The Invisible Cure: Africa, the West and the Fight Against Aids Helen Epstein Viking, 352pp, £16.99

Who do you blame for Africa's struggle with Aids? Helen Epstein doesn't blame the chimps or the monkeys that harboured the virus's forerunner, nor the hunters who butchered them clumsily enough to pick up the disease themselves. She doesn't even blame the doctors who she suspects inadvertently made the virus more vicious, their 20th-century efforts at vaccination giving it a chance to mutate.

To begin with, it doesn't sound as though she blames Africans. "When it comes to fighting Aids," she says, "our greatest mistake may have been to overlook the fact that, in spite of everything, African people often know best how to solve their own problems." Yet the next few hundred pages seem to suggest that she believes this generality to be inaccurate. Epstein's Africa is a corrupt, hypocritical and lazy place. People are perpetually willing to mislead, and to be misled. "Denial [seems] to be the unofficial policy of the nation, even much of the continent," she concludes in South Africa.

But it is because of the way whites behaved in Africa, Epstein decides, that Thabo Mbeki and leaders like him appear to prefer denials and excuses to attempts to help their people. She spends a great deal of effort trying to work out how it was that Uganda, at least briefly, did very much better. It was down to honesty, she decides, and a collective sense of being both vulnerable and responsible. (Speculatively, she credits this to colonial rule in Uganda having been less of a shattering experience.) Epstein describes the disappearance of these successful attitudes in the late 1990s, the country's previously pragmatic public health campaigns giving way to condom-burning and the preaching of sexual abstinence. In the past decade, she notes, a third of all Ugandans have become born-again Christians, their conversion aided by American Aids money being directed towards using the disease as an opportunity to evangelise.

Sexual concurrency takes centre stage in her explanation for why HIV rates are vastly higher in Africa than in the west. Even promiscuous serial monogamy, she argues, does not transmit the virus so efficiently as having two long- term partners on the go at once. In among the stories of cheating lovers, and occasionally lost between them, are statistics supporting her argument that long-term concurrent sexual relationships are a very African custom. (Less persuasively, she also seems to suggest that heterosexual men sleep with more partners on average than heterosexual women.)

This book is partly an account of HIV's appearance and spread, partly a memoir of Epstein's own experiences, and mostly an attempt to explore the awful mismanagement of the crisis in Africa. Epstein starts with her own entry into Aids research, after her original interest in more abstract postdoctoral biochemistry evaporates. But when she moves to Africa, her new experiments fail, and a sense of futility and frustration quickly emerges. "Sometimes I don't know what I am doing here," says an American doctor she meets, and Epstein agrees.

A little way along, Epstein's personal account of her medical career gives way to years researching attitudes to Aids in Mozambique or Uganda, or Zimbabwe or South Africa. At worst, she slips into bad travel writing. At best - and there is far more good than bad in this book - she makes a serious attempt to explore the epidemiology of thoughtfulness, as well as that of HIV. She wants to know why clarity and honesty, as well as human lives, so often become casualties of Aids.

The Invisible Cure suggests that neither charity nor anecdote is a robust enough solution. The worst in human nature too easily corrupts them. Epstein argues forcibly, but never suggests putting her ideas to a formal test. The temporary improvements in Uganda coincided with steps that Epstein believes to have been causal, but such associations will never be enough to wipe away prejudice, persuade the misguided or shame the lazy and the corrupt. Objective trials just might. Testing social policies, as well as drugs, would be a huge undertaking, but Aids deserves the effort.

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