“A horribly cruel and insidious virus”, April 30, 2002

Randy Shilts masterpiece, “And The Band Played On”, reads like a detective story; from the discovery of an unusual new organism that was killing a few people slowly and inexorably in the late 1970s and early 1980s, and multiplied exponentially underground until it exploded into the number one health catastrophe on the planet.

The fact that AIDS at first took its heaviest toll among gay men, and then among intravenous drug users, guaranteed that its early victims would become outcasts. The AIDS panic seems unbelievable in retrospect but was all too real in the 80s; people were forced off their jobs, children were barred from schools, and anyone who belonged to the “4-H club” (homosexuals, hard-drug users, hemophiliacs, and — incredibly — Haitians)were treated like pariahs. The secrecy and denial in dealing with the crisis helped it to spread unabated.

Shilts pulls no punches in writing this book. He is equally angry at the Reagan administration which preached pious platitudes while withholding desperately needed funds for medical research; the radical gay community which refused to acknowledge its own responsibility for the sexually promiscuous behavior that helped spread the disease like wildfire, and those in the medical community who played grandstanding politics and plain old-fashioned spite while patients were dying all around them. And then of course there was the media, which treated this puzzling, terrifying new disease, which for two years after its discovery didn’t even have a name, as something the “general public” didn’t have to be concerned about — until heterosexual men and women began to be infected.

But there were also the heroes — the physicians who devoted their days and nights to treating their patients, gay men like Larry Kramer who refused to let the gay community sweep the problem under the rug, Rock Hudson, whose up-front candor and admission of his illness shocked the American public and helped to bring AIDS out of the closet once and for all, and C. Everett Koop, Reagan’s Surgeon General, who refused to play politics and demonstrated the leadership his boss lacked in his common-sense and compassionate approach to meeting the crisis, to the horror of his right-wing constituency.

Shilts wrote his story with such compelling urgency that it wraps the reader up like a whodunit you don’t want to put down. One shares his disgust at the doctors who cared more about their own self-promotion than about their patients; the right-wing politicians who treated the victims of a devastating and deadly disease as if they were sinners who had earned the wrath of God; the gay men who didn’t care how many people they infected as long as they could enjoy the promiscuous atmosphere of the bath houses, and most incredibly, the for-profit blood banks, which refused to admit their product was carrying a deadly virus and fought against blood testing for three years while the number of people who died from transfusions of infected blood grew by the thousands. And in a heartbreaking coda to this story, Shilts deliberately put off having his own blood tested while he was writing this book because he didn’t want his judgement biased if he turned out to be HIV positive. It was only after he finished the book that he learned that he was infected with the virus that had killed so many and in a few years would also kill him.

Shilts’ death from AIDS was a tragedy, but he left us this magnificent book as his legacy. After reading his book, we are the richer and the wiser for his information, his insight and his understanding.

Judy Lind

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This Book Encouraged me to Ride My Bike 350 Miles, March 31, 2003

I read this book several years ago, and the effect of that reading is still making an impact on my life.

Randy Shilts blends science, sexuality, politics and humanity into a gripping and emotion-provoking story detailing the rise of the AIDS Epidemic. By drawing the readers into the lives of individuals and communities at the core of the epidemic, Shilts gives them the opportunity to see how the epidemic developed and spread, and the ways in which it was allowed to spread further, thru apathy, inaction, ignorance (both deliberate and not), fear, and even egotism.

When I listen to the news in today’s world, and I hear accounts of the post-9/11 Anthrax scares, or the recent pneumonia illness that has now affected some 1,500 people — my heart aches. Not to discount the reality of these illnesses, but all I can remember is how angered and saddened I felt as I read “And the Band Played On” and realized that hundreds of thousands of people were infected before the word AIDS was ever mentioned in the media. I was a sophmore in college when I first remember hearing about AIDS. That was in 1987. How many people had died from the disease before I even knew what it was????

I feel everyone should read this book. It doesn’t just apply to people in high-risk populations. I happen to be a young heterosexual female, and this book made such an impression on me, that last summer, I found myself joining a 350-mile bike marathon to raise money and awareness for people living with HIV and AIDS. When people asked me why I was doing the ride, I told them about “And the Band Played On.”

Randy Shilts’ book is haunting and most of all, REAL. The only bad thing is that the book ends — AIDS doesn’t.

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An outstanding work of journalism, April 27, 2004

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Trixie “cupcakejones” (Ohio) – See all my reviews

  

I’m sure most people are familiar with the story but just as very brief background Randy Shilts was a reporter at the epicenter of the AIDS crisis when it first began. When his paper assigned him to cover the story on a regular basis (the only paper in the country to do so), he gained access to an vast wealth of material and a unique perspective-one that for many years went largely unreported by most of the media until the death of Rock Hudson changed everything. Shilts discovered he himself was HIV positive after he finished the book; he had asked his doctor not to reveal the test results to him until then. He passed way in 1994. His work to alert his own community on the coming health crisis often made him a pariah within it.

This is an amazing history of how the virus took off in America and an insight into why it remained so under-reported for so long. The story involves some very brave patients, some very irresponsible ones, incredibly dedicated medical professionals, major bungling by our government and the blood industry-some of it intentional and some paths paved with good intentions, and the mixed, frustrating reaction of the gay community itself. Shilts doesn’t write completely without bias-he calls the decision of the CDC to release patient names to an NYC bloodbank “incredibly stupid” but who wouldn’t agree with him on that point? Also, Shilt’s fury at certain members of the Reagan administration and Reagan himself is palpable. Once again though, who wouldn’t agree with him once the story has been unfolded. His anger is not limited just to the government nor is this just an anti-Republican screed-he praises Orrin Hatch and Everett Koop while bitterly recalling the inaction of Ed Koch’s administration in New York. Gay leaders also are not always portrayed in a flattering light. For all of that though, Shilts struggles to be fair and largely is successful.

This book may look daunting, both because of it’s subject matter and it’s length (clocking in around 600 pages.) However it is incredibly worth your time and written so well that you’ll make surprisingly short work of it. Even if you aren’t interested in AIDS per se, the story of how our government responded to this crisis (or, rather, largely failed to) should and will frighten you. An incredible call to action and snapshot of a moment in time and place that might otherwise have been forgotten. And that would be a tragedy.

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An important contribution to addressing this ongoing tragedy, July 19, 2007

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John Bergren (KwaZulu-Natal, South Africa) - See all my reviews

  

I'm an American doctor working in rural KwaZulu-Natal, South Africa. I can attest to the substance of much of the material presented in this book and the importance of its message, specifically that norms of sexual behavior in this culture need to be discussed and changed for prevention efforts to begin to be effective. As the author aptly discusses, numerous aid organizations, flush with good intentions and funds, seem to operate on the periphery of this central issue. One of the most disturbing lessons of my time in the midst of this horrible tragedy is the realization that the stigma attached to this disease in many parts of sub-Saharan Africa remains so severe that many people prefer to die than to find out that they have AIDS, a point the author seems to get across through with many informative anecdotes. The fundamental thesis is that we need to begin to engage the leaders within these societies at a fundamental cultural level regarding relationships and sexual behavior. No small task. I would highly recommend this book as the first read for someone trying to understand why AIDS is so unbelievably prevalent in Sub-Saharan Africa. As of today, for every person we enroll in antiretroviral treatment in rural KwaZulu-Natal, five will be newly infected. It's very depressing to see so many people dying from a preventable disease--1,000 people die of it every day in South Africa alone.

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hiv prevention: now and how, August 6, 2007

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Daniel B. Clendenin (www.journeywithjesus.net) - See all my reviews

  

  

"As a woman living with HIV," says Beatrice Were of Uganda, "I am often asked whether there will ever be a cure for HIV/AIDS, and my answer is that there is already a cure. It lies in the strength of women, families and communities who support and empower each other to break the silence around AIDS and take control of their sexual lives." With a vaccine against HIV far off in the distant future (if at all), and with treatment of AIDS in the two-thirds world difficult, expensive, and limited in effect, the name of the game in HIV-AIDS is prevention. But in places like Africa, which is the focus of Helen Epstein's book, prevention is not as simple as it sounds. As she notes in her appendix, measles, syphilis, tuberculosis, and other entirely preventable diseases still kill millions of people even though they can be treated for pennies.

Why has HIV-AIDS ravaged eastern and southern Africa like no place on earth? "In 2005," she writes, "roughly 40 percent of all those infected with HIV lived in just eleven countries in this region-- home to less than 3 percent of the world's population." In some of these countries the infection rates have hit 30 percent, decimating the general population, while in the west, for example, rates hover at about 1% and are generally limited to specific demographics like gay men, intravenous drug users, and commercial sex workers." Theories abound about this discrepancy, but Epstein argues a narrow point, that Africa's problem is not profound promiscuity, or even the normal culprits of high risk groups like prostitutes or truck drivers, but instead a social phenomenon of "concurrent partners." That is, Africans do not have more sexual partners than in other places in the world, and nowhere near as many as gay men among whom infection rates are exponentially lower; but they do have a small number of sexual partners concurrently, at the same time, rather than one at a time or sequentially. This has set the virus loose among the general population like a runaway train.

And why has prevention been so elusive? Epstein appeals to what she calls the comprehensive "social ecology" of denial, silence, shame, adverse gender roles, and stigma about HIV-AIDS. Western-initiated and donor-funded programs will always be less successful than listening to Africans themselves and their own suggestions about how to address the problem. Uganda, of course, has been the amazing success story in this regard, and the subject of bitter debates about why. In 1989 Uganda had one of the highest infection rates in the world, but from about 1992-2002 the infection rate dropped by two-thirds. The key to the success, argues Epstein, was not in the billions of dollars from the west, but from the "collective efficacy" of a "shared calamity," by people helping each other and talking openly about the scourge. In particular, "partner reduction," she says, and not the much vaunted condom use, helped Ugandans to address the cultural phenomenon of concurrent partners. Partner reduction, as one worker described it, is thus the "neglected middle child of the ABC approach" of abstinence, fidelity ("be faithful"), and condoms. Zero Grazing, as Uganda's president Yoweri Museveni called for, is thus the silent cure already available, however valuable other prescriptions.

Epstein, a molecular biologist who has written widely on public health issues, combines rigorous science and the anecdotal evidence of substantial field research. She's clearly as comfortable with and interested in meeting with a dozen African widows under a mango tree as she is in the latest results of a demographic study. Her book has received strong reviews in the New York Times and the New York Review of Books (where her mother was a co-editor before she died), and also a rebuttal of sorts on the home page of UNAIDS that was provoked by her somewhat conspiratorial stance toward research that she argues they ignored because it didn't fit their partisan ideology.

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A CLASSIC WORK, May 15, 2007

The most important book published on AIDS in a long time, and one of the most important books of the year. If you liked Rachel Carson's Silent Spring or And The Band Played On, you will love this book. It is readable, impassioned and brilliant, and despite its savage denunciation of the failures of the West to deal with the AIDS crisis, it is an essentially optimistic work. Publishers Weekly in a starred review said it will save lives, and that is not hyperbole. I urge anyone who is interested in the greatest medical crisis of our time; anyone who is interested in Africa; anyone who is outraged by the failure of the UN, the WHO and the Bush administration to deal with this tragedy, to buy this book and give it to your friends. It is the kind of book that will change peoples' minds and will move continents. It will be read for years to come...

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