THE INVISIBLE PEOPLE

A study of the US government’s failure to react meaningfully to an epidemic that “is refashioning the social, economic, and geopolitical dimensions of our world.”

The overstuffed subtitle says it all. When the US citizenry first awakened to the realities of AIDS in the early 1980s and demanded that something be done about it, officialdom was slow to respond; still, by the end of the 1990s, when about one million Americans were infected, the government, writes policy analyst Behrman (Council on Foreign Relations), spent “more than $10 billion per year on the domestic epidemic.” Yet, he adds, “In that same period more than 40 million infections would accrue worldwide. The US would spend little more than $100 million per year on the global dimension” of what was incontestably a global disease. The results are scarifying: more than 8,500 people die each day from AIDS worldwide, and by 2010 it is projected that the number of people affected will grow to at least 100 million. Africa has already been ravaged, Behrman writes: “Approximately 40 percent of adults in Botswana are HIV positive. . . . Life expectancy in Botswana has decreased from seventy-one to thirty-nine years, and in Zimbabwe from seventy to thirty-eight years.” Such statistics did not much sway the well-meaning but perhaps feckless Clinton administration, which failed to lead where leadership was required, while the federal agency charged with providing health leadership “seemed acutely aware of its inadequacy.” Current Secretary of State Colin Powell seemed most aware of AIDS as an issue of national and global security, writes Behrman, and helped change Bush administration policy to a more activist stance—but slowly, and only after it had become apparent that the disease had spread to China, India, and Russia, with potentially devastating consequences.

At once white paper and polemical study of demographic and epidemiological trends—and a hard glimpse of government’s role in world healthcare.