A I D S B O O K R E V I E W J O U R N A L

University of Illinois at Chicago

H. Robert Malinowsky

Editor

ISSN 1068-4174

Number 2 - April 1993


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Reviewed in this issue:

14. AIDS: Effective Health Communication for the 90s, edited by Scott C. Ratzan.
15. The Politics of Popular Representation: Reagan, Thatcher, AIDS, and the Movies, by Kenneth MacKinnon.
16. If a Partner Has AIDS: Guide to Clinical Intervention for Relationships in Crisis, by R. Dennis Shelby.
17. Counseling Chemically Dependent People with HIV Illness, edited by Michael Shernoff.
18. AIDS: A Communication Perspective, edited by Timothy Edgar, Mary Anne Fitzpatrick, Vicki S. Freimuth.
19. HIV Infection and Developmental Disabilities: A Resource for Service Providers, edited by Allen C. Crocker, Herbert J. Cohen, Theodore A. Kastner.
20. AIDS in the World, by the Global AIDS Policy Coalition.

14. AIDS: Effective Health Communication for the 90s, edited by Scott C. Ratzan. 1993. Taylor & Francis, 1101 Vermont Ave., NW, Ste. 200, Washington, DC 20005-3521. 268p., bibliog., index. ISBN 1-56032-273-X. $39.50. (Descriptors: Prevention, Communication in Medicine, Education, Media, Adolescents) (Contributors to this volume: Michael L. J. Apuzzo, Univ. of Southern California School of Medicine; Cynthia L. Bartlett, Emerson College; Nina Biddle, The Mercantile Library; Jill F. Blair, New York City Public Schools; Ellen W. Bonaguro, Northern Illinois Univ.; David A. Brenders, Emerson College; Lisa Conte, Kidder, Peabody & Co.; Edwin Diamond, New York Univ.; Denise E. Dyson, freelance writer in London; Valeria Fabj, Emerson College; Louis R. Franzini, San Diego State Univ.; Lisaanne Garrett, small claims court, Quincy, MA; Karen K. Hein, Albert Einstein College of Medicine; Gary L. Kreps, Northern Illinois Univ.; Michael L. Levy, Univ. of Southern California School of Medicine; Edward W. Maibach, Emory Univ. School of Public Health; John Marlier, Emerson College; Kevin A. Mercuri, Emerson College; Katherine I. Miller, Arizona State Univ.; J. Gregory Payne, Emerson College; Scott C. Ratzan, Emerson College; Matthew J. Sobnosky, Emerson College; Joseph P. Van Der Meulen, Univ. of Southern California; Eric G. Zook, Pennsylvania State Univ.)

The purpose of this book is to "present appropriate ethical and effective communication strategies to prevent the spread of HIV." A well-qualified list of contributors have reported on a wide range of topics that pertain to communication. The three sections of the book cover "AIDS: Effective Health Communication," "AIDS: Communication, Education, and the Media," and "AIDS: The Cutting Edge of Awareness, Action, and Policy." The first part lays out the framework for effective health communication through an effective campaign of prevention messages and strategies that are targeted at those audiences who are in the greatest need. Through the preplanning of goals and objectives it is possible to have a highly effective communication structure. This section also covers the COAST model for health communication which mandates that all parties "communicate a particular medical exigence and brainstorm all available options." Finally, this section discusses the effectiveness of the AIDS Coalition to Unleash Power (ACT UP) in order to get points across to the public. The second section is an interesting section that discusses how printed coverage in magazines has had an impact. The result from studying this aspect is that the public is still significantly uneducated. The coverage of celebrities such as Rock Hudson, Magic Johnson, and Arthur Ashe have had a significant impact but the "journalistic ethics in reporting those diagnosed demand careful study and further investigation."

The last section describes the cutting edge of AIDS awareness and prevention action. It points out that those with AIDS are severely discriminated against by not being included in the American policy making agenda. Another important area that has been neglected involves those individuals with impaired communication ability. They are sometimes overlooked and the effectiveness in communicating with these individuals needs to be improved. For the health care provider "education of the physician and general population is essential to return AIDS to its categorization as an infectious disease and return patient care to the level of the patient-physician relationship." In fact, it is pointed out that the fear of the disease and of the political ramifications of having the disease have compromised the physicians' ability to provide the proper care. Adolescents are targeted as a population that need special considerations. It is the fastest growing population with HIV incidence and, therefore, needs the attention of educators, counselors, physicians, and public health professionals. The final chapter presents an "AIDS Action 2000 Plan." It stresses proactive communication.

This is a well planned and written book which should make those who read it be more concerned about how we are communicating what needs to be done. Education is the key to help stop the spread of HIV infection. Effective communication has to be maintained in order for the money to be available for research. This book does very well in putting this point across. It should be available in public and academic libraries. Although it is somewhat technical, school libraries may want the book, also, especially since it treats a whole chapter to adolescents. (H. Robert Malinowsky)

15. The Politics of Popular Representation: Reagan, Thatcher, AIDS, and the Movies, by Kenneth MacKinnon. 1992. Associated University Presses/Fairleigh Dickinson University Press, 440 Forsgate Drive, Cranbury, NJ 08512. 257p., bibliog., index. ISBN 0-8386-3474-5. $38.50. (Descriptors: Social Aspects, Movies and Familialism, Sexuality, Movies and Sexuality, Homosexuality, Movies and Homosexuality, Movies and AIDS)

Kenneth MacKinnon has done a remarkable job in presenting his observations that the Reagan/Thatcher years have molded the thinking of Americans and Britains dramatically. During these years AIDS became a health crisis around the world. Gays, drug users, and Haitians were made the responsible culprits and to a wide number of individuals they were dispensable and need not be saved or at least large amounts of money should not be diverted to their saving. To many it was God's punishment and, therefore, there was nothing that the rest of the population could do, including medical science. The influence of the Christian right has been frightening and makes one wonder what the definition of these individuals is of compassion for the mankind and womankind in the world. This interestingly written book documents how, through movies, the power of the Christian right was thrust into the minds of the populations. In the chapter "Movies and the Reagan-Thatcher Epoch," MacKinnon documents this with his discussion of the story lines of the movies of that time, all of which push nationalism, militarism, and familialism as the norm and anything that pertains to gays, blacks, feminism, and the like is not normal and, therefore, should be put down.

The rest of the book further documents these observations by looking at movies and familialism, movies and sexuality, movies and homosexuality, and movies and AIDS. In each of these chapters the author looks at particular movies and points out how they have affected the viewers. He indicates how this religious right attitude has affected the attitudes of those in power in their concept of what should be spent on AIDS research, education, and help to the sufferers. He shows that "the emphasis on individual responsibility for health and material security, not to mention resurgent machismo and a restored belief in the natural and unnatural, help to explain the health disaster" that has hit the world today. He shows that the movies of this time barely mention this health crisis and that militarism, masculinity, and family loyalty were the overriding themes. For those of us who believe and know that AIDS is everyone's concern, this is an eye-opening book that should be in every library. It clearly shows how the general population is influenced negatively by what is produced and shows us how difficult it is to get the proper funding for anything related to AIDS. "The AIDS imagery recoverable from eighties movies helps to make visible the linking of negative thought and phobia that has so singlely helped to produce the health crisis." This is a must read book. (H. Robert Malinowsky)

16. If a Partner Has AIDS: Guide to Clinical Intervention for Relationships in Crisis, by R. Dennis Shelby. 1992. Harrington Park Press/The Haworth Press, 10 Alice St., Binghamton, NY 13904-1580. 277p., bibliog., index. ISBN 1-56023-002-9pbk, 1-56024-145-4. $14.95pbk, $29.95. (Descriptors: Patients, Family Relationships, Counseling, Lovers and AIDS)

Intended for the clinician, this book presents information that will help the counselor understand the realities of AIDS in a relationship, particularly that of a gay couple. He has drawn upon his work with gay couples, presenting what he believes will help anyone who is faced with such counseling. Shelby's basic philosophy is the use of self psychology. The first idea of self psychology is empathy. In order to show empathy in the book, Shelby described in great detail the experiences of men whose partners have AIDS. The second idea is selfobjects. Here, each partner is a being and comfort and soothe each other. It is on these two concepts--empathy and selfobject--that the book is developed, resulting in useful guidelines that counselors will want to know about.

The first chapter is a brief narrative literature review on AIDS, mourning and grief, self psychology, and mourning in the context of gay and lesbian relationships. The following chapters cover methodology of the research, introduction of the results, wondering, confirmation, the long haul, fever pitch, calm and peace, chaos, retreat, exploration, back into the world, mourning, and clinical intervention. This is a down to earth and frank discussion of AIDS and its impact on gay couples. Numerous examples are given that should help any counselor who has not encountered this situation. For example in the chapter on fever pitch the following quotation should indicate the tone of the book: "Fever pitch encompasses the experiences of the well partner during the last weeks or days of his partner's life. Usually, by this time, the ill partner is gravely ill and the dialogue between the partners is substantially diminished. An increasing sense of aloneness comes to dominate the well partner's experience. The well partner is negotiating family, medical personnel, his own career, household business and the needs of his partner, all while evidence continues to mount that the end of his partner's life, and their dialogue, is near."

This is not a happy book. It is a book on the facts of life in dealing with AIDS, dying, death, and mourning. It is a book that you may be reluctant to read unless you are a counselor because it is so realistic in the way it is written. This is a highly recommended book for counselors and should be in all research libraries. It is an important book for individuals who can handle the facts of death and dying. It should not be read by the unsuspecting gay male who is not ready to face the fact that his partner may have AIDS and have to encounter what lies ahead. Although the entire book is about gay partners, it could be used on straight couples as well. The same feelings are there and the same approaches can be used. (H. Robert Malinowsky)

17. Counseling Chemically Dependent People with HIV Illness, edited by Michael Shernoff. 1991. Harrington Park Press, 10 Alice St., Binghamton, NY 13904-1580. 172p., bibliog. ISBN 1-56023-016-9. $14.95. (Descriptors: Substance Abuse; Counseling; HIV Infections; Substance Dependence; Drugs and AIDS) (Contributors to this volume: Esther Chachkes, Columbia Presbyterian Medical Center in New York City; Iris Davis, St. Vincent's Hospital and Medical Center; Barbara G. Faltz, Santa Clara County Drug Abuse Services; Michele Fontaine, Greenwich House Counseling Center in Manhattan; Darrell Greene, Gay Men's Health Crisis in New York City; Yvonne Harris, St. Luke's/Roosevelt Substance Abuse Program in Manhattan; Stuart Kaufer, Columbia Presbyterian Medical Center; Hannah Kusterer, Friendship House Association of American Indians; Donald McVinney, Gay Men's Health Crisis; Melvin I. Pohl, PRIDE Institute; Sabina Primack, Columbia Presbyterian Medical Center in New York City; William Reulbach, Montefiore Medical Center; Ron Rowell, National Native American AIDS Prevention Center; Peter S, a person with AIDS; Edith Springer, Clinton Peer AIDS Education Coalition; Evelyn Ullah, Columbia Presbyterian Medical Center; Carol Weiss, Cornell University Medical Center; Paul Zakrewski, Bellevue Hospital)

This book was originally published as Journal of Chemical Dependency Treatment, v.4, no.2, 1991. AIDS and drugs is now recognized as a devasting combination. Unfortunately, governmental response has not been the best in meeting the needs of this group of people who are usually poor and people of color. In fact, there are some drug centers that try not to work with these people because they do not want to work with those individuals who have a drug problem and are HIV+. This book is intended to help professionals who are working with chemical dependency "gain a better understanding of how to work with their own chemically dependent clients who have HIV illness."

The first chapter is by a person who has AIDS and is recovering from alcoholism and drug addicition and the second chapter presents the varieties of medical problems that are associated with people who have a chemical dependency and are infected with the virus. Each of the remaining chapters covers a specific problem or area of concern: counseling chemically dependent HIV positive adolescents, working with individuals in a hospital setting, persons with HIV on methadone maintenance, treatment of gay men with HIV infection, Native American substance abusers, counseling incarcerated individuals, psychotherapy, residential treatment, AIDS prevention with active drug users, and countertransference in professionals working with chemically dependent clients with HIV. Each of the chapters is a case study, presenting background information, research, methods, study, and results. As an example the chapter "Care of HIV Infected Native American Substance Abusers" studies the clients at the Friendship House Association of American Indians in San Francisco. The first part of the chapter discusses the makeup of the clients, type of chemical dependency, the gay/bisexual aspects, lesbian problems, and an indication of how much they know about AIDS. Three separate case studies are presented followed by a brief discussion of post-traumatic stress syndrome. The final paragraph sums up the problem as one of concern that AIDS is presently under-reported for Native Americans and based on the high incidence of sexually transmitted diseases in general, drug abuse centers will be faced with more and more HIV infected Native Americans.

The other chapters are very similar to this one. They are not detailed but give the facts in well-written text that professional counselors will find as informative and directive. Since this is just one issue of a periodical, there is no index to this work, but the table of contents is adequate enough to guide the reader to the chapter of interest. Counselors will probably find that reading the entire work will be the greatest benefit, since each chapter covers a topic that will at sometime be of concern to any counselor at a drug dependency center. This is a recommended book for all medical libraries, as well as large public and academic libraries. Counselors will want their own copy if they do not subscribe to the journal. (H. Robert Malinowsky)

18. AIDS: A Communication Perspective, edited by Timothy Edgar, Mary Anne Fitzpatrick, Vicki S. Freimuth. 1992. Lawrence Erlbaum Associates, Publishers, 365 Broadway, Hillsdale, NJ 07642. 236p., illus., bibliog., index. (Communication) ISBN 0-8058-0998-8. $49.95. (Descriptors: Prevention, Health Risk Communication, Health Behavior, Safer Sex, Condoms, Education) (Contributors to this volume: Sandra Metts, Illinois State Univ.; Mary Anne Fitzpatrick, Univ. of Wisconsin; Yoshihisa Kashima, La Trobe Univ., Australia; Cynthia Gallois, Univ. of Queensland; Malcolm McCamish, Univ. of Queensland; Timothy Edgar, Univ. of Maryland; Mara B. Adelman, Northwestern Univ.; Vicki S. Freimuth, Univ. of Maryland; Ivana Markova, Univ. of Stirling, Scotland; Kevin Power, Univ. of Stirling, Scotland; Charles T. Salmon, Univ. of Wisconsin; Fred Kroger, Centers for Disease Control; Paula Michal-Johnson, Villanova Univ.; Sheryl Perlmutter Bowen, Villanova Univ.; James W. Dearing, Michigan State Univ.; Everett M. Rogers, Univ. of Southern California; Matthew P. McAllister, Virginia Polytechnic Institute and State Univ.)

A cure for AIDS is still in the future with prevention the primary thrust at this time in the communities. It has been shown that individuals will take the necessary actions for prevention only when "(a) they are properly informed and (b) they feel motivated to respond to the information they possess." This communication about AIDS is a non-stop process because slowing the information only a fraction results in individuals falling back into their old ways of unsafe sex. Much research is being conducted on how better to communicate and how better to educate. "The specific purpose of the book is to examine how theory informs our understanding of communication processes as they relate to the AIDS crisis in the United States and other parts of the world." Chapter one covers safer sex with the advice of "know your partner." The authors center their discussion around sexual scripts and how they communicate. The next two chapters cover the use of condoms and chapter four has the title "Healthy Passions: Safer Sex as Play." These four chapters form the groundwork for the rest of the book. The six following chapters cover such topics as AIDS media campaigns, audience response to health messages about AIDS, the National AIDS Information and Education Program as an example of a systems approach to AIDS communication, culture in HIV education, AIDS and the media agenda, and "AIDS, Medicalization, and the News Media."

These are serious, well-researched articles showing the power of communication and how information on AIDS is brought to the attention of the public. They also indicate whether or not those who are being targeted, really comprehend what is being told. It is interesting to read that the medical profession and its publications have loosened up what appears in the general publications that the layperson reads by using terms that until now were not allowed or were considered offensive. This is particularly true when it comes to talking about sex, safer sex, and gay sex. All in all this is an excellent overview of how communication is helping but it also shows that, unless the targeted individuals read and understand, all the communication in the world will go on deaf ears. This book certainly shows that when it comes to AIDS, nothing should stand in the way of education, not even the church. A highly recommended book for all libraries. (H. Robert Malinowsky)

19. HIV Infection and Developmental Disabilities: A Resource for Service Providers, edited by Allen C. Crocker, Herbert J. Cohen, Theodore A. Kastner. 1992. Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624. 292p., illus., bibliog., index. ISBN 1-55766-083-2. $47.00. (Descriptors: Children and AIDS, Developmentally Disabled Children, Developmentally Disabled Diseases; Education) (Contributors to this volume: Allen C. Crocker, Children's Hospital in Boston; Herbert J. Cohen, Rose F. Kennedy Center Univ.; Theodore A. Kastner, Morristown Memorial Hospital; Gitta Acton, Robert Wood Johnson Medical School; Gary R. Anderson, Hunter College School of Social Work; J. Burt Annin, Child Welfare League of America; Ronald Berchert, Bureau of Community Services; Arnold Birenbaum, St. John's Univ.; Edna Bolivar, New England Hemophilia Center; Doreen B. Brettler, New England Hemophila Center; Gerard A. Cabrera, Young Adult Institute, New York; Marklyn P. Champagne, Moonstone Group of Rhode Island; Stephen Chanock, Harvard Medical School; Curtis L. Decker, National Assoc. of Protection & Advocacy Systems; Gary W. Diamond, Albert Einstein College of Medicine; Raymond Dinoi, New England Hemophilia Center; Patricia Driscoll, Project WIN; L. Jean Emery, Child Welfare League of America; Patricia M. Forand, New England Hemophilia Center; Ann D. Forsberg, New England Hemophilia Center; Geoffrey B. Garwick, Ramsey County Mental Health Clinic; Michele Granger, Children's Hospital of New Jersey; Jenny Grosz, Albert Einstein College of Medicine; Meredith Hinds Harris, Northeastern Univ.; David C. Harvey, National Assoc. of Protection & Advocacy Systems; Karen Hopkins, Albert Einstein College of Medicine; Judith Hylton, Oregon Health Sciences Univ.; Raymond Jacobs, Young Adult Institute; Elaine Jurkowski, Winnipeg West Central Region; Piotr B. Kozlowski, Institute for Basic Research in Developmental Disabilities; Elissa M. Kraus, New England Hemophilia Center; Joel M. Levy, Young Adult Institute; Philip H. Levy, Young Adult Institute; Allen G. Marchetti, Brook Run; Brigitta U. Mueller, National Cancer Institute; Ruth S. Nathanson, Morristown Memorial Hospital; Philip Pizzo, National Cancer Institute; Shirley A. Rees, Bureau of Community Services, Washington, DC; Sharon Rennert, American Bar Assoc.; Martha F. Rogers, Centers for Disease Control; Sheri Rosen, Children's Hospital of New Jersey; Arye Rubinstein, Albert Einstein College of Medicine; Anne F. Rudigier, American Assoc. of Univ. Affiliated Programs for Persons with Developmental Disabilities; Perry Samowitz, Young Adult Institute; John F. Seidel, Pediatric AIDS Program; Marc J. Sicklick, Albert Einstein College of Medicine; Robert J. Simonds, Centers for Disease Control; Elaine Durkot Sterzin, Foundation for Children with AIDS; Claudia K. Swanson, Ramsey County Community Human Services Dept.; Leslie Walker-Hirsch, Moonstone Group of New York; Geneva Woodruff, Foundation for Children with AIDS; Terrence P. Zealand, AIDS Resource Foundation for Children)

The goal of this book "is to speak to primary service providers, public planners, families, and students about the meaningful link between developmental disabilities and the presence of HIV infection." The contributors have assembled a large mass of information that deals with HIV infection as it is related to persons with genetic disorders, birth defects, complications of preterm delivery, certain chronic illnesses, and exposures to toxins, injuries, and infections. The goal is to "ensure that HIV infection can be prevented in persons with disabilities, and if accidental infection occurs that effective programs can be maintained." Although this is a difficult goal to achieve, the information that is presented should be quite helpful to those who are working with persons with disabilities. Discrimination has to be eliminated, personal empowerment needs to be provided, and the quality of life of these individuals has to be enhanced.

Part 1--"Child and Family"--focuses on children with congenital HIV infection. The epidemiology of HIV infection is described as is the neuropathology of the disease, the transmission, neurodevelopmental consequences and the circumstances of families in which a child has HIV infection. There are 13 short, but very informative chapters covering such topics as tretment, school programs, habilitative and rehabilitative needs of children, child welfare concerns, barriers in the service system, and hemophilia and HIV infection. The chapters are concise and technical with long bibliographies at the end of each. Suggestions on how to handle each situation are given and numerous case examples are presented. Part 2--"Youth and Adults"--consists of eight chapters. These are very serious presentations since we are dealing with individuals who in many cases are unable to think quickly enough to make the right decisions, ending up having unsafe sex or participating in drug activity. "Addressing the socio-sexual needs of people with developmental disabilities should be one of our highest priorities." Discussed in this section are such topics as comprehensive sexuality policy, procedures, and standards; HIV education programs; stopping AIDS through functional education; evaluation of HIV prevention programs; and treatment of sex abusers with developmental disabilities and HIV infection. These chapters should be essential reading for all care providers.

Finally, part 3--"Policy Considerations"--deals with the real issues of accuracy regarding transmission of the virus, protection of information, maintaining programs, fair play in the functions of public agencies, funding, feelings of care providers, guidelines, human response, drug problems, and problems of being disadvantaged. These twelve chapters cover legal rights and benefits; policies and procedures in confidentiality; state guidelines, financing developmental services; training; public opinion, discrimination, and integration; substance abuse; and prevention of HIV infection. These are very brief chapters but full of facts, figures, and suggestions. This is an excellent book in presenting an overview and providing plans of action. Some will say it is not comprehensive enough and it is not if just considered by itself. It is, however, intended to be used with other sources and probably more than anything, it is intended to raise the consciousness of anyone working with developmentaly disabled individuals. In the epilogue Allen C. Crocker states "There is reason to hope, as this second decade begins, that the biomedical front will see important gains regarding control of HIV infection. Eleven versions of vaccine are now in some degree of human trial, and one hundred drugs for treatment are in human testing. In the immediate future, however, science alone will not save the day. There is a great deal of unfinished business in organizing our present capacity for effective assistance." This is a recommended book for all medical, academic, and large public libraries. (H. Robert Malinowsky)

20. AIDS in the World, edited by Jonathan M. Mann, Daniel J.M. Tarantola, Thomas W. Netter. 1992. Harvard University Press, 79 Garden St., Cambridge, MA 02138-9983. 1,037p., illus., bibliog., index. ISBN 0-674-01265-8, 0-674-01266-6pbk. $34.95, $15.95pbk (Descriptors: Epidemiology; World Health)

This is the first global report on AIDS published by the Global AIDS Policy Coalition, an independent coalition, with funding coming from the Association Francois-Xavier Bagnoud. It "covers the period from the recognition of AIDS in the early 1980s through mid-1992, and thus contains both a retrospective and a current analysis of the pandemic's dimensions, shape, and impact, as well as the range of societal responses." The Coalition discovered very quickly the unavailability of information throughout the world. Some of the information is incomplete because various governments are not willing to share the data on AIDS with anyone. The basic features of this pandemic are frightening--"No community or country in the world already affected by AIDS, can claim that HIV spread has stopped." "HIV is spreading--sometimes quite rapidly--to new communities and countries around the world." "The epidemic becomes ever more complex as it matures: the global epidemic is composed of thousands of smaller, complicated epidemics." The statistics alone are chilling: "By early 1992, 12.9 million people around the world (including 4.7 million women, 7.1 million men, and 1.1 million children) had been infected with HIV. About one-fifth (2.7 million; 21 percent) have thus far developed AIDS; of these, over 90 percent (nearly 2.5 million) have died." These are grave facts that are unfortunately falling on deaf ears of the world's leaders. It is estimated that with no vaccine or cure there will be a minimum of 38 million adults with HIV infection by the year 2000. Complacency seems to be the norm. Of the 37 countries surveyed by the Coalition, the head of state has said nothing publicly about AIDS in 13 with an additional 13 only having made their first statements since 1989! This is a pessimistic but realistic book that is intended to "guide and inspire individual, community, and global work for health into the next millennium."

Part 1--"The Impact of the Pandemic"--covers the status and trends of the HIV pandemic, the pandemic itself, interactions of HIV and other diseases, HIV and other sexually transmitted diseases, and the demographic, economic, and social impact of AIDS. These are serious chapters setting the stage for the rest of the book. Statistics, graphs, charts, and other visual data are used throughout making the impact even greater. Much of this information is data gathered by the Coalition and never before published. Part 2--"The Global Response"--covers four phases: mid-1970s until 1981 where HIV spread, silently and unnoticed to all inhabited continents; 1981-1985, a period of discovery and initial response marked by tremendous scientific creativity and progress; 1985-early 1990 when the world's first truly global strategy against a disease was developed; and finally the current phase where commitment and resources have reached a plateu with the pandemic intensifying and the gap between the pace and the response growing and widening dangerously. Part 3--"Global Vulnerability"--is a very informative section consisting of one chapter that discusses individual vulnerability in becoming infected with the HIV virus. From these facts it then discusses collective vulnerability with a warning to those countries that have thus far escaped the brunt of the HIV/AIDS pandemic, including Indonesia, Egypt, Pakistan, Nigeria, Bangladesh, Afghanistan, and Somalia--"you must act now--for the warning signs are clear."

The last part--"Critical Issues"--looks at a variety of issues. Trends in the United States and Europe are discussed, as are such topics as breast feeding, perinatal HIV transmission, does male circumcision prevent HIV infection?, gay men and AIDS, children and AIDS, and dementia. This is the part to read if one is interested in how the world should be attacking this problem. Policy and program issues are critical. Without strong policies and programs, AIDS will continue to expand and the world will continue to suffer from this devastating disease. The final chapter of this excellent book covers "The Next Epidemic." There are currently some 60 newly recognized viral agents whose origins are unknown. Any one of these agents could be the next epidemic. It is extremely important that global surveillance be top priority in funding by all nations of the world. Numerous tables of AIDS statistics are included in the appendices. This is a highly recommended book for all libraries. It is heavy reading, full of facts and figures, and alarming. (H. Robert Malinowsky)


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