Improper use of water is a major global health threat. Here in downtown Calcutta a single water source is used for washing, drinking, animal defecation and food preparation.
-- Photo by Laurie Garrett
"Half the city dwellers of developing countries who were not classified as homeless would live in shantytowns and slums that, among other things, lacked safe drinking water. Forty percent would be without public sanitation or sewage facilities." (pg. 250)
As the rural poor of the world move to urban centers, they bring their livestock into the densely populated settings, creating ideal conditions for zoonotic disease. (Calcutta, India)
-- Photo by Laurie Garrett
“In the microbial magnets – the world’s urban centers – research is needed to determine which aspects of city life most amplify microbial spread.” (pg. 615)
The world is undergoing the most rapid urbanization in history, with most new residents of burgeoning Third World cities condemned to squalor such as this, outside Saigon.
-- Photo by Linda Garrett
“Cities, in short, were microbe heavens, or, as the British biochemist John Cairns put it, ‘graveyards of mankind.’ The most devastating scourges of the past attained horrific proportions only when the microbes reached urban centers, where population density instantaneously magnified any minor contagion that might have originated in the provinces.” (pg. 235)
Like this woman, many Tanzanians suffer the double insult of tuberculosis and HIV.
-- Photo by Rian Horn
“Thus, hundreds of thousands—perhaps millions—of people in developing countries, who didn’t yet realize that they were infected with HIV, were at tremendous risk for tuberculosis.” (pg. 516)
In Masaka, Uganda, business is down, the casket makers complain, as they toil under the watchful eyes of AIDS orphans. But this may not be good news, as the epidemic has created so much poverty in the villages that families can no longer afford coffins for their dead.
-- Photo by Rian Horn
“The most lethal clade—one whose members seemed to kill human beings with terrifying efficiency—was Type D, which was found almost exclusively in Africa’s Lake Victoria region, encompassing Rwanda, Uganda, and Tanzania.” (pg. 378)
Bishanga Ndamwesiga, age 40, is dying of AIDS in his tiny home in Ntoma village, Tanzania. His 3-year-old daughter and young wife are also dying of the disease. On his wall are all the fond memories they share.
-- Photo by Rian Horn
“The virus had gone from epidemic to endemic status in key population groups around the world. It had defeated the powers of science that just a decade earlier had led public health planners to confidently agree to cut their sexually transmitted diseases budgets.” (pg. 361)
Matilda Namuli, age 80, has lost her husband and seven of her children to AIDS, and is now raising 23 orphaned grandchildren. She is pointing to one of her daughters' graves, buried on the family farm in the village of Kyebe, Uganda.
-- Photo by Rian Horn
“There is no doubt, AIDS threatens to alter the economic and social fabric of many societies, which may affect the developmental process…The major problem AIDS presents today is the factor of creating an increasing number of orphans which traditional societies are beginning to fail to cope with.” (pg. 487)
Here in Kansansero, Uganda, the modern AIDS epidemic began around 1974. Today, after three generations of epidemic suffering, all the children are orphans, most of the women are sex workers, and most the fishermen are HIV+.
-- Photo by Rian Horn
“The period 1970-75 was marked by guerilla warfare, civil war, tribal conflicts, mass refugee migrations, and striking dictatorial atrocitites in some parts of Central and Southern Africa. Such strife could have affected the historic course of HIV in both direct and indirect ways.” (pg. 368)
The AIDS epidemic has taken such a toll in the Lake Victoria region that this Lutheran orphanage in Ntoma, Tanzania specializes in caring exclusively for under-2-year olds whose parents have died of HIV infection.
-- Photo by Rian Horn
“Meanwhile, the U.S. Census Bureau predicted dire upturns in infant and child mortality in several African nations, due both to direct AIDS deaths and to neglect of children orphaned by the deaths of parents who succumbed to the disease.” (p. 487)
These HIV+ women in Kampala, Uganda all acquired their infections from their husbands, who refused to use condoms. Women are powerless to protect themselves.
-- Photo by Rian Horn
“I know my boyfriend is seeing other women when he travels to this place or that place, but what can I do? When he comes home he is so handsome and I reach out and say ‘Oh darling, darling,’ and all is forgiven.” (p.340)
Sex workers in Bombay learn how to use condoms to prevent HIV infection.
-- Photo by Laurie Garrett
“By mid-1990 the infection rate among Bombay’s prostitutes had risen to 10 percent and 5.6 of every 1,000 blood donors in the city carried the virus….One Bombay STD clinic was finding infection rates among prostitutes of 40 percent.” (pg. 491)
The new urban centers of the poor world have markets, but little else -- including no sewers or water drainage systems.
-- Photo by Laurie Garrett
“Continued urban growth was forecast, and it was predicted that by 2000 there would be 3.1 billion Homo sapiens living in increasingly crowded cities, with the majority crammed into 24 megacities, most of them located in the world’s poorest countries.” (p. 2)
Swine flu vaccination 1976
-– archive photo
“Swine Flu threw ice water on the previously warm relationship between public health and individual rights. It set a precedent that would haunt all vaccine effors inside the United States for decades…” (pg. 183)
Smallpox eradication
-- archive photo
“In 1958 the Soviet Union went before the World Health Assembly – the legislative body of the World Health Organization in Geneva – to request an international campaign for the elimination of smallpox, winning virtually universal support.” (pg. 40)
The last smallpox case in Bangladesh
-– archive photo
“In Bangladesh, for example, where the worldwide campaign faced its toughest battle due to the great population density and ancient smallpox endemicity, French physician Daniel Tarantola braved confrontation with an infamous murderer thought to be a smallpox carrier.” (pg. 42)
The last case of smallpox
-– archive photo
“Finally, in Merka, Somalia, the team found the world’s last case of variola minor. Ali Maow Maalin would be cured, and all forms of smallpox disappeared. Smallpox had been conquered.” (pg. 46)
Mother Theresa’s AIDS care center in Calcutta.
-– Photo by Laurie Garrett
“When officials at WHO plotted India’s AIDS forecast…they were able to compare its growth rate with Africa’s: while the slope of Africa’s pandemic arched upward at a gentle angle for the 1990s, India’s forecast was a sharp line soaring up at a 60-degree angle.” (pg. 493)
About photographers
Rian Horn was a young South African on his first photojournalism assignment outside of his home country when he traveled with Laurie Garrett in Uganda and Tanzania, documenting the impact of HIV. Horn continues to live in South Africa, working as a freelance photojournalist for such entities as Reuters, The Guardian and The Washington Post. See more at: http://www.facebook.com/people/Rian-Horn/100000010571266.
Laurie Garrett sitting in Brezhnev's lap, Moscow, 1997
Though Laurie Garrett is not a professional photographer, more than a hundred of her pictures have been professionally published over the years, particularly by Newsday. Many of her photographs appearing on this website – including all of those shot in September 2001 – are herein seen publicly for the first time.