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AIDS, Civil Rights and Public Health : PRIVATE ACTS, SOCIAL CONSEQUENCES : AIDS and the Politics of Public Health <i> by Ronald Bayer (The Free Press: $22.95; 275 pp.) </i> : AIDS, INC. : Scandal of the Century <i> by Jon Rappoport (Human Energy Press: $13.95; 343 pp.) </i>

<i> Shapiro, an internist, is associate professor of medicine at UCLA and author of "Getting Doctored: Critical Reflections on Becoming a Physician" (New Society)</i>

The 1980s will be remembered much longer as the decade of AIDS--the acquired immunodeficiency syndrome--than as that of Ronald Reagan. AIDS has had a pervasive effect upon society, transforming the eros of human relationships into a flirtation with death in a way that has hardly been known since syphilis rampaged across Europe as a fatal illness nearly 500 years ago.

The notion that love is uncompromisingly joyous usually has faced challenges. Venereal diseases were difficult to eradicate until the introduction of antibiotics in the 1940s. Pregnancy was a serious, life-transforming (and occasionally fatal) consequence of sexual intercourse, even when mechanical means of contraception became available. It was in the 1950s, however, with the introduction of birth control pills, that pregnancy prevention became nearly fool-proof. The legalization of abortion a few years later was but the final stage in this process. Sexual mores had been inhibited, very likely as a pragmatic response to the problems of infection and pregnancy, but by the late 1960s eroticism was flowing freely.

“Make love, not war” was a popular slogan of those who wished to contrast the affirmation of life with the propagation of death. It was not surprising that homosexuals, too, sought to liberate their sexuality from the prejudices and formal restraints with which it had contended for so long. The 1970s was the first and last decade of innocence in the sexual Garden of Eden of our time. Sexuality was to be celebrated by all, free of legal recrimination (at least in some jurisdictions), of disease and of inevitable pregnancy.

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AIDS changed all that, in ways that are only now permeating the heterosexual community. Sex became a risky enterprise, and the risks extended well beyond the occasional brief episode of an uncomfortable herpetic rash. Sex became a chance to die. Perhaps more ominously, it became a chance to kill.

Ronald Bayer’s fine book, “Private Acts, Social Consequences: AIDS and the Politics of Public Health” is an important and compelling document of the transformation of eros by AIDS and of the ways in which government agencies and various interest groups have responded to this unwanted development. Bayer, who teaches at Columbia University, chaired the first national project to study the ethical and social challenges posed by AIDS. Writing in an engaging narrative style, he explores a series of issues that have aroused communities, preoccupied public health officials and been exploited by politicians.

When John Snow demonstrated a century ago that cholera was caused by water coming from a well in London, he removed the handle from the pump and the epidemic was ended. Much public discourse on AIDS has been a search for that pump handle. Perhaps the most interesting chapter in the book is one on the campaigns to close bathhouses frequented by gay men in order to deter propagation of the disease. In San Francisco, after some vacillation, public health officials ultimately won court approval to regulate high risk behavior in the baths. In so doing, they had to endure protracted battles with the owners of the establishments and with civil libertarians, who were concerned that any effort to forbid unsafe sexual acts ultimately would be extended to private homes and, eventually, to all homosexual relations. In New York City, public health officials were very reluctant to compromise the right to privacy. Ironically, in their ultimate effort to close some of the baths, they sent in inspectors, who witnessed nearly 50 episodes of high risk oral or anal sex.

Throughout these debates, gay civil rights groups and advocacy groups seemed conflicted. On the one hand, they wanted to defend the gains in the right to privacy and sexual acceptance that had been achieved. On the other hand, the people being exposed to the virus in these establishments were other gay men. In most cities, no action was taken against bathhouses which did not limit high risk sex. Bayer argues that public health officials moved unevenly against the bathhouses because of political constraints of needing cooperation with the gay community, the liberal political cultures in the cities most heavily infected and the recognition that bathhouses were only a small part of the problem. He contends that it was a misjudgement not to act more decisively, because as a symbolic act, the closure would have sent a resounding message to the community about the disease.

Bayer reminds his readers of the now-forgotten battles about testing the blood supply and discouraging high risk individuals from donating. The concerns about the invasion of privacy and about the possibility of a list of infected individuals that might fall into government hands were once again pervasive. Other problems addressed by the book include testing various groups or the population as a whole for antibodies to the AIDS virus, the degree of confidentiality to be associated with testing and the occasional suggestions that infected individuals be quarantined. These are issues that have captured the interest of the political world in a way unlike that of any recent health problem other than the Swine Flu. Last year, the various presidential candidates had far more to say about AIDS testing than about their plans for reducing the deficit. California voters have had to declare their position on AIDS almost as frequently as George Steinbrenner fires a manager. Throughout the debate on these issues, there was consistently an intense concern about privacy held by gay groups, a desire to act in intrusive and hostile ways on the part of those who were anti-gay, and a lack of data available to support any position.

What Bayer demonstrates best of all is that health care is not just science. It is intrinsically linked to the social and political process. He raises the question about whether the current measures to contain the epidemic are optimal, noting that the level on which health bureaucrats have settled their efforts has been that which their constituencies were willing to accept.

“AIDS Inc.: Scandal of the Century” is another recent book that manifests the transformation that a virus has wrought. Jon Rappaport taps into the desire of many to return to a pre-AIDS world, where life was simpler and sexual intercourse was not a clinical entity to be encountered in formats prescribed according to serostatus. The book is angry, and is contemptuous of the medical research and public health establishment. It is also unquestionably wrong in its major theses: that human immunodeficiency virus does not cause AIDS, that zidovudine (AZT) does not improve the prognosis and that AIDS is not really a disease but rather a collection of symptoms caused by a variety of other phenomena (sexually transmitted diseases, antibiotics, stress, malnutrition) that can be addressed in more naturopathic ways. The evidence for the existence of AIDS and for the virus’ role in it has been scrutinized by a wide variety of virologists and epidemiologists and has been judged to be sound. The drug treatment surely can be toxic and is not a cure, but the best available evidence is that it does prolong life. This book is a rage against the dying of the light that does not sustain its argument with coherent data.


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