Book Review : The Medical and Personal Sides of AIDS

Mobilizing Against AIDS: The Unfinished Story of a Virus by the Institute of Medicine/National Academy of Sciences, Eve K. Nichols, writer (Harvard: $15; $7.95 paperback)

The Plague Years: A Chronicle of AIDS, the Epidemic of Our Times by David Black (Simon & Schuster: $16.95)

The progress of medicine in the 20th Century has seen the virtual elimination of most contagious diseases as significant threats to life. Tuberculosis, diphtheria, smallpox, influenza--once major killers--have largely been brought under control.

But the chronic diseases have proved more intractable. The near-eradication of contagious diseases has allowed people to live long enough to die of cancer and heart disease, this country’s biggest killers.

Testing the Frontiers

Just as people began to believe that contagious diseases had been defeated, a new one has arisen: acquired immune deficiency syndrome, AIDS, a virulent, fatal disease unlike any in history. It is testing the frontiers both of medicine and social policy.

AIDS is alternately called an epidemic or a plague. Either word is accurate. The disease is spreading, and spreading rapidly. It has already killed more than half the people who have contracted it, and few who get it survive as long as three or four years.

AIDS is contagious, but only through the most intimate sexual contact or directly from contaminated blood. As they have throughout history, people are once again dying in the prime of life. Some people--even its victims--consider AIDS the wages of sin.

“Mobilizing Against AIDS” is a compilation of everything science knows and doesn’t know about this fearsome disease. In a measured, neutral tone, it tells the story of AIDS from the first cases in 1979 through the discovery of the virus that causes it (and how it works) to researchers’ efforts to develop a vaccine and a cure. It discusses the ethical questions and the public policy questions that have swirled around AIDS, three-quarters of whose victims are gay and nearly a fifth of whom are junkies.

Medical Puzzles Abound

In five years, medical science has learned an enormous amount about AIDS. The virus and its mechanism have been identified, and the way the disease is spread has been established beyond doubt.

But as in all scientific research, the amount that is unknown far exceeds the amount known. Puzzles abound. How many people who now test positive for AIDS antibodies will eventually develop AIDS? How long is eventually? Does exposure to other factors increase the likelihood of getting AIDS? What other factors? Why do some people with the virus get the disease while others don’t? Among patients with AIDS, why is the incidence of Kaposi’s sarcoma declining? Will it be possible to develop a vaccine? What kind of health education is most successful in persuading people to deny their sexual urges?

One problem with being up to the minute is that in the next minute, you’re out of date. This book went to press at the end of last year, and states that there have been 13,000 cases and 6,500 deaths. Eight months later, the totals are 23,000 cases and 13,000 deaths.

“No one diagnosed with AIDS has ever recovered,” the book says flatly. But the recent AIDS conference in Paris heard a report of one AIDS patient who apparently has recovered. His body shows no sign of the infection.

“Mobilizing Against AIDS” is cautious and accurate. But when I finished reading it, I wrote in the margin, “Not enough attention to this being a disease that most of all affects gays.”

So imagine my surprise when I started reading David Black’s “The Plague Years,” and not too many pages into it came across the following: AIDS is “not just a medical story and not just a story about the gay community, but also a story about the straight community’s reaction to the disease. More than that: It’s a story about how the straight community has used and is using AIDS as a mask for its feelings about gayness.”

What is a faggot? A homosexual gentleman who just left the room. This is the fact that “Mobilizing Against AIDS” fails to address, but it is a central point of “The Plague Years,” which is based on an award-winning series of articles that appeared last year in Rolling Stone. It covers much of the same ground as “Mobilizing Against AIDS,” but it sears with emotion. “Mobilizing Against AIDS” is clinical; “The Plague Years” is political.

A Wasting Death

In several places in “The Plague Years” physicians describe AIDS deaths, which, they say, are the most horrible they know of. The patient’s immune system is disabled. Unable to defend itself against usually minor invaders, the body wastes away.

There is much in “The Plague Years” about the politics of AIDS. How much different would the public’s response be if AIDS were perceived as affecting people other than society’s outcasts: gays, drug addicts and prostitutes? How much different would the public’s response be if there weren’t the lingering, sometimes spoken belief that these people are getting what they deserve?

“Mobilizing Against AIDS” is about a disease. “The Plague Years” is about people. Unfortunately, though, passion and accuracy do not necessarily go hand in hand.

“The Plague Years” is a personalized account of one writer’s reporting on AIDS over the better part of a year. He learned much, experienced much and felt much. But some of his conclusions are wrong, particularly when he writes about the factors that influence media coverage of AIDS. There is no conspiracy. More things appear or don’t appear in newspapers as the result of ignorance or inattention than as the result of plots.

Nonetheless, there is something to be said for the personalized, passionate approach, just as there is for the detached, factual approach of “Mobilizing Against AIDS.” Both books lead inescapably to the same frightening conclusion: No solution to AIDS is in sight, and it’s going to get much worse before it gets any better.