Farmer, a physician-anthropologist and activist, examines both the way that poverty and inequality result in the spread of HIV and TB today and the flawed justifications for inequitable access to treatment. His ethnographic analysis provides a powerful complement to standard epidemiological work, and this treatise on the danger as well as the immorality of inequity in medical care is largely convincing.
Farmer illustrates several broad themes effectively with case studies from Haiti and Peru. One is the idea that most studies overemphasize individual agency, failing to recognize serious "structural" factors, such as the pressure that extreme poverty exerts on people to engage in unhealthy behaviors and the problems introduced by economic inequality. (One example of the latter is that in unequal countries like Peru, second-line TB drugs are available because of demand by the rich, so doctors also prescribe them to the poor who can only afford them intermittently, which generates drug-resistant strains of the disease.) Another theme is that people in rich nations tend to place heavy weight on "strange" cultural beliefs and customs in explaining high disease prevalence, whereas actual epidemiological research tends to show that these factors carry little weight relative to poverty-related factors. While he uses AIDS in Haiti to illustrate this tendency, it applies perfectly to popular Western conceptions of AIDS in Africa: the popular media tend to emphasize cultural practices such as wife inheritance and a strong sex drive, whereas epidemiological research fails to support a major role for these.
A third theme, which Farmer often trumpets but not as convincingly, is that many of the trade-offs voiced by policymakers are ultimately false. One example is the question of whether to treat tuberculosis with drugs or prevent it (e.g., by investing in economic development). He then uses the success of his clinic in Haiti as an example of both treating and preventing TB. The ultimate argument is that the wealthy have no right to withhold their wealth from the poor. However, he gives us no clear sense of how the resources to generalize this to the world at large should be marshaled. While the trade-off may be philosophically false, the practical application is unclear.
But even without a plan of action, Farmer illuminates key problems in the analysis of infectious disease spread and makes a convincing plea to share the wealth (and the technology).