Leslie Craig

It’s Not My Problem Until It Is

And the Band Played on: Politics, People and the Aids Epidemic by Randy Shilts

is a captivating and compelling exposé that chronicles the emergence of AIDS and its stance as a disease of epidemic, endemic and even pandemic proportions. Well written and profoundly insightful, the book details the absolute disregard for the growing AIDS epidemic, then dubbed an “affliction of pariahs” (p. 579) – until it appeared to extend beyond an issue of homosexual concern to penetrate socially accepted people – the ‘rich and famous’ and ‘heterosexual’ subgroups. Replete with statistical figures, information from journalistic reviews and conversational recounts, as well as data from interviews, medical records and other factual sources such as death certificates, this historical account of the AIDS epidemic is a guide for professionals, public and private sector agencies, medical and scientific experts associated with healthcare, on how to, and how not to approach any incident or prevailing medical or disease crisis in the interest of human health and ultimately human survival.

Furthermore, an important indicator of the book’s contribution to the public health discipline is the awareness that it provides the lay person, informing him/her of the ubiquitous role of politics within disease management, which necessitates individual responsibility to fight and advocate for personal health, medical research, disease education and prevention strategies.

The reality surrounding individuals living in the time when the disease first appeared is portrayed as a horrific, infuriating and saddening one. Shadowing the period from 1980 – 1987, Shilts reveals the inaction of politicians and healthcare officials, and the lack of the concern typically afforded other diseases by authoritative figures in all professional spheres. Shilts argues that the total indifference towards AIDS from news media, as well as the limited financial support from government and health organizations only served to propagate and fuel the ideology that AIDS was a disease of a lawless, disenfranchised few and not a major societal concern. His details, all timely interspersed with appropriate statistics that divulge the insidious growth of the epidemic in the interim, provide a firsthand view into this world of disinterest. Accordingly, he suggests that the AIDS response was characterized by apathy and neglect except in cases where prestige, scientific publications, medical acclaim or financial gain – as was the case with bathhouse owners and the blood-banking industry – could be derived.

Amid scientific warfare, political tiptoeing and federal inattention and inaction – all constituting a gross display of inhumanity – Shilts provides a powerful, warming account of a lone community’s response to the emerging epidemic. Himself a gay man, this representation may be construed as somewhat biased. This is hardly the case, as the homosexual community, who at the time bore the greatest brunt of the disease burden, is identified as playing a significantly obstructive role in a crucial aspect of public health attainment and disease spread mitigation. Interestingly, he explores the gay community’s opposition to bathhouse closure on the basis of a long denied and long sought after right to sexual freedom, in addition to their resistance to and, later, sluggish acceptance of healthy sexual behaviors such as condom use; actions which though not commendable were not wholly condemnable. Though empathetic to the gay plight, the book in no way applauds the homosexual community for the position it took regarding these “cesspools of AIDS contagion” (p.305). Quite the contrary.

Shilts commends the gay community for its role in acting as volunteers at AIDS-afflicted centers and hotlines, social activists, research and financial lobbyists or even respectful patrons at funeral services, in the midst of disease progression and overwhelming infection. Homosexuals are personified, throughout the book, in their fight against AIDS as sources of courage, strength, compassion, love and support.  Empowered by a will to make a difference, the gay community awakens a sense of pride and inspiration in readers at the perseverance of a socially rejected community to make a difference where needed most.

At the same time, he delivers upon these gay men their share of the blame in perpetuating an unfortunate and somewhat draconian belief that AIDS was an affliction of an unruly few. Accordingly, and ultimately, as Shilts so accurately points out, the fact remains that matters of public health concern should not be left to the decision and management of a societal subset. Consequently, such matters should fall in the hands of health authorities who, armed with scientific evidence and statistical grounds for the preventive or promotional actions to ensue, can thus ensure the well-being and ultimate survival of the human population. To this end, he explains that government and society at large should not be easily subverted by the objections of others and not be apt to let common sense and public health interests be overshadowed, or worse yet, abandoned, for the sake of inconvenience and industry.

Evoking a wide range of sentiments from anger and disbelief, to pride and admiration, and even fear and humility, the book gives an enlightening and fascinating historical account of a woeful period in American politics, and serves as a highly informative reference material to any health care professional. Regardless of one’s proficiency – be it medical, scientific, research, or administrative, And The Band Played On is a firm indicator that the realm of healthcare, health promotion and disease prevention has no space for discrimination and indifference since disease vectors do not suffer from human prejudices and share no interest in our self-constructed social divides.

As the book illustrates, the subsequent prevalence of the AIDS disease in society at large, in the aftermath, proclaims this truth and is an ever-present reminder to all individuals against bigotry and money-making ideations that preclude public health. This book reminds us that disease has far-reaching consequences and a wide-reaching scope, is based on scientific principles, not moral or sexual ones, and that since disease is open to humankind, we need to be ready always to employ an attitude of action and not reaction!