While tracking the progress and pitfalls of the global fight against HIV/AIDS, Victoria Harden shows in her book, AIDS at 30: A History, that understanding how we got here is key to charting the path to overcoming the pandemic.
It is important to remember, Harden emphasizes, the doubt and fear that surrounded the unknown illness as it attacked marginalized populations before eventually harnessing the attention of the medical community. And to note the developments that doctors and researchers, under constant pressure from a host of actors, have made in understanding HIV and, more recently, in stemming its spread.
The book's strength lies in its methodical documenting of the medical community's response to the virus – no surprise given Harden's background as a medical historian; she was founding director of the Office of History at the National Institutes of Health. The first quarter of the book is a highly readable, chronological record of the various approaches to diagnosing and treating the virus.
This was, she emphasizes, no small feat. HIV appeared during a time of "complacency about epidemic infectious disease", Harden recalls. This new virus was "a humbling reminder that after less than four decades of apparent triumph over microbial pathogens, humans will never be able to divorce themselves from the exigencies of being a part of the natural world".
She goes on to explore the theories, personalities and battles for funding that enabled the world to finally begin effectively fighting the virus. Nothing is too small to escape her attention, including an exhaustive look at the creation of safe blood-banking policies. Above all else, AIDS at 30 is an important reminder of the need for both constant medical vigilance and flexibility within the scientific community.
Harden also seeks to explain how political and cultural ideas influenced the science of AIDS. In specific instances, such as explaining how stigma about a sexually transmitted disease initially associated with the gay community hampered early research in the United States, she succeeds.
But she does not make the same effort to explain later shifts in political perceptions. There is very little discussion of former President George W Bush's decision to launch the President's Emergency Plan for AIDS Relief, for instance, or what impact it had. And an attempt to document the different approaches to communicating about the virus suffers from a lack of the same level of detail that Harden brings to the medical section.
More critically, Harden attempts unsuccessfully to capture the virus's impact on the entire world in one chapter, minimizing both the impact of AIDS on places outside the US and the knowledge that they have brought to fighting the virus. She fails to illustrate how HIV/AIDS drew together an international community in the battle against the pandemic.
The book nevertheless offers significant value, and not just as a historical account. In documenting the constant pressure AIDS activists put on governments and pharmaceutical companies to keep them honest and focused, Harden seems to be drawing a roadmap for the current crop of advocates. There has never been another medical challenge, she writes, where those most personally affected took such strong political action. The key to keeping governments and donors engaged, she seems to say, is not to let up.
While Harden does not attempt to apply any sweeping lessons from the early days of HIV to contemporary times, it is easy to draw some parallels. Current funding shortfalls, including the suspension of Round 11 of the Global Fund to fight AIDS, Tuberculosis and Malaria, mean there is less money to battle HIV/AIDS than in the recent past.
And even at a time when the US is projecting a vision of an AIDS-free generation, Harden's history shows that constant monitoring and new perspectives are critical. She reminds us that the world only arrived at the idea of an AIDS-free generation through constant trial-and-error; first, in determining the causes and later in producing effective therapies to prolong the lives of people infected. Science has brought the world to the brink of an AIDS-free generation, but ongoing research is still important.