Book review: And the Band Played On.

Randy Shilts, And the Band Played On: Politics, People, and the AIDS Epidemic. St. Martin's Press, 1987.

There are a few books on my shelf that I can read any given number of times without being bored or impatient. One of these is And the Band Played On, a painstaking work of journalism that never feels laborious in the reading -- despite being in excess of 600 pages.

Randy Shilts, who was a reporter for the San Francisco Chronicle reporting on AIDS in the early 1980s, assembled an intricate chronological telling of the early unfolding of the AIDS epidemic, from the first glimmerings of awareness of a new disease among doctors, public health workers, and trackers of epidemics, to the reactions of people in communities hit by this new disease (especially the gay communities in New York City and San Francisco), to the responses of politicians and policy makers who, almost without exception, dropped the ball.

The book is structured in such a way as to shift between the perspectives of doctors, scientists, people with AIDS, gay leaders, and politicians and political staffers at national, state, and local levels. Each viewpoint here has its own compelling narrative: the medical mystery behind the growing clusters of exotic and seemingly unrelated illnesses, the scientific drama around trying to identify a tricky virus (not to mention the fisticuffs around issues of collaboration and credit), the human drama about what AIDS might do to the identity (and survival) of a gay community still at the early stages of its struggle for acceptance, and the horror story about the prospects of mounting serious scientific or public health initiatives in a political climate allergic to allocating resources. As these distinct but connected narratives unfold, the constant drumbeat in the background is the mounting rate of reported AIDS cases and the growing death toll.

There is no shortage of villains in this story. The biggest turn out to be complacency and greed (whether for money, prestige, or re-election). Also, for those who think a docile press corps is a recent development, this book provides numerous examples of reporters trusting government press releases rather than digging for the facts -- not to mention ignoring the epidemic until it touched "the general population". Meanwhile, the virus proves itself utterly indifferent to most human concerns, like whether the funding to track it down is provided, whether the benefits of Factor VIII for hemophiliacs or blood transfusions for surgical patients argue for or against donor deferral or screening of blood donations, whether its host is an "acceptable" kind of person or not.

Drawing on the points of view of so many people, And the Band Played On reads as a very evenhanded treatment of the people and events in the first years of the AIDS epidemic. Shilts works from interviews, memos, and sworn testimony, among other sources, letting each of the principals speak in his or her own words but also revealing the contradictions inherent in those words -- especially the contradiction between the official story and the reality on the ground. For those who thought the administration of George W. Bush invented the strategy of hammering official science into the box provided by its policy initiatives and political commitments, Shilts provides ample evidence that the Reagan administration did it, too, and better.

There are not many good guys who emerge here. Many of the politicians who turn up in this story and are still actively involved in politics have a lot to be ashamed of with regard to their calculations in the early years of the epidemic. It's shocking enough that New York City, the U.S. locus with the largest initial AIDS caseload, only endorsed responses to the epidemic that didn't cost them any money, but it is the San Francisco politicos who really disappoint, letting local political rifts trump the interests of public health. How many lives did these politically savvy machinations ultimately cost?

It's easy enough to get drawn into any one of the distinct narrative threads here -- the scientific detective work, the political intrigue, the human drama. But the strength of this book is the way that it shows how all of these strands are woven together. Even when the battle for scientific prestige seems to eclipse all else in the minds of the scientists involved, the reader cannot escape the larger issues riding on the scientists' actions: What will happen to funding? Will patients be able to get antibody tests? Will the blood supply be tested? Will anyone do the research to develop treatments, a vaccine, a cure?

And how many need to die before that will happen?

Despite the horrifying willingness in so many quarters to treat science, politics, and business as a game with immutable rules, the heroes who emerge in this story are the people who see that they are not -- that lives hang in the balance -- and who plead for their fellow members of the human race to wake up to this fact.

The good guys did not win the first round of the AIDS epidemic. I am hopeful that we can learn from Shilts' document of those first years and acquit ourselves better as we write the final chapters.