This book is a summary of AIDS and its spread around the world, primarily in the post-1980 period. The book seems divided into three sections: first, with the outbreak of AIDs in New York City and San Francisco among gay men. The second section is mostly devoted to a history of studying AIDS itself: the laborious process of identifying HIV, its genetic structure, its method of reproduction, and the search for a cure. The third section is roughly devoted to histories of AIDS around the world, with chapters on the virus's presence in Africa, Asia, and Eastern Europe in the 1990s and 2000s.
I've read other accounts of how AIDS managed to leap from monkeys to humans, and how epidemiologists traced the virus back to its origins in Africa, so I was eager to read about AIDS in its later years. I found the book to be informative and interesting, but not exactly gripping. The writing is clear, and divided up helpfully with headings and subheadings. But unlike some nonfiction can be, it wasn't dramatic. In fact, the author almost seems to want to downplay any drama that might have been part of the AIDS crisis.
This desire for low drama is especially evident, and probably intentional, in the section on AIDS in the North America and Europe. Engel takes great pains to emphasize the fact that AIDS is no longer a scary threat to sexually active people, unless you happen to be an IV drug user, a prostitute, or a promiscuous gay man. I found this part of his narrative to be quite interesting, because I was in college during the big push to raise AIDS awareness among sexually active people. Condoms were everywhere, red ribbons were everywhere, and safe sex was a constant theme. Ironically, says Engel, this is the period when AIDS had ceased to be the threat that everyone had thought it would be. Scientists and epidemiologists had at this point pretty much proven that AIDS is difficult to acquire for most members of the North American population.
However, it was also at this point in history (mid 90s) that AIDS became a huge problem for all members of populations in Asia, Africa, and Eastern Europe. This section of the book is catalogs the difficulties that AIDS workers have (and still have) in preventing the spread of the disease among populations for whom "safe sex" has no meaning. The descriptions of the cultural roadblocks to AIDS prevention were quite interesting, especially as Engel emphasizes how those roadblocks are/were different for every country.
The concept of having a drug that can cure, or at least delay, AIDS is also problematic. The current AIDS drugs require very specific timing and some require refrigeration. How can you expect a homeless junkie to follow those rules? How can you expect drugs like that to work in rural African countries?
In this section of the book, Engel also addresses the efforts of researchers to formulate a vaccine for AIDS, and the problems inherent in such a concept. For example, how would you test it? Imagine the difficulty in vaccinating someone (either with a placebo or with a live vaccine) and then asking them to participate in risky behavior! How do you give someone a placebo in that situation anyway?
The least gripping part of the book was the middle section, the one about researching AIDS and the search for an effective drug, though the little snafu with competing claims about discovering the virus are entertaining.
Recommended if you like infectious disease (like me) or if you like medical history.