AIDS and Accusation is concerned with refuting these accusations and examining the interesting question of why these were made. On the question of the origins of HIV/AIDS, Farmer's initial arguments that Haiti was neither the ultimate nor the proximate source of the American HIV/AIDS epidemic have been confirmed by modern science. We now know, for instance that HIV/AIDS likely originated in central Africa not Haiti, while modern virological studies and sad medical cases like that of a young New Jersey girl born to an IV drug-using mother who died of a straightforward case of pediairic AIDS in 1979 at the age of five that HIV/AIDS was present in the United States at least as early as it was in Haiti. At the very least, HIV was transmitted in both directions between the two nations. Haiti was certainly not responsible.
Why did HIV/AIDS find such firm root in Haiti, so much more so than in the United States? Farmer traces the reasons for this to Haiti's position of extreme dependency. As Farmer demonstrates in his survey of Haitian history, Haitians have very rarely ever been in a position to bargain, whether as slaves brutally oppressed by the ancien régime or as nominal subjects of dictatorships supported by racist Great Powers. The destruction of Haiti's pre-independence sugar industry destroyed Haiti's main sources of foreign exchange, while multiple foreign interventions kept Haiti from developing an alternative source of income and Haitian peasant agriculture collapsed under the strains of population growth and destructive foreign competition. This slow-motion collapse left Haiti in the 1970s with no choice but to use its people as export commodities, whether as cheap labour in the assembly plants of Port-au-Prince or as prostitutes whose services were contracted by foreign tourists. This pervasive desperation precipitated by dependency on a remote American metropole, Farmer argues, is responsible for the rapid diffusion of HIV throughout Haiti. His counterfactual hypothesis that absent Castro's revolution, Cuba might have been an epicentre of what Farmer calls the "West Atlantic" epidemic might be overstated but he does have a point.
What makes AIDS and Accusation more than a competent survey of the Haitian HIV/AIDS pandemic is Farmer's superb integration of his Do Kay experiences into his wider narrative of Haitian dependency. The village that is his subject was founded on infertile highlands by refugees from an Artibonite river valley drowned by the 1956 construction of the Péligre dam. Education was the only way for Do Kay's residents to better themselves, but this cost money that the inhabitants lacked and so many of their number left, travelling to Port-au-Prince or even the United States in the search for something better. Manno, the first man in Do Kay to die of AIDS, was a schoolteacher come from away who was unpopular because of his foreignness and whose death meant little. It was only later when Anita returned to Do Kay, suffering from tuberculosis that was infinitely worsened by her infection with HIV by the only man she had ever slept with, cared by a godmother who wanted to make sure that she at least had a good death, that the people of Do Kay slowly realized that they faced still another new threat to their existence, something else coming from outside.
AIDS and Accusations demonstrates superbly that the Haitians have a long acquaintance indeed with globalization, and that HIV/AIDS--certainly one of Haiti's more pressing problems--is only the latest in a series of catastrophes. Farmer deserves to be praised for his insights, though I'm left wondering why more people didn't pick up on the connections between poverty, globalization, and illness. If more people had paid attention to southern Africa after apartheid and the former Soviet bloc after Communism, so much suffering could have been averted. It certainly should have been.