THE AIDS BUREAUCRACY by Sandra Panem (Harvard...

THE AIDS BUREAUCRACY by Sandra Panem (Harvard University Press: $22.50, cloth; $9.95, paper)

While critical of the Reagan Administration’s failure to mobilize government and private industry for a collective national war against AIDS, “The AIDS Bureaucracy” is not an angry book like “And the Band Played On.” This isn’t surprising, for while Randy Shilts oriented his story around the victims themselves, Panem stands one step removed from the fray, studying the institutions. Her book, moreover, isn’t focused narrowly on the disease, but on how AIDS calls attention to gaps in our nation’s ability to cope with epidemics. AIDS, Panem writes, raises fundamental questions about science reporting, fiscal priorities, and vague federal policies that make it difficult to decide when a disease becomes a national emergency: “After how many cases? How many deaths? How broad a geographic distribution? Did AIDS become a serious problem only after it was featured on the nightly news?” Panem’s focus on how the AIDS experience can help our nation battle future epidemics reflects a belief among many public health professionals that current bureaucratic quagmires are being solved. She doesn’t, however, gloss over the fact that a fundamental problem remains: the lack of a powerful federal agency to secure funds and direct treatment and research.

This problem became prominent in last year’s feuding within the Reagan Administration over AIDS policy and resurfaced on April 30, when an official at the National Institutes of Health admitted that important trials of AIDS drugs had been delayed because of insufficient funding. “This nation,” Panem concludes, “is still not moving in a unified direction.” Panem, who is program director for the Alfred Sloan Foundation (a major private funding source for science), illustrates the benefits of planning in a revealing section on how visionary leadership helped San Francisco set up a special AIDS hospital ward in 1983, while New York City, where an estimated 1 in 400 males is HIV-positive, had no official plans for such a ward until 1985. Panem seems less certain about how to improve media coverage of AIDS: the mainstream press tended to over-emphasize the human interest angle, she writes, while the homosexual press lapsed in coverage in part because of denial and in part because of ambivalence about the implications of AIDS for sexual liberation.