There are many aspects to AIDS. This book, written by two New Scientist journalists, while not ignoring the political and social context, concentrates largely on the science of AIDS, from the first report of Pneumocystis pneumonia in Los Angeles in June 1981 up to the end of 1987.
In the early days of AIDS when symptoms were found mainly in intravenous drug users and gay men who took poppers and had many sexual partners, there were suggestions that the disease was caused by general overloading of the immune system. By the Summer of 1982, when the Centers for Disease Control adopted the term AIDS, and over 350 Americans had been diagnosed as having it, its sudden and rapid spread should already have made clear that it was instead caused by an infective agent. Its appearance in haemophiliacs with previously healthy immune systems provided specific evidence for this. The prime suspect was a virus.
The first scientific paper describing the virus, by Luc Montagnier, was published in Science in May 1983. A year later a paper by Robert Gallo identified the virus as HTLV-3. The remarkable wrangle between them over who first discovered the virus and whether it really was an HTLV-type virus was finally put to an end by a legal compromise only last Spring.
There was an urgent need to develop a test for the presence of the virus in order to screen donated blood. A test for antibodies to the virus was licensed in the United States in March 1985, but the UK government claimed the test was unreliable and waited until August for a British test before starting to screen blood. The use of the test for other purposes highlights a number of ethical issues, some of them touched on in the book, which are likely to become increasingly controversial.
Less than five years after the initial discovery of what is now called the Human Immunodeficiency Virus (HIV), there is considerable knowledge about its structure and life cycle. The practical significance of this knowledge lies in its use to develop vaccines against HIV and treatments or cures for AIDS. It may sometimes seem that identifying useful drugs is a matter of trial and error; certainly there is some of both, but there is also scope for design. The book reviews the various substances which have been investigated, showing how or why they might work. Tests of potential vaccines are still in the early stages and only one treatment, zidovudine (as AZT was renamed to avoid confusion with another drug having the same initials), has so far seemed to be particularly effective, albeit with side effects. But there are several hopeful avenues yet to be explored.
One subject treated in the book, the spread of HIV, and education to prevent it, is of widespread concern. The degree of public ignorance is suggested by a 1986 survey of students in San Francisco: 40% were unaware that AIDS is caused by a virus or that a condom could help prevent its transmission. This is undoubtedly connected with the US government’s continuing failure to emulate the belated public education campaigns in European countries despite a two-year headstart and 50,000 American citizens now living with or dead from AIDS. But I wish I could share Kingman’s optimism (expressed not in the book but more recently in New Scientist) that “due to the success of education campaigns on safe sex, transmission of the virus between homosexual men in Britain is essentially a thing of the past”. Unfortunately, scientific knowledge in this area – also hampered by prejudices and taboos about sexual lifestyles, race and drugs – is making relatively slow progress. There is still little definite information about transmission rates, though statistical evidence is gradually accumulating to narrow down the really risky activities to anal and vaginal penetrative sex, injection with used needles, and being born.
With the present rapid rate of advance generally, any book on the science of AIDS is at high risk of becoming dated quickly. The Search for the Virus is nonetheless a well-written survey of the brief history and current state of medical science of HIV and AIDS at the end of 1987. The book should be particularly valuable to people who are interested in exactly what HIV is, how it works and how it might be defeated, but who haven’t the time, inclination or knowledge to follow the scientific or medical press. The style of writing avoids journalistic hyperbole (unlike the blurb on the back cover) and is pitched to be easily readable by a non-scientist, without over-simplifying the content. A glossary and reasonable index are provided, but no references or bibliography. About sexual orientation the authors are generally neutral – it’s a shame, though, that they felt the need to qualify heterosex as “conventional” several times.