[In the following mixed review, Geiger lauds Shilts's reportage of various elements of the AIDS epidemic in And The Band Played On, but notes that the study contains an excessive amount of detail, focuses almost entirely on the homosexual population, and lacks information on such individuals as intravenous drug users, who have also been widely infected with HIV and AIDS.]

We are now in the seventh year of the AIDS pandemic, the worldwide epidemic nightmarishly linking sex and death and drugs and blood. There is, I believe, much more and much worse to come. But great and lethal epidemics are never merely biological events, and never elicit merely biological or scientific responses. They become social forces in their own right, carving deep new fissures in the political and cultural landscape, thrusting up buried fears and hatreds. "Objective" medicine and science may be as vulnerable to these pressures as, say, Congressmen, evangelists or budget directors.

And so acquired immune deficiency syndrome is not only an epidemic; it is a mirror, revealing us to ourselves. How did we respond? What does that say about us, and about the future? In And the Band Played On, Randy Shilts, a reporter for The San Francisco Chronicle who has covered AIDS full time since 1983, takes us almost day by day through the first five years of the unfolding epidemic and the responses—confusion and fear, denial and indifference, courage and determination. It is at once a history and a passionate indictment that is the book's central and often repeated thesis:

The bitter truth was that AIDS did not just happen to America—it was allowed to happen…. From 1980, when the first isolated gay men began falling ill from strange and exotic ailments, nearly five years passed before all these institutions—medicine, public health, the federal and private scientific research establishments, the mass media, and the gay community's leadership—mobilized the way they should in a time of threat. The story of these first five years of AIDS in America is a drama of national failure, played out against a backdrop of needless death.

In the beginning, Mr. Shilts writes, physicians and scientists (with the exception of a heroic and dedicated handful) did not devote appropriate attention to the epidemic "because they perceived little prestige to be gained in studying a homosexual affliction." Desperately underfinanced and shorthanded, epidemiologists were delayed for months and years in linking all the cases of a little-known skin cancer and bizarre infections with obscure microbes, tracking down the chains of transmission from person to person, understanding that the root cause was a new sexually transmitted virus—spread via semen and blood—that destroyed the immune response, the body's ability to fight off all infection.

And even when that understanding was dawning and the massive epidemic threat was clear, as Mr. Shilts documents exhaustively, the Reagan Administration ignored pleas from many scientists and physicians, cut funding mercilessly and sent its agency heads to mislead Congressional committees by saying that the researchers had everything they needed. For example, Margaret Heckler, Secretary of the Department of Health and Human Services, testified in May 1983 that "I don't think there is another dollar that would make a difference because the attempt is all out to find an answer." Even when funding increased, the scientists carried on interagency wars. The National Institutes of Health, the Communicable Disease Center and others competed rather than collaborated, engaged in domestic and international wars for prestige and thus delayed progress. Medical journals delayed or rejected publications. Public health agencies vacillated.

Meanwhile, he notes, gay community leaders (like everyone else!) "played politics with the disease, putting political dogma ahead of the preservation of human life." With few exceptions, they denied that the epidemic existed except as a homophobic fantasy, fiercely labeled attempts to modify behavior as "sexual facism" and an infringement on civil liberties and failed to mobilize effectively for more funding for research and treatment.

The mass media, meanwhile, yawned in indifference and shunned the story—until the movie star Rock Hudson died of AIDS in the summer of 1985.

There are some troubles with this thesis, both in substance and in presentation. In his appropriate rage over indifference and lives lost, Mr. Shilts overstates the effect earlier intervention would have had. There would have been a major epidemic in any case because AIDS patients—unknowingly infected and capable of transmitting the virus for years before symptoms appeared—were steadily infecting others. Even an all-out early effort, given the state of knowledge, could not have stopped it.

But this is only one of the five major stories Mr. Shilts is covering. There is the epidemiological story—the medical stumbling over clues, the exhausting tracking down and charting of cases. There is the human story: the anguish, terror, rage, denial, painful suffering and miserable deaths of specific human beings. There is the pain of their friends and lovers, the growth of fear in whole communities.

There is also the clinical story of physicians struggling both to treat and care for AIDS patients—desperately comparing notes, searching the medical journals, fighting for hospital beds and resources. There is the story of the scientific research that led at last to a basic understanding of the disease, the identification of the virus, the test for antibodies. And, finally, there is the larger political and cultural story, the response of the society, and its profound impact on all the other aspects of the AIDS epidemic.

Mr. Shilts tells them all—but he tells them all at once, in five simultaneous but disjointed chronologies, making them all less coherent. In the account of a given month or year, we may just be grasping the nature of the research problem—and then be forced to pause to read of the clinical deterioration of a patient met 20 or 40 or 60 pages earlier, and then digress to a Congressional hearing, and then listen to the anxious speculations of a public health official and finally review the headlines of that month. The threads are impossible to follow.

The reader drowns in detail. The book jacket says that Mr. Shilts—in addition to his years of daily coverage of the epidemic—conducted more than 900 interviews in 12 nations and dug out thousands of pages of Government documents. He seems to have used every one of them. Reading And the Band Played On sometimes feels like studying a gigantic mosaic, one square at a time.

Finally, and most disturbingly, there are people missing from the book: the intravenous drug users and their sexual partners—a population that is mostly poor and black or Hispanic—who now constitute the great second wave of the AIDS epidemic, and a great share of its future. Mr. Shilts gives them a few paragraphs, no case reports, no personal or human accounts.

Not long ago, Dr. Stephen Joseph—New York City Health Commissioner, and one of the most skilled and humane of public health officials—sketched the future of the AIDS epidemic. In 1991 alone, he told a small medical meeting, there will be more new AIDS cases than there have been in all the years from 1980 to the present. The city will need 2,000 to 4,000 hospital beds just for AIDS patients—with comparable and overwhelming needs for chronic-care facilities, social services, welfare assistance, nursing services and counselling. A majority of the anticipated tens of thousands of 1991 New York City AIDS patients will be black and Hispanic intravenous drug users, their sexual partners and their babies.

How, someone asked, will two more oppressed minorities move the nation, the rest of us, to provide the needed resources? There was a long pause. "Well," Dr. Joseph at last said softly, "we'll find out what kind of people we are, and what kind of people we want to be." And the Band Played On is about the kind of people we have been for the past seven years. That is its terror, and its strength.