Washington, DC — The Invisible People: How the U.S. has Slept through the Global Aids Pandemic, the Greatest Humanitarian Catastrophe of our Time. Greg Behrman. Free Press, 2004. 368 pp. $17.50 cloth. ISBN 0743257553
Scholars of African history and developing world politics have long known that the American "solution" is not always right for problems outside America's borders. In his recent book, The Invisible People, international relations expert Greg Behrman takes aim at America's failure to contain the global HIV/Aids epidemic. In the spirit of Laurie Garrett's The Coming Plague and Betrayal of Trust, which depict a re-emergence of killer infectious diseases and a failed public health system, Behrman's The Invisible People paints a bleak picture of the world outlook on Aids. Despite noble efforts by activists, journalists and some politicians, the overall American mechanism failed to engage the issue seriously enough. The consequences have been disastrous.
The book traces the chronological history of the Aids epidemic, with vignettes about various participants who shaped the U.S. and the world's response to this emerging threat. These vignettes serve to provide hope in what is overall a damning report of the American government's inability to address Aids as a national and a world security issue. Despite Behrman's assessment that "the U.S. has slept through the global Aids pandemic," many dedicated and heroic scientists, politicians and activists, such as Jonathan Mann, Kofi Annan and Jeffery Sachs, boldly attempted to stem the spread of disease.
Early in the book, Behrman lays out the basics of the growing HIV/Aids pandemic from its discovery in the early 1980s through the production of the first antiretroviral treatments near the end of the decade. A high level of Aids awareness and activism in the United States emerged during this period. Such activism brought the domestic Aids crisis to the press's attention, and forced policy makers to create institutions and plans to address the disease in the United States. Global Aids was ignored.
In the first half of the book, the reader is introduced to a bewildering number of organizations, bureaus, activists, journalists, scientists and policy makers. In sometimes overwhelming fashion, Behrman's story weaves together the work of hundreds of individuals. The book is the result of over 100 interviews with such notables as Peter Piot, Anthony Fauci, Donna Shalala, Joe McCormick, Richard Holbrooke and many others. However, one of the book's weaknesses is that the plethora of names makes it difficult to keep everything and everyone straight in your mind. Whereas in her related books, Laurie Garrett presents fewer, more thoroughly described personalities, Behrman fails to make his multitude of characters memorable and vivid 100 pages later. It is not entirely Behrman's fault. In fact, the reader's confusion probably reflects accurately the confused response of the Aids community and the government during this early part of the HIV/Aids response.
As the book progresses, Behrman's descriptions of who did what, when, where and why takes on a more complete approach, perhaps indicative of a maturing Aids community with more concerted, defined contributions and ideas. Despite its early confusion, the book illustrates the tireless efforts and incredible foresight of people like the late Jonathan Mann, the excitement generated when economist Jeffery Sachs brought his talents to bear on the pandemic and many other tales, good and bad, about the unfolding response to global Aids.
As the book moves into its latter pages, the presidencies of Bill Clinton and both George Bushes are examined. Health-minded Americans may be surprised to find that Clinton encouraged Aids programming, but did little to generate concrete funding. The reader will be dismayed to uncover how close George W. Bush came to providing billions of dollars for global Aids funding, only to let the issue die on his watch. Close observation of the Bush and Clinton administrations' approaches to Aids reveals Behrman's most important thesis. Both administrations empathized with Aids victims and activists and supported Aids-based proposals. However, Behrman contends that the U.S. ignored or could not see the national security risks posed by a disease that was "at work destroying Southern African states, creating breeding grounds for conflict and terrorists." Instead, the U.S. response to Aids was largely soft, consisting of humanitarian efforts that lacked the no-nonsense approach that "real" security threats received. Security experts simply failed to acknowledge the health-security nexus inherent in this unprecedented pandemic. According to Behrman, HIV/Aids is not a soft issue. Aids is a major destabilizing force in Africa, and its effects will soon be felt in the second-wave countries, China, India and Russia. All of this should have placed the pandemic squarely in the crosshairs of national security advisors.
Behrman's message is clear - our leaders need to be strong advocates for Aids education, control and treatment here and throughout the world. This means that the U.S. should not single out individual countries for Aids drugs, should not make empty promises for billions of dollars in funding, and should not let other world events supercede our response to the most calamitous pandemic in history. Behrman's writing provides many examples of ways in which Aids issues were tabled, and further instances where political infighting and 'turf wars' proved damaging for those dying on the ground in Africa and elsewhere.
This book is a great read for anyone with strong opinions and interests in public health and global responsibility. Skeptics and supporters alike will learn from Behrman's careful reporting and readability. Quoting columnist Sebastian Mallaby of The Washington Post, Behrman closes with the bottom line on Aids. "A century from now, when historians write about our era, one question will dwarf all others, and it won't be about finance or politics or even terrorism. The question will be, simply, how could our rich and civilized society allow a known and beatable enemy to kill millions of people?"
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This book should provide even the most domestic-oriented American with ample reason to change the future and advocate for U.S. participation in the fight against global HIV/ Aids. Whether you invoke moral, religious, economic or security reasons for uplifting the world's at-risk populations, this book makes it clear that U.S. intervention is urgently required and that our annual contribution of billions of dollars toward the control of global HIV/ Aids will serve to head off future losses, both in human and economic terms. If the U.S. insists on fighting foreign wars, then the battle against HIV/ Aids is the most formidable and urgent enemy for us to engage.
Sean Murphy is an MD and PhD candidate at Northwestern University Medical School in Chicago. As a graduate student, he has conducted molecular parasitology research on malaria. Murphy also holds a post-graduate Diploma in African Studies from the University of Cape Town, South Africa, where he studied HIV/Aids. His research has been published in Blood, the American Journal of Tropical Medicine and Hygiene, and Virology.
