Infectious disease is, for better or worse, intertwined with politics in a manner no other form of medicine is. While certain infectious disease require core governmental functions such as quarantine to be exercised and bioweapons involve multiple aspects of government role in promoting national security, it goes beyond that -- as a daily perusal of the headlines in our post-Ebola world reveals. Of the infectious diseases, HIV is in a realm all of its own really marking a new phase in how politics and infectious disease interact. While tuberculosis, plague, cholera, yellow fever, and malaria all had political importance, HIV is sui generis.
I recently finished an excellent, up-to-date guide to the global politics of HIV/AIDS by a major force in the field: AIDS: Between Science and Politics by Dr. Peter Piot, the 1st director of UNAIDS, one of the discoverers of Ebola, and the director of the famed London School of Tropical Medicine and Hygiene.
The book is based on a series of lecturers Dr. Piot delivered and covers the most pressing aspects of the global battle against HIV/AIDS which is now in its 4th decade. Throughout the book, Dr. Piot concretizes the nuances of the HIV pandemic with special attention to its heterogeneity ("know your epidemic") and the vicissitudes of infection rates, including the alarming increase in cases in American bisexual and homosexual men causing HIV rates in New York City and Washington DC to eclipse rates in some African countries. Dr. Piot also expertly emphasizes that the HIV pandemic is not explained by a simple linear model. For example industrialization can, depending on the context, foster or hinder the spread of HIV.
Arguing for renewed efforts to harness all the scientific knowledge gleaned--which now includes pathbreaking concepts such as treatment-as-prevention, PrEP, needle exchange, decriminalization of sex work--Piot provides a path forward for controlling what has become the emblematic infectious disease emergency of our time, which killed 1.2 million people in 2014 and approximately 40 million since its jump into our species.