discuss the current AIDS situation and its possible remedies in sub-Saharan Africa. An area that has drawn particular concern, discussed in Chapter 2, is the increasing prevalence of HIV/AIDS in women and children. Due to the social constructs of certain African cultures, men may have multiple sex partners, and it is not only taboo for a man to wear protection, but it is also considered disrespectful for a woman to suggest it. The articles selected propose possible strategies to change the way women are treated domestically and medically, given the great concern not only for their well-being, but also for their children’s. Indeed, the number of AIDS orphans has been growing exponentially each year, and while most of these children do not contract the disease themselves, they are often left without care and support.

Though the HIV/AIDS pandemic has garnered mass attention in and out of Africa, researchers, scientists, health care providers, and some philanthropists are attempting to ensure that people do not overlook what have been termed “neglected diseases.” Chapter 3 features articles that discuss the various problems encountered in combating tuberculosis, malaria, and other tropical diseases, as well as their possible solutions. Chapter 4 presents specific difficulties and some of the various methods that have been suggested to improve the health care system in sub-Saharan Africa, including importing health care workers from elsewhere in Africa, creating relationships between private and public health care institutions, using traditional cures, and focusing on regional support.

Finally, as sub-Saharan Africa has reached a state of crisis, Chapter 5 looks at the issue of U.S. aid to the region. Most of the articles focus on the HIV/AIDS pandemic because of President Bush’s PEPFAR campaign to combat the disease internationally, but sub-Saharan Africa has become the topic of the moment, and more and more aid is being supplied via programs initiated by the United States. The question now is whether or not that aid will be enough.

I would like to extend my gratitude to all the authors and publications that have granted permission to reprint their work in this collection. Also, I would like to especially thank Lynn M. Messina, Richard Stein, Paul McCaffrey, David Ramm, Ronald Eniclerico, and Christopher Mari for their help and advice with this project.

Forrest Cole
June 2007