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The Epidemic: A Global History of AIDS

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THE EPIDEMIC is a comprehensive and compelling history of AIDS - a devastating disease that has evoked not only human suffering, but medical, political, religious, and social controversy in the 25+ years since it exploded onto the world scene.

Unlike some authors, who use the issue as a platform for whatever cause they are espousing, Jonathan Engel, Ph.D., offers a systematic exploration of the disease, its rapid and far-reaching proportions, the victims and their suffering, and the barriers to effective eradication. The author writes with great urgency, bringing clarity and focus to an affliction whose medical issues are often overshadowed by other factors.

AIDS is a frightening illness, bringing agonizing suffering and death to countless numbers throughout the world. Yet, because of its origins, means of transmission, and perceptions of the "typical" patient, the human suffering is often ignored amidst strident politicizing - in effect dehumanizing its victims, transforming them into abstract stereotypes.

Dr. Engel's research is comprehensive, his writing is clear and compelling, and his methodical exposition sheds important light onto a subject that many prefer would be swept into the dark crevices of society. The author puts a human face on a global pandemic; only through compassion, care, and nonjudgmental treatment and addressing of root causes, will the scourge ultimately be eliminated.

I read The Epidemic hoping to find new, useful information to use in updating my own 1999 AIDS history, Victory Deferred: How AIDS Changed Gay Life in America (University of Chicago Press). I have to admit I was skeptical that any book could capture the global breadth of the HIV pandemic, and The Epidemic proved my skepticism well-founded. Not only does it skim along the surface of important, even profound, events, but the book is written in language that leaves the impression the author has not learned anything from what the pandemic has taught about the vital importance of language. I was surprised to learn the author holds a PhD in the history of medicine from Yale.

Here is what I mean: Throughout the book the terms HIV and AIDS are used interchangeably; they are not interchangeable. As it has been used since HIV testing became available, in 1985, AIDS refers to the advanced stage of HIV disease (the preferred term for the spectrum of HIV-related infection and illness) at which the virus has seriously damaged the immune system. The Centers for Disease Control and Prevention (CDC) considers a CD4 T-cell count below 200, a CD4 T-cell percentage below 14 percent, or the presence of an opportunistic infection in someone who has HIV to be what "defines" AIDS. A person cannot "catch" AIDS, though an HIV-positive person can progress to AIDS if his/her HIV infection is not managed with antiretroviral therapy. Throughout The Epidemic, the author refers to people "catching," being "infected with" or "spreading" AIDS. This is inaccurate, misleading and even a bit histrionic.

Other examples of poor language choice (and sloppy writing): "the gay community has been uniquely vulnerable to the virus." No, individuals who practice particular activities (primarily unprotected receptive anal intercourse) are uniquely vulnerable to the virus; the gay community includes such men, though not all gay men practice such activities. "Diseased already, the prostitutes could both more easily get the disease as well as give it." This is highly stigmatizing language. "AIDS babies." What is an "AIDS baby"? I will assume it's a "baby born with HIV infection"?

In a 300+ page book, the tremendously important role of AIDS service organizations in caring for the sick and preventing further HIV transmission is considered in a few paragraphs. The global impact of gay American men with AIDS in the early 1980s insisting on an active role in their health care decisions, demanding respect and rejecting the label of "AIDS victim" isn't even considered. But maybe that isn't surprising because they were the very people with AIDS (as they insisted on being called) who pointed out that language--how one refers to a person or describes a disease caused by a retrovirus--matters.

Clearly this book has not benefitted from some of the most basic, and most important, lessons of the history of the HIV pandemic. It breaks no new ground, and offers only a superficial, not very well polished, gloss on what was called as early as 1983 "the most important health crisis of our time." I wish I had found something useful here to help update my own book, but unfortunately I didn't.

This book gives an excellent overview of the history, spread and consequences of HIV as it spreads through the global population. Written in a clear and easy to read style it provides a depth of accurate information to the layperson that I do not think can be easily gotten elsewhere.

I was particularly impressed with the author's grasp of the cultural aspects of the disease and the way in which beliefs, traditions and practices contribue to how effectively specific populations are coping with the virus.

This book should be recommended reading!

This is a well-written, fascinating account of a disease that will define our generation. The discussion of the social and political construct surrounding the epidemic was extremely interesting. I would highly recommend this book to any person who wants to understand the global AIDS crisis and its challenges a little better.

from it's first days to the present. an excellent read and very informative. i particularly like that the author doesn't try to take sides on the political issues that sprung up around hiv/aids. instead, he seems to tell it like it is. everyone made mistakes and everyone has to share responsibility for the fast spread of hiv, and, hopefully, realize that another new virus could come out of nowhere and create another epidemic.

The Epidemic: A Global History on Aids

The topic of AIDS (Acquired Immunodeficiency Syndrome) and HIV (Human Immunodeficiency Virus) is broad, complex, catastrophic, and incredibly interesting. ¬¬¬ Jonathan Engel's The Epidemic: A Global History of Aids does a coherent job in explaining the complex history of the AIDS epidemic. Engel breaks down the AIDS/HIV timeline and its catastrophic effect on the world beginning from the 1930's. He begins with the origins of AIDS and continues with its vast effect on people, its effect in different countries, differences in trends, societal views and morals, government action, civil rights, and global connections.
Engel jumps right into the topic in the preface, leaving out unnecessary boring anecdotal information. As Engel focuses on the many facets of AIDS and its problems, he jumps from different topics, focusing one chapter on the science of AIDS and focusing on government and society in other chapters. This book is a comprehensive collection of short books. Engel, for instance, sums up the origins of AIDS with its similarity to the SIV (Simian Immunodeficiency Virus) in monkeys in Africa and then begins to tell the long story of AIDS how it made its way to the West. The book is interesting, making it a relatively easy read. Engel breaks this broad topic into chapters with sub-chapters
This history itself is fascinating and the evidence Engel uses to support his information is excellent. Engel makes it easier to understand AIDS and HIV as it progressed in the 1930's through the 1990's. This book is a great resource to build a foundation to understand this virus from a social perspective. The Epidemic does not provide very much information about the myths that are associated with the denial of HIV causing AIDS. Although a few myths were mentioned, Engel refuted those claims in short, swift sentences in his summary.
Engel portrays a very neutral connotation when describing controversial situations regarding AIDS and society's reaction to it. The flow and cohesiveness of the book is more objective in its reporting on AIDS. For example, when relaying the details about the beginning of the outbreak, starting with its prevalence in homosexuals, and IV drugs users, Engel does a good job in explaining the situation from an objective point of view. He describes how AIDS is used as means for political gain, if not for moral humiliation by religious parties, then for homosexuals' Civil Rights or other political agendas.
The Epidemic is very informative and does an excellent job in explaining and summarizing these difficult subjects. Instead of going too in-depth about how HIV and AIDS work, Engel simplifies this topic with more general terms, making it easier for any reader who is unfamiliar with this topic to understand. Engel describes how AIDS redefined the world, from its first appearances in homosexuals and how some people thought they deserved what they got, to how the third world countries struggled to cope with such an expensive and difficult disease. Engel also incorporates stories, experiences, and perspectives regarding AIDS from either a victim or by-stander viewpoint in order to get a reaction from his readers. Engel illustrates the trials and errors America took in trying to tame this epidemic. Despite the complexity and how far the AIDS effect reached, Engel is able to explain everything in a concise and fluid manner. Also, because Engel focuses on the global aspect of AIDS, he talks about AIDS and its transition. He discusses changes in demographics, how AIDS spread between different genders, and trends within race groups, sexuality, countries, and government involvement.
One of the best features about The Epidemic is its list of sources in the back of the book. Engel has broken down all the sources he has used for each chapter, therefore providing more sources to readers who might want to look for more in-depth information on all of his subtopics.
If a reader's purpose is to find more research into the skeptical claims made about HIV and AIDS, this is not the book to get. It offers good background information so far as its history, but it does not offer much science behind the virus nor does it delve into how the virus works or evolved. This book only scratches the surface with what AIDS and HIV is in detail. The Epidemic offers its readers a quick history of the aids virus and also compares its effect in different parts of world and to different groups of people. It is easy to navigate through the book or skip parts of little interest because not all of the chapters must be read to fully understand its topic. For example, Engel focuses a section to AIDS in Africa as well as AIDS in Asia. Therefore, a reader would not be left in the dark if they chose not to read certain chapters. This book takes readers on a trip, from the origins of AIDS in Africa to the homosexual bathhouses in America.
This book is intended to intrigue general readers who are either unfamiliar or who know very little about the AIDS epidemic. The purpose of The Epidemic is to explain in coherent detail the facts. This book is not intended for medical doctors. As the book begins with basic information about AIDS, it also continues to describe the AIDS/HIV more complex history and how it effected the world on every level. In Engel's conclusion, he describes how many countries and societies had to adapt and change and the differences are even more interesting as countries such as Africa remained in denial and ignorance. Engel's novel is both thorough, easy to read and quite interesting.

Not only is this book well documented and thorough, it is well written and interesting. So many opportunities for teaching AIDS awareness and prevention and opportunities for saving lives were missed because of misguided fear of teaching human sexuality and AIDS prevention. Because of such ignorance and fear, too many lives were lost. This is an excellent book for libraries, and should be on every church and school library shelf.

The review by Mr. Andriote is spot on. The history of AIDS is a compelling and tragic story that deserves the sort of treatment Dr Engel tries to give it. His effort, however, falls short. From the very outset the book contains awkward language and some pretty basic factual mistakes. One does not have to look far. For example, in the prologue (page 2) the author describes pneumocystis carinii as "associated almost exclusively with elderly men of Mediterranean or Ashkenazic Jewish extraction." Incorrect. That describes another opportunistic infection associated with AIDS, Kaposi's sarcoma. Engel's book gives the impression of being hastily written and poorly edited.

And the Band Played On by Randy Shilts, although a bit dated now, is a far more interesting and moving book on the history of AIDS, especially in America. Similarly, Edward Hooper's The River is a more rigorous and detailed history of the origins and early growth of the disease, even if Hooper's hypothesis -- that HIV's spread was hastened through contaminated oral polio vaccine -- has now been discredited.