AMID the dozens of books about AIDS, one stands out-Steven Epstein鈥檚 Impure Science (University of California Press, $29.95, ISBN 0 520 20233 3). I read it with growing recognition-and relief.
Epstein has documented the fast-moving history of the epidemic鈥檚 first years in an eloquent, readable narrative which focuses exclusively on the politics of research: the unwritten rules that govern the way knowledge about HIV and AIDS is advanced.
A sociologist at the University of California, San Diego, Epstein argues convincingly that AIDS research is a more public arena than many other fields of science. The many 鈥渙utsiders鈥� involved-activists, politicians, pharmaceuticals companies, reporters and gatekeepers such as journal editors-have influenced the paths that the research has taken. In such a politicised arena, he says, raw evidence alone is not enough to establish 鈥渇acts鈥�. The credibility of those who present that evidence is crucial.
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Epstein examines the importance of power and trust as factors that shape scientists鈥� credibility with each other and with nonscientists. He argues that in the AIDS crisis, 鈥渢he normal flow of trust and credibility between experts and laypeople has been disrupted. The autonomy of science has therefore been challenged: outsiders have rushed into the breach.鈥� He also demonstrates that AIDS activists have become a new class of 鈥渓ay experts鈥�, many of whom have gained credibility with scientists. The effect of this shift to expert status has been uncertain, both for the activists and for the science.
Without taking sides, Epstein documents some of the key 鈥渃redibility struggles鈥� as they unfolded, such as that between Peter Duesberg, the Berkeley virologist who believes HIV is not the cause of AIDS, and the AIDS 鈥渆stablishment鈥�; and the interpretation of clinical trials that have shaped the roller-coaster history of the drug AZT.
Those stories, you might think, are all too familiar. So why would I feel relieved? Because Epstein is interesting to read, that鈥檚 why: his refusal to take sides means that his analysis is refreshingly free of predictable formulas. Most popular books about HIV either trot out what is well known or repeat tired conspiracy theories. Epstein falls into neither camp, and his analysis is intelligent and original.
Two other popular AIDS books to emerge this year were Neville Hodgkinson鈥檚 AIDS (Fourth Estate, 拢17.99, ISBN 1 85702 337 4) and Duesberg鈥檚 Inventing the AIDS Virus (Regnery Publishing, Washington DC, $29.95, ISBN 0 89526 470 6). Both are classic polemics by 鈥淎IDS dissidents鈥�, and precisely the kind of challenges to the orthodoxy that so intrigue Epstein. Both repeat their now well-rehearsed arguments that HIV is not the cause of AIDS, and that the world has been deceived by an AIDS 鈥渋ndustry鈥�.
I made myself read to the end of Hodgkinson鈥檚 book but I failed to find anything new, except for the revealing sections explaining some of the decisions he and his editors took at the Sunday Times to champion Duesberg. Of course AIDS research had a chequered history, and of course some of the questions raised by Duesberg and his followers were valid. But ultimately, the dissidents鈥� arguments are circular, and ignore diverse and robust evidence linking HIV with AIDS. That their views continue to attract attention demonstrates Epstein鈥檚 point: credibility is not defined the same way for everyone in the AIDS arena.
For those who just want the information rather than the polemic, Virginia Berridge鈥檚 AIDS in the UK (Oxford University Press, 拢12.99, ISBN 0 19 820473 6) will prove invaluable. It鈥檚 a scholarly synthesis of the early history of AIDS in Britain, and may prove useful for AIDS policy makers in other countries.
In the middle of all these histories and arguments, the human epidemic can all too easily be forgotten. So books such as Positively Women: Living with AIDS, edited by Sue O鈥橲ullivan and Kate Thomson (Pandora, 拢9.99/$18, ISBN 0 04 440943 5)-an updated version of the 1992 Sheba edition-are all the more essential to report the experiences of HIV-positive individuals, and to offer informed advice to anyone affected.