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Learning from HIV and AIDS
  1. Joel E Gallant

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    Edited by G Ellison, M Parker, C Campbell. Cambridge: Cambridge University Press, 2003, pp 299 (+17). ISBN 0-521-80866-9 (hardback); 0-521-004705-5 (paperback).

    The chapters in Learning from HIV and AIDS come from talks presented at a multidisciplinary symposium organised by the UK BioSocial Society in May 2001. The goal was to transcend the more traditional question of what we have learnt about AIDS, and instead to focus on what we have learnt from AIDS. The organisers hoped to provide a framework that would foster inter-disciplinary and intra-disciplinary collaboration that would improve our ability to deal with the biological, social, and political challenges brought about by the epidemic. It was hoped that the symposium would shed light on advances in a variety of scientific and psychosocial disciplines that have been brought about as a result of the AIDS epidemic, leading to a more holistic, multidisciplinary approach to our understanding of this disease, its consequences, and our attempts to control it. Disciplines represented in this book include infectious disease, clinical medicine, epidemiology, demography, behaviour change and prevention, anthropology, political science, and even history.

    The contributors of this book have succeeded in their assignment to varying degrees. Like most multi-authored books compiled from symposium presentations, this is an uneven collection. Some of the authors did their homework as assigned: the chapters on epidemiology and demography, for example, explicitly detail the advances in these disciplines resulting from study of the AIDS pandemic. Others, such as the comprehensive chapter on HIV and the evolution of infectious diseases, focus more on what we have learnt about AIDS itself. Some authors use their chapters to discuss weaknesses in the current state of research. For example, the chapter on behaviour change focuses specifically on research on sex workers in developing countries, criticising traditional psychologically focused research as compared with community based research. While undoubtedly important, a discussion on what we have learnt in the broader field of behaviour change and disease prevention as a result of the AIDS pandemic would have been of greater interest to the general reader.

    Two chapters, while fascinating, seemed somewhat out of place. One provided an intriguing look into HIV transmission among gay and bisexual men in the backrooms of London from a descriptive anthropological perspective, focusing less on research and more on advocacy of a different approach to prevention. In a book that deals mostly with research issues and that focuses primarily on HIV/AIDS in Africa, this chapter felt a bit lonely. The nod to the clinical sciences was a thoughtful and personal account by a physician in the UK, in which he discussed his experiences treating HIV infected gay men and immigrants in London, including his battles against the many obstacles to their care. I should disclose the fact that I’m a clinician and a clinical researcher—perhaps not the most appropriate reviewer for a book dealing primarily with non-clinical disciplines in the study of AIDS in developing countries. But a chapter on what we have learnt in the clinical sciences as a result of AIDS would have been an easy one to write, and its absence in a book that otherwise attempts to span the breadth of the disease from micro to macro was glaring. Also missing was an in-depth discussion of the role of patient advocacy and activism in the AIDS epidemic. While it is mentioned in passing by several authors, it deserves a chapter of its own, as it has dramatically changed the way patients view their own health and illness in the developed world, and is now beginning to become a factor in developing countries as well.

    While Learning from HIV and AIDS sometimes misses its target, I found the individual chapters fascinating, approaching them, as I did, as a clinician and therefore an “outsider.” This book would be valuable for anyone working in the field, especially in developing countries, whether as a researcher, policy maker, or field worker. It succeeds in reminding us that there are many ways of looking at an epidemic, ranging from the focus on the microbiology of the infecting organism, to the epidemiology of the spread of that organism within communities and societies, to the behavioural and anthropological factors that facilitate transmission, and finally to the socioeconomic and political factors that can either slow the epidemic or impede our efforts to control it. While it is tempting to focus on the discipline we know best and (as some of the contributors do) to minimise the importance of the other disciplines, Learning from HIV and AIDS reminds us of the importance of the bigger picture—to know how those in other fields think and what they have learnt. Just as physicians are taught to take a holistic view of their patients, it is important that we also view epidemics holistically. It is unlikely that the global AIDS pandemic will be brought under control by any one discipline in isolation.