Reviewed by Eleanor J. Bader
Nicole Itano’s No Place Left to Bury the Dead zeroes in on three communities in Botswana, Lesotho and South Africa and scrutinizes the dynamics that make females vulnerable to the AIDS virus. Her findings are gripping.
A professional journalist, Itano spent years with the women she profiles and confesses that she often acted less like a reporter and more like a friend. When a small amount of cash is needed, for example, she doles it out. This in no way tarnishes the book but instead gives readers deep insights into the lives she documents.
The first person Itano introduces is Adeline, a college student in Lesotho who fell in love with a man she later learned was HIV-positive. At first, Adeline blames her exhaustion and illnesses on a grueling schedule that has her juggling work and school with care of an infant son. But after two years of declining health, she finally heeds her doctor’s suggestion and takes an AIDS test.
Adeline’s story moves from despair to activism and showcases the political denial that kept Lesotho’s government from slowing the pandemic. The largely Catholic country, Itano writes, refused to promote condoms and waited until 2003 to open its first no-cost screening center. By that point, she reports, life expectancy had fallen to 36 years and an estimated 25 percent of Lesotho’s population was infected.
The issue of culture is also addressed. Although polygamy is officially banned, in practice most Sotho men have both wives and mistresses. “According to a contemporary saying,” Itano writes, “a man is a pumpkin, with many vines stretching in different directions. A woman, in contrast, is a cabbage; she stays closed up, waiting for her man to come home.”
On top of this, appropriate healthcare is often unavailable. “When Adeline gave birth in 2001,” Itano continues, “no hospital in Lesotho routinely offered HIV tests to pregnant women, much less antiretroviral drugs. The use of antiretrovirals to prevent the transmission of the virus from mother to child was well proven by 2001, but only a tiny number of HIV-positive pregnant women had access to it.”
It’s an enraging, shameful story that extends far beyond Lesotho’s borders.
There’s South Africa, for one, with approximately five million HIV-positive people. Everywhere Itano travels, elders scramble to care for orphaned children and she is once again shocked by governmental inaction and the taint that surrounds the disease. Religious resistance to condom use, alongside rumors that AIDS is an effort to reduce the Black population, compound the crisis by stalling discussions of safer sex practices.
Thankfully, Botswana offers a more enlightened approach. The first African nation to offer free antiretroviral drugs to people with AIDS, government leaders openly encourage testing, discuss condom use, and are respectful of PWAs. Although the program did not begin until 2000—when an estimated 40 percent of adults were infected—it’s progress.
That said, stigma persists and many Botswanans refuse to be evaluated or examined.
The women Itano introduces are rarely model citizens—some drink too much while others fail to follow medical protocols—but they offer an insightful look into the difficulties endemic to challenging societal norms and shifting human behaviors. While the book could have been more political—lambasting pharmaceutical companies and international aid programs that require promotion of abstinence over prophylactics—the personal focus is effective and highlights the links between health, education, poverty, substance abuse and misogyny.
The result is by turns poignant and painful, hopeful and sad—a vivid reminder, should we need it, that the pandemic is far from over.