The Big Sleep

From its inception, the AIDS pandemic has generated extraordinary expressions of sadness and anger. The sadness is easy to understand. The disease kills young men and women and the newborns of infected parents. Some of the poorest and most vulnerable people have become infected and then infected friends and strangers. The anger, too, was there from the start. It could be heard in the chants and demands of ACT UP protesters as they picketed the FDA; it could be seen in the faces of dying mothers who did not have kin to care for their children about to be orphaned. As the numbers of people infected with the disease continues to rise, the sadness and the anger persist.

Science has not lived up to our grandiose expectations. Although combinations of antiretroviral drugs now extend the lives of many people with AIDS, we still lack treatments that would eliminate the virus and an effective vaccine that would protect against the disease. But whatever the shortcomings of science, they are more than matched by those of public health officials and policy-makers. Strategies to alter behavior to prevent the spread of the disease have proved only sporadically effective. Decades later, millions of people who are HIV-positive do not have access to treatment and do not know how to protect themselves; many are not even aware they are carriers of the disease.

Starting from these dismal facts in their new books on the AIDS crisis, Jacob Levenson, Greg Behrman and Lawrence Gostin all try to explain why, despite its considerable resources and expertise, the United States has done such a poor job of containing and treating the disease both at home and abroad. Levenson, a freelance journalist and grantee of the Open Society Institute, wants to understand why so many black Americans are dying of AIDS. Behrman, a staff member of the Council on Foreign Relations, wants to understand why we have not been able to devise and "implement a comprehensive global response that would reduce the death rate from AIDS in the developing world." Gostin, a professor of law and public health who has written for almost twenty years on AIDS policy, has brought together his many essays in an effort to understand past failures and future possibilities. The United States, the authors believe, has the skills and the resources to meet the challenge of AIDS and to extend the lives of the world's poorest and most vulnerable citizens. That we have not done so, they argue, reflects our selfishness and prejudices--a charge that cannot be easily dismissed.

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