BOOK REVIEWS 103do not easily fall in line with the thrust of protest African literature. His isan unsettling voice closer perhaps to A. Kwei Armah's in The BeautyfulOnes Are Not Yet Born (1968) and Yambo Ouologuem's Bound to Violence(1968). Flora Veit-Wild's book captures in detail the complex and oftenconflicting facets of Marechera's life and art. The work of Marechera andhis life are shown as closely related and near the anarchist tradition. Thebook is accessible to most members of the public and a more than welcomesource of information for literary scholars.Literary works referred to In the textARMAH A. K., The Beautyful Ones Are Not Yet Bom (London, Heinemann,1963).MARECHERA D., House of Hunger (London, Heinemann, 1978).Š, The Black Insider (Harare, Baobab Books, 1990).Š, Black Sunlight (London, Heinemann, 1980).Š, Mindblast (Harare, College Press, 1984).Š .Cemetery of The Mind (Harare, College Press, 1984).OUOLOGUEM Y., Bound to Violence (Oxford, Heinemann Int., 1968).WILD F., Dambudzo Marechera: A Source Book on his Life and Work (Harare,University of Zimbabwe Publications, 1992).University of Zimbabwe R. ZHUWARARAAIDS: Action Now: Information, Prevention and Support in ZimbabweBy H. Jackson. Harare, Aids Counselling Trust and School of Social Work,2nd edn., 1992, xvii, 334 pp., ISBN 0-7974-1146-1, Z$25.The second edition of AIDS: Action Now is so substantially revised that itscarcely resembles the first edition. The new edition bears the stamp ofthe author's own longstanding involvement in AIDS research, preventionand treatment programmes. The chapters are well chosen, covering mostmajor areas of AIDS activity. The book is comprehensive, insightful andreadable. It skilfully interweaves scientific publications, workshopproceedings, conference papers, donor-agency reports, newspaper articles,letters and interviews with AIDS workers. Its presentation is appealing asit includes numerous maps, graphs, charts, cartoons, samples ofeducational materials and photographs. Well-chosen quotations heightenthe reader's interest. Boxes are skilfully used to complement the maintext, particularly in highlighting the key points at the end of the chapter.Each chapter also contains reference lists.The book begins with a chapter on the global, regional and nationalepidemiology of HIV and AIDS. The global review is excellent, as is the104 BOOK REVIEWSZimbabwean analysis which notes that, unlike many countries in easternand central Africa, Zimbabwe has comparatively high levels of HIV infectionin rural areas Š probably because of Zimbabwe's relatively well-developedtransport infrastructure. 1 think regional differences could have been moreclosely examined. Why, for example, are HIV rates in Zambia's Copperbeltand Luapula provinces apparently several-fold higher than those in Zaire'scontiguous Shaba province? Similarly, why are HIV infection levelsapparently so much higher in many East African countries than in most ofWest Africa (excluding Cote D'lvoire)? Are the underlying dynamics of HIVtransmission inherently different between East and West Africa? Such ananalysis has important implications for an understanding of the socio-economic concomitants of HIV transmission and for the formulation ofprevention strategies.The chapter on biomedical aspects of HIV and AIDS, notwithstandingminor technical quibbles, will be of particular value to individuals andfamilies seeking to understand the symptoms and progression of HIVillness. The chapter on the transmission of HIV highlights the role of STDin facilitating HIV transmission, but does not address the derivative questionas to whether substantial investment in STD prevention and control willdemonstrably reduce HIV transmission. The section on avoiding HIVtransmission gives sound advice for the individual and highlights generalareas and issues for consideration in prevention programmes. Programmesfor vulnerable groups, such as prostitutes and their clients, long-distancetruck drivers and soldiers, are stressed, but the underlying logic andcontroversy of the 'core group' theory is not presented. By citing manyreasons people give for not using condoms, the author may unintentionallyactually 'mystify condom use'. Regardless of the objections people maycite, the evidence strongly suggests that wherever condoms have beenintensively promoted in Africa, a rapid and dramatic increase in condomuse has resulted. Up to now the fault has been with our programmes notour audiences.The section on testing is good, probing the personal issues involvedin seeking an HIV test and the economic wisdom of apportioning a largeproportion of medical resources to HIV testing. The only possible additionto this chapter would be a critique of recent data from Rwanda andUganda on the role of counselling centres and anonymous testing.The chapter on self-help and community support provides usefuladvice for the individual and valuable examples of support programmesfor communities, but concrete programme advice is not provided.Community care is well introduced and sound advice is offered to anyonewith HIV or anyone who is caring for somebody with HIV but, as is the casewith much of the literature, there is little analysis of its cost-effectivenessor large-scale feasibility. Recent studies by Susan Foster (1993) and hercolleagues from the London School of Hygiene and Tropical Medicine ofcommunity care in Monze District Hospital in southern Zambia reflect agrowing pessimism about the cost-effectiveness of community care. Thefounder of one of Zimbabwe's least expensive home-care programmesBOOK REVIEWS 105recently estimated that the cost of their community-care programme wason average about Z$200 per home visit. Ways of reducing the cost ofcommunity care are urgently needed.The counselling section is probably the best I have read, but there isno debate regarding the priority that should be assigned to counselling. Itmay be argued that counselling is perceived by communities as lessimportant than ongoing Person with Aids (PWA) support groups andsolidarity, community care, material support and orphan and survivorsupport programmes and that counselling is frequently a refuge oforganizations who feel overwhelmed by the magnitude of other needs andwho do not have experience of outreach work or of planning and managingcommunity-based programmes.The section on AIDS and employment, drawn partly from Ms Jackson'sseminal work (Jackson and Pitts, 1989) in this area, is very useful. Thechapter on public awareness, policy and programmes is interesting andwide-ranging, perhaps too much so. The recommendations are admirable,but there is little indication of the four or five most critical areas uponwhich Zimbabwe should focus its greatest energies. The final chapter, oneducation for change, outlines many options and offers advice, but includeslittle concrete help on-programme management. AIDS training programmesconsistently find that organizations have a general linguistic and conceptualfamiliarity with AIDS approaches that belies their ability to plan andmanage intensive, sustained outreach programmes. The cost-effectivenessof different intervention strategies could also have been examined.In conclusion, AIDS: Action Now is comprehensive, readable andaffordable. It is a remarkable achievement, one which deserves the widestpossible circulation in Zimbabwe and elsewhere in Africa.ReferencesS. FOSTER, Cost and Burden of AIDS on Zambian Health Care System:Policies to Mitigate the Impact on Health Services (Virginia, John SnowInc., 1993).H. JACKSON, and M. K. PITTS, 'AIDS and the press: An analysis of thecoverage of AIDS by Zimbabwe newspapers', AIDS Care (1989), i, i, 62-64.University of Zimbabwe D. WILSON