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Infectious Ideas: U.S. Political Responses to the AIDS Crisis by Jennifer Brier (review)
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It is widely and accurately believed that the federal government responded indifferently and belatedly to the HIV epidemic. This view has been supported by numerous scholarly and journalistic accounts beginning, most notably, with Randy Shilts’s And the Band Played On. Presenting nearly moment by moment snapshots mainly focusing on New York, San Francisco, and Los Angeles—the three initial epicenters—Shilts’s widely influential book vividly illustrated how little was done by the state to fight AIDS in the early years of the epidemic. At the same time, the mobilization of gay men to “fight” AIDS was a striking contrast to government inaction with the exception of pockets of activity in San Francisco. Echoing these views, the most vocal and visible AIDS activists described the efforts of federal, state, and city governments in even more strident ways. Public officials of all sorts were accused of being murderers engaged in “genocide.” At a 1993 statewide AIDS conference in New York I attended, Larry Kramer, one of the most vocal and influential leaders of the AIDS community, accused an audience of public employees and representatives of nonprofit organizations of being “desk killers,” likening them to the faceless bureaucrats engaged in the Nazi Holocaust.

Without overlooking the reality of the slow response, Jennifer Brier offers a carefully researched and highly ambitious account of the development of HIV policy, mostly about the United States but with two chapters that take a global perspective, discussing Brazil and South Africa. Written for scholars, policy analysts, students, and general readers, the book is well written and covers a wide-ranging set of selected key issues.

Infectious Ideas offers an important, nuanced view of the evolution of AIDS policy. One reason for its strength is that Brier looked closely at primary data in the Ronald Reagan Presidential Library. This allowed her an inside view of policy development that no other scholar to date has been able to consider. Among the important points she makes, three are most noteworthy.

The first is the continuity between early AIDS prevention and politics and the evolving sense of cohesiveness, political influence, and social responsibility in the gay community. This is an aspect of AIDS policy that has been overlooked. Indeed, the very first steps taken to influence both local and national policy were done by leaders and staff of the National Gay and Lesbian Task Force and the Lambda Legal Defense Fund alongside representatives of nascent AIDS organizations who met on a regular basis with local officials and were the first to meet with White House representatives.1

A second major theme was the significant differences of opinion among federal officials, including some of President Reagan’s key advisors. Brier points out:

Given that Reagan did not mention the term “AIDS” in public until 1987, I expected to find very little on AIDS in Reagan’s official papers. I was wrong. . . . Contrary to standard historical narratives of conservativism that argue AIDS served as a rallying point for conservative activists, . . . AIDS divided conservatives. . . . While I agree that the Reagan administration’s sluggishness in responding to AIDS must be documented, . . . the historical record points to a more complicated and internally contradictory, administrative reaction to AIDS after 1985. . . . The federal government’s decision to design an AIDS prevention strategy produced splits and disagreements among political appointees in both the domestic and foreign policy areas.

(7, 80–81)

A third theme is that the AIDS community—what Brier labels AIDS workers—was not so neatly divided into political activists and service workers. Advocacy, politics, and service provision overlapped considerably in terms of both the people and the organizations that engaged in each type of collective action. One of the two chapters on global AIDS focuses on the important role of the Ford Foundation working with community-based organizations in Brazil. Foundations, service providers, and members of ACT UP and other AIDS organizations shaped public policy both domestically and globally, and, as Brier notes in her conclusion, “a disparate group of actors . . . came together, however uneasily, to address the AIDS crisis. In doing so, they put the debate about what constituted health on the table” (200).

As we look back on an epidemic that has now...

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