How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time

By Greg Behrman. Free Press. 352 pp. $25 Greg Behrman's assessment of America's response to the global AIDS pandemic is reminiscent of Randy Shilts's 1988 bestseller, And the Band Played On. Where Shilts traced the shortcomings of the federal government's response to AIDS in the United States in the 1980s, Behrman documents its failures on other continents, particularly Africa.

In The Invisible People, Behrman sees the United States of a few years ago as a country in a daze of denial brought on by enjoyment of its own affluence and resistance to the onslaught of bad news -- from genocide in Rwanda to the incomprehensible numbers of people dead from AIDS. "Consumed with an explosion of wealth, encamped in 'virtual' communities, awash in frivolous entertainment and a dizzying sea of technology, and smug in its seemingly impregnable might," Behrman writes, the United States in the 1990s was caught up in "an insular, frivolous and apathetic epoch."

Behrman examines various entities that could have helped, but his primary focus is on the federal government. Just as Shilts accused the government of failing to act aggressively against the epidemic at home due to the unpopularity of the groups most affected early on, so Behrman charges with regard to our global response. "The historical record is highly unlikely to reveal any instances of policy makers opposing engagement in the issue because black Africans were dying," he writes. "Rather, there was simply less of an impetus to move policy because it was black Africans who were dying."

But it was more complicated than that, as Behrman goes on to make clear. The United States was growing numb to the skyrocketing numbers of AIDS cases on its own turf. Meanwhile, the end of the Cold War had diminished Africa's strategic importance, and the United States had begun scaling back its foreign aid to the continent. And all the news from Africa seemed to be about famine and civil war; the AIDS crisis was just another "part of one long, uninterrupted narrative of death and suffering in a faraway land."

But where Shilts's book tended to see the key players as good or bad, Behrman tries to see both good and bad in everyone. He paints former Sen. Jesse Helms as a formidable obstacle to efforts to send U.S. dollars to Africa, but then credits him with a complete change of heart in his last term that led him to promote a $500-million commitment to combat mother-to-child transmission of HIV in that continent. Behrman casts former president Clinton in a harsh light, characterizing him as "responsive, engaged, and in agreement" that the United States should do all it could to help fight AIDS in Africa, but unwilling "to expend one dime of political capital to move U.S. policy" until after he left the White House.

As for the current President Bush, Behrman says that, early on, he "had little appetite for the issue." But in short order he lavishes praise on Bush for proposing an "Emergency Plan for AIDS Relief" that calls for the United States to spend $15 billion over five years for treatment and care of Africans with HIV. "With one dramatic and unexpected stroke," Behrman writes, "President Bush had punctured the bubble of U.S. abdication and inaction that had engulfed the country throughout the twenty-year history of the pandemic's flight."

Not everyone will see things Behrman's way; that's politics. And there are weaknesses in his methodology and thoroughness of coverage. He lays considerable blame for the early American lack of interest in Africa at the feet of President Reagan's assistant secretary of Health and Human Services, Ed Brandt Jr., but did not interview Brandt. Nor did he interview senior HHS official Gregory Pappas, yet he passes along a "third-hand account" of a scandalous rumor that Pappas allegedly conveyed to a relatively unknown AIDS activist.

Behrman's involvement in writing a report on "Improving U.S. Global AIDS Policy" for the Council on Foreign Relations Roundtable has given him a meaningful vantage point. And he shares with Shilts a passion for investigating the government's failure to act decisively when it had the resources to save so many lives. He clearly cares about people with HIV, particularly those in Africa. (His publicist's Web site indicates that Behrman will be donating "all the proceeds" from the book to a nonprofit organization in South Africa that cares for children orphaned by AIDS.)

But the book may be too late and too far ahead of its time: Its likely readers will be people who already care and those, in the distant future, who seek to answer a question that Washington Post editorial writer Sebastian Mallaby posed almost two years ago: "How could our rich and civilized society allow a known and beatable enemy to kill millions of people?" *

Lisa Keen, an award-winning journalist who covered AIDS for the Washington Blade for almost 20 years, is a freelance writer and co-author of "Strangers to the Law: Gay People on Trial."

AIDS patient in Tembisa, South Africa