The Epidemic: A Global History of AIDSby Published 19 Sep 2006
|The Epidemic: A Global History of AIDS.pdf|
From the Castro bathhouses to AZT and the denial of AIDS in South Africa, this sweeping look at AIDS covers the epidemic from all angles and across the world. Engel seamlessly weaves together science, politics, and culture, writing with an even hand—noting the excesses of the more radical edges of the ACT UP movement as well as the conservative religious leaders who thought AIDS victims deserved what they got.
The story of AIDS is one of the most compelling human dramas of our time, both in its profound tragedy and in the extraordinary scientific efforts impelled on its behalf. For gay Americans, it has been the story of the past generation, redefining the community and the community's sexuality. For the Third World, AIDS has created endless devastation, toppling economies, social structures, and whole villages and regions. And the worst may yet be to come: AIDS is expanding quickly into India, Russia, China, and elsewhere, while still raging insub-Saharan Africa.
A distinguished medical historian, Engel lets his characters speak for themselves. Whether gay activists, government officials, public health professionals, scientists, or frightened parents of schoolchildren, they responded as best they could to tragic happenstance that emerged seemingly from nowhere. There is much drama here, and human weakness and heroism too. Writing with vivid immediacy, Engel allows us to relive the short but tumultuous history of a modern scourge.
"The Epidemic: A Global History of AIDS" Reviews
I do not recommend this book as a comprehensive history of the AIDS pandemic, as promised in the title, and still less as an introduction to the subject. Engel, a graduate of Yale's history of medicine program, covers an interesting spread of issues, but at least a moderate amount of background reading on HIV/AIDS, particularly the early history of the disease in the US, is absolutely essential for wading through this decidedly mixed-bag. The book suffers from a muddled treatment of important subjects and occasionally alarming lapses in basic research.
The author’s discussion of Reagan’s handling of the nascent AIDS epidemic falls into the first category. Engel sketches Reagan’s record in almost entirely laudatory terms. At worst, the president is portrayed as tone-deaf in his long failure to overtly acknowledge the crisis, but with his heart essentially in the right place. Engel dispenses with the prevailing negative assessment of Reagan with one sentence blaming inter-agency fighting over the allegedly copious funding for AIDS research. As anyone who has read Randy Shilts’ And the Band Played On knows, such inter-agency squabbling certainly existed at stultifying levels. It does not, however, explain Reagan’s willfully lackadaisical and dismissive stance during the early years of the epidemic. Engel also does not make clear how difficult it was for scientists in the trenches to obtain a slice of the much-contested funding. Bewilderingly, after apparently exonerating Reagan, Engel declares in his conclusion on the subject that Reagan’s record on AIDS is actually “middling to poor” and finally mentions the president’s “latent homophobia.” Better late in the discussion than never, I guess?
Even more troublingly, on the second page of this book I hit a glaring medical error. Engel reverses the ordinary pathologies of pneumocystis carinii pneumonia (PCP) and the skin cancer Kaposi’s sarcoma (KS). Both these conditions were common in early cases of AIDS and were included in the official diagnostic criteria for the disease. It was an unusual spike in requests for the medication to treat PCP that initially alerted the CDC that something strange and new was unfolding. So inseparable from the early ravages of AIDS was KS that it famously came to be called “gay cancer." Point being, the basic details on these conditions can be found in almost any source that covers the early history of AIDS. This book is not primarily concerned with the clinical aspects of AIDS, but reversing the simple descriptions of seminal conditions associated with the disease is shockingly sloppy.
Engel’s depiction of celebrated AIDS activist Larry Kramer manages to highlight all this book’s problems. Kramer was a divisive figure in the 1980s, but is now acknowledged as one of the prescient heroes of the early AIDS fight. While Engel must concede Kramer’s outsized role in efforts to assist AIDS victims and draw attention to their plight, his discussion is constantly tempered by strangely disparaging asides. Engel seems determined to strike out against received opinion in a misjudged bid to appear even-handed-- a recurring problem with his entire account of the disease in the US. Considering how prominent a figure Kramer cuts in this and any chronicle of early AIDS history, you’d think Engel would manage to get the basic details of his life correct. In referencing Kramer’s famous op-ed “1,112 and Counting,” however, Engel mistakenly places the date of Kramer’s own infection in 1983, the year of the article's publication, rather than in 1988. As a result, he mischaracterizes Kramer’s work as the product of intense frustration “at the inability of the government to cure him, or even define his illness;” that is, as essentially selfishly motivated, instead of as the desperate and angry appeal of a man contemplating the decimation of his community. By getting wrong this well-known fact, Engel completely changes the tone of one of the early epidemic's most fundamental works. Again, shockingly sloppy and illustrative of the agenda that Engel brings to bear on the material.
I found Engel’s treatment of the pandemic in Africa and Asia better than his chapters on the US, but this could very well be because I am less well-versed in the history of the disease in these places and therefore could not readily spot where he went astray. His discussion of the rest of the world is also a broader overview and so lacks many of the fine details he gets wrong on the US side.
"AIDS is strangely preventable, yet stubbornly resistant to modern medical intervention. The virus has proven itself a formidable foe, evading vaccines and antidotes, while mocking our own imprudence. It has exposed much of what is worst in human nature, while giving us little opportunity to shine. It is a mirror that selectively reflects our ugliest warts and deepest weaknesses."
Overall, this book provided a competent social and medical overview of the first twenty years of the AIDS pandemic. However, there are some serious issues which must be noted.
First, the author has a tendency to use unnecessary and politically loaded language. Oddly, though, Engel uses this sort of language to describe nearly every organization involved in the epidemic, so his agenda--if he has one--is uncear. For example, in the space of a few pages, he describes the gay community as extreme and decadent, while lambasting the Catholic church as recalcitrant and backward. Perhaps this was an attempt to be balanced, but it comes across as unnecessarily combative. There is already enough controversy about the AIDS pandemic without courting more.
Second, the book suffers from excessive brevity and poor editing. There are some topics which are covered in a page or two, but deserve entire chapters to themselves--the overall Christian response to the pandemic is one of the most obvious examples. Other areas contain unnecessary repetition, and obvious typoes that should have been caught.
Excellent book about AIDS that starts with the American epidemic and expands outwards for a carefully paced and laid out global overview, with a great job detailing the different challenges faced due to cultural differences. Fascinating emphasis placed on the dangers of politicizing the disease - from both liberal and conservative sides.
The layout of the book was one that I thought was very interesting. Rather than attempting to go through issues chronologically, which would've been extremely difficult given the many overlapping areas and sheer range of the research, Engel instead breaks it down topic by topic. This results in some of the repetition that other reviewers complained about, but I didn't find it intrusive. Rather, information was able to build on previous areas explained.
I read this after Randy Shilts's incredible And The Band Played On and Elizabeth Pisani's The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. The Epidemic is an excellent addition to these works.
There's a great deal of information here but Engel isn't great about keeping the ball rolling without feeling bogged down or repetitive. It took me forever to read, even though I'm incredibly interested in the AIDS pandemic.
There definitely seems to be an emphasis on downplaying current threats to "general" populations, which has some root in reality but only, in my opinion, serves to further marginalize high-risk groups and third-world nations. I was also uncomfortable with the spotlight on the behaviour of gay men which, again, had plenty of basis in fact, but felt a lot like telling us how weird and Not Like Us gay men were/are. I absolutely understand that this was the point, and it's worth looking at an examination of how the desire of some to not marginalize may have set up false assumptions about the disease. That said, in general by the book's end AIDS was pretty much relegated to belong to The Other.
The book did a great job of examining AIDS on a global level and how different cultures led to different paths/infection rates/etc.
Virology is something of a new interest for me, so I decided to look at one of the more well-known modern diseases. I had read one or two historical books on smallpox--the most compelling parts of which were the primary records of each individual case, and the hunt for the disease's cause and treatment. Assuming that AIDS was at least as well-documented, I picked up this book.
Much to my disappointment, the books was less about the discovery and treatment of the disease; and even less about individual cases. As far as I can tell, Engel wrote this book to remind people that HIV-AIDS are statistically found only in groups of people that make poor life choices (or conversely, have their life decisions made by irrational people); and that HIV-AIDS are relatively preventable.
If AIDS is your thing, or if you're into the condemnation of civil libertarians (who often occur Engel's wrath) you should check this out.