The AIDS Pandemic: Complacency, Injustice, and Unfulfilled Expectations
demic rises, particularly in the poorest regions, there remains fierce debate about humanitarian assistance, property rights, and ethics"
Lawrence 0. Gostin; The University of North Carolina Press; ISBN 0-8078-2830-0; 496 pages; $34.95 hardcover
In The AIDS Pandemic, Lawrence 0. Gostin provides an overview of the AIDS crisis in public health, law and human rights in the United States and abroad. Gostin's command of legal, human rights and public health perspectives on HIV/AIDS makes this volume an invaluable resource in AIDS research, social policy, law and activism. The book's subtitle, Complacency, Injustice, and Unfulfilled Expectations, characterizes the current moment in the AIDS epidemic as Gostin sees it. The author calls the first phase of the epidemic (from 1981-1987) "Denial, Blame, and Punishment" and the second (from 1987-1997) "Engagement and Mobilization." Since 1997, Gostin argues that encouraging advances in public health, prevention and treatment have been coupled with the shifting demographics of the epidemic to poor, minority and women populations in the United States and to the poorer countries around the world. Additionally, there is the lack of political will on the part of governments, conflicts between public health and economic interests and uneven access to resources:
"One would expect the international community to mobilize against a threat of this magnitude, but somehow there is complacency, even indifference, where there should be resolve and unity. As the toll of the pan-
Given the extraordinary odds he identifies, one might expect a veteran like Gostin to have a negative view of the future of the pandemic. However, Gostin does not succumb to pessimism, and one of the most refreshing qualities of this book is the way he mines the history of AIDS law and policy to show challenges and opportunities for the future. As he optimistically, yet cautiously, puts it at the end, "reducing the burden ofHIV/ AIDS is achievable" (page 325). The work is divided into five parts. The first of these, "AIDS in the Courtroom," details the history of policymaking and litigation. By presenting data from the AIDS Litigation Project concerning cases of personal privacy and discrimination, Gostin reveals transformations of the U.S. legal system spawned by the AIDS crisis. "Rights and Dignity," the second part ofthe book, examines the ways that human rights discourse and law have made their way into litigation to protect persons living with HIV/AIDS. Apart from uncovering conflicts between human rights and public health in personal privacy debates, for instance, Gostin assesses the role that the American with Disabilities Act (ADA) has played in the protection of persons living with AIDS. The author also describes legal challenges to the ADA and its implication to the Act's effectiveness in protecting the disabled against discrimination. The third part of Gostin's book, "Policy, Politics, and Ethics," combines public health and human rights perspectives to consider the conflicting priorities of govern-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
ment, public health authorities and researchers. While epidemiological data gathering is crucial to develop programs and allocate resources, justifying surveillance of HIV/AIDS infections has proven to be challenging on ethical and human rights grounds. Public health and human rights perspectives have been at odds with each other at various moments during the crisis. Nevertheless, Gostin suggests ways in which these two perspectives might be brought together. One example he offers is combining human rights and public health perspectives to develop evaluation criteria for testing and screening policies. "Special Populations" discusses HIV/AIDS controversies in cases ofperpetrators and survivors of sexual assault, HIV-infected healthcare workers, HIV-infected pregnant women and injection drug users. Debates about these populations have usually concerned balancing public health and criminal justice priorities, reducing high-risk behaviors and respecting individual privacy, and making larger structural changes to reduce HIV transmission where possible. The final section of the book, "AIDS in the World," surveys the HIV/AIDS pandemic on a global scale. Apart from challenging U.S. policies on screening immigrants and travelers for HIV/ AIDS on public health and human rights grounds, Gostin shows the uneven distribution of the epidemic around the world and challenges to action. As a pioneer in bringing human rights to bear on HIV/ AIDS policymaking, Gostin identifies instances in which law, public health and human rights contradict and challenge one another while also suggesting frameworks that make them complementary. Thus, while providing sober assessments of key debates and VOL. 97, NO. 12, DECEMBER 2005 1741
challenges in HIV/AIDS public health and social policy in the United States and abroad, Gostin's recommendations promise to spark much discussion among those interested in strengthening the linkages between public health and human rights.
Reviewed by Carlos Ulises Decena, PhD Project Director National Development and Research Institutes, Inc. 71 W. 23rd St. Eighth Floor New York, NY 10010 phone: (212) 845-4549 fax: (917) 438-0894 [email protected]
Fitness Information for Teens: Health Tips about Exercise, Physical Well-Being, and Health Maintenance Edited by Karen Bellenir; Omnigraphics, Inc.; 425 pages Fitness Information for Teens: Health Tips about Exercise, Physical Well-Being, and Health Maintenance is part of the Teen Health Series by Omnigraphics Inc. The book is divided into six sections, including: Before You Get Started, Fitness Fundamentals, Activities to Try, Maintaining Health and Fitness, Avoiding Fitness Busters, and Resources for Additional Help and Information. Each section includes several concise chapters that provide relevant information on various aspects of teen fitness. Documents and excerpts are included from publications from a variety of agencies and organizations, including the Centers for Disease Control, the National Institute ofDiabetes and Digestive and Kidney Diseases, the U.S. Department of Health and Human Services, the American Academy of Family Physicians, and the
American Council on Exercise, to name a few. Part 1 of "Fitness Information for Teens" provides important information on the physical, psychological and social benefits of exercise. The logistics of preparing to participate in an exercise program are also included-for example, tips on purchasing athletic shoes and the importance of obtaining a sports physical. Other chapters that may not apply to all teens but that are important nevertheless include tips for exercising if one has asthma and what to consider when purchasing home exercise equipment. Part 2 includes chapters on practical guidelines for developing and implementing a personal exercise program, the importance of stretching and strength training as part of an exercise regimen and the common myths about exercising that people harbor. One chapter describes examples of exercises for stretching and strength training with picture illustrations demonstrating the specific exercise techniques. In Part 3 of the book, there are 14 chapters on various exercises in which teens can participate, including traditional sports such as basketball and football, and "newer" activities, such as Pilates and kickboxing. Each of these chapters gives a brief description of the activity and its benefits as well as guidelines on avoiding injury while participating in the activity. Part 4 includes information on health and fitness basics, such as nutrition, hydration, sleep and hygiene. Part 5 includes chapters on the barriers to exercise and how to overcome these barriers. It also discusses health risks to exercise, such as injury, muscle soreness and amenorrhea. The final section, Part 6, includes a variety of resources for obtaining more information on teen fitness.
1742 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
Fitness Information for Teens is a good resource book that providers will find helpful as they counsel teens on their exercise habits. The book is written in clear, concise language that is understandable and provides key concepts about exercise that all teens need to know. Although this book is geared towards the teen population, it would have to be a highly motivated teenager to read such a book cover to cover. At most, they could use it for a reference book to refer to as needed. Another viable option is for health education teachers, health educators or other similar professionals to use this book in health promotion classes for adolescents. Used as such, the teen can be guided through the concepts presented in the book. I enjoyed reading this book because it addresses a variety of important concepts related to exercise. I like the fact that it not only focuses on the physical benefits of exercise but also on the psychological benefits. The book provides the logistics of exercising that will be useful to teens as they begin a program of physical activity, and that will hopefully make the process easier. Providing information on a wide array of sports and exercise activities is a good way of informing teens that there are a wide variety of options to choose from in order to maintain a healthy level of physical activity. The information on overcoming barriers to exercise is very necessary in order to help teens move from the contemplation stage of exercising to the action stage. Although not all potential barriers could feasibly be listed, many of the most common ones are discussed. The book is comprehensive but is written in a simple format and not difficult to read or to understand. In addition, I was able to obtain many useful ideas on how to effectively communicate with teens when counVOL. 97, NO. 12, DECEMBER 2005