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AIDS: Between Science and Politics By Peter Piot Columbia university Press, 2015 Peter Piot has played many roles in the fight against AIDS—researcher, activist, international bureaucrat. He was a co-discoverer of the Ebola virus and founding director of UNAIDS. He brings all of that com- plex background to the writing of a complex book. Originally pub- lished in 2010 in French, the work has been exten- sively updated for this English translation. Piot takes us through the his- tory of the epidemic (or "epidemics"—more on that in a bit), where we stand currently, where treatment and preven- tion have worked—and why—and where they have failed—and why. This is not an easy book to read. The organization is not always smooth or logical and the prose style lacks the flow of the great science popularizers like Stephen Jay Gould, Carl Sagan, or Lewis Thomas. But the effort of reading is richly repaid by a much deeper understanding of the threat the world faces from AIDS and what we need to do to defeat it. One of the more important points that Piot makes is that the AIDS epidemic is really many epidemics, each of them unique to its own social, cultural, political, and economic environment and each of them evolving and changing over time. Treatment and prevention strategies that fail to take that into account are doomed to fail. For example, in many countries, AIDS is largely a disease of spe- cific risk groups: gay men, injecting drug users, sex workers, and their clients. But in Sub-Saharan Africa, AIDS is much more a dis- ease of the general population and most sexual transmission is het- erosexual, with young girls being among the highest risk groups. A recurring theme is the interaction between the characteristics of each local epidemic and the political and cultural factors that can make it harder to treat the disease effectively: the stigmatization of the various risk groups, the criminalization of homosexuality in many places and of injection drug use and sex work almost every- where, the reluctance of countries to admit the problem exists, lin- gering pockets of AIDS denialism, and the unwillingness to spend money on people often seen as less than deserving. Piot does cover successes, and reminds us of a few surprising bits of history. It would be easy to forget, for example, that it was George W. Bush who made a game-changing choice to commit the first real- ly large sums of money to fighting AIDS in the poorer countries of the world. And it's both disturbing and uplifting to read the history of anti-retroviral treatment for infected people. For a number of years after effective drug treatment became available, it was nearly universally accepted by the World Health Organization and other international organizations that the drugs could never be extended to the infected in poorer countries; they had to simply be allowed to die while efforts were focused on preventing spread. And yet, through the efforts of a few determined visionaries, millions of peo- ple in Sub-Saharan Africa are being successfully treated. A fascinat- ing fact is that the first country to make access to anti-retroviral drugs universal was not one of the world's rich countries, but Brazil, which did so very soon after effective treatment became available. Finally, in discussing solutions, Piot makes a strong case for an approach that he calls "combination prevention." If AIDS is to be transformed from a worldwide pandemic to at least a manageable disease, it must be attacked with all available weapons and the social and legal barriers to doing so must be confronted. Among those weapons are the usual well-known ones and a few surprises: con- dom use, needle exchange and other harm reduction programs, treatment to prevent mother-to-child transmission, empowering women and raising their economic status, fighting sexual violence, and reducing economic inequality, among others. And, because both the virus itself and the nature of the epidemics are constantly evolv- ing, we can never forget that even our successes are fragile and reversible and that constant vigilance and a flexibility of approach must always be watchwords. There is hope for the future, but no easy road. —david welch, rn MORE THAN HOT: A Short History of Fever By Christopher Hamlin johns Hopkins university Press, 2014 In this fascinating but incredibly academic and hard-to-read book, Christopher Hamlin, a professor of history at the University of Notre Dame, details exactly what the title claims: the history of fever. Starting off chronologi- cally, Hamlin describes the fevers of classic medicine through the modern and post-mod- ern age. We take for granted now our under- standing of fever as a symptom that gives an indication of our body's response in fighting some type of infection or pathogen. Today, it is one of the all-important vital signs we collect. At the preschool my daughter attended, a temperature above 100 degrees was the litmus 14 n a t i o n a l n u r s e w w w . n a t i o n a l n u r s e s u n i t e d . o r g j u ly | a u g u s t 2 0 1 5 PREVIOUS PAGE: LUIS_ANDRADE | ISTOCKPHOTO.COM

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