The chief reasons for the failure of international Aids policies in Africa during the late twentieth century were that they came too late to check an expanding epidemic and had no effective medical remedy with which to do so, but another reason was that the medical thinking underlying international policies often conflicted with the ways in which most Africans perceived the crisis. Their responses were diverse, as is commonly true in epidemics, but this was particularly so with HIV because its long incubation period and lack of distinctive symptoms bred confusion and encouraged denial. At an individual level, as a Ugandan woman said, ‘Everybody suffers from silimu differently.’ At the collective level, understandings were set within the context of a long dialogue between indigenous notions of causation, which were chiefly moralistic, and the medical explanations propagated by governments and Western-trained doctors. Similar debates surrounding cholera epidemics in nineteenth-century Europe and America had resulted in victory for medical explanations because they worked, but in late twentieth-century Africa the doctors had no effective remedy and moralism remained powerful. Yet this moralism was not merely traditionalist, for it had blended with the imported moralism of world religions. The result was a hybrid, a popular response to the epidemic that was at once stigmatising, caring, and capable of motivating behavioural change.

The initial response to HIV/Aids was commonly to blame Others. Indignant at suggestions that the virus had originated in Africa, intellectuals insisted that it was rather ‘the white man's burden’, a disease of American and European homosexuals, imported, it was said in Kinshasa, in canned food threatening both health and authenticity. Villagers in Burkina held that HIV originated when a white man paid a woman to have sex with a chimpanzee. The ANC's periodical suspected ‘the laboratories of many imperialist countries’. Other black South Africans saw it as an Apartheid device, spread perhaps by teargas, designed to decimate the black population - an outcome described by one white extremist as ‘like Father Christmas’. Immigrants and refugees from other African countries were widely held responsible. Villagers blamed townsmen. Elders blamed the young. Men and women blamed one another.