Vol. 10 No. 6 (June 2000) pp. 380-382
BLOOD FEUDS: AIDS, BLOOD, AND THE POLITICS OF MEDICAL DISASTER by Eric A. Feldman and Ronald Bayer (Editors). New York: Oxford University Press, 1999. 375 pp.

Reviewed by Joe Rollins, Department of Political Science, Queens College, CUNY.

The story of HIV/AIDS is frequently told by or about gay men, and the politics of the gay/lesbian/transgendered community often figure prominently, especially in America. With the publication of BLOOD FEUDS, Eric A. Feldman and Ronald Bayer have made a significant contribution to our understanding of the politics of blood, emphasizing the actions and reactions of the hemophiliac community as analyzed from a global perspective. This edited volume brings fifteen authors (including the two editors), into one very informative and well written book that will be useful to students of law, AIDS, and public health, as well as those interested in comparative politics, public policy, and social movements.

In the introductory chapter, Feldman and Bayer summarize five core issues that they argue have "animated conflicts over contaminated blood, to varying degrees, in all industrialized democracies" (p. 5). These include: managing threats to blood safety; volunteerism, markets and the blood supply; blood safety and national ideologies of self-sufficiency; justice and compensation for people infected with HIV through blood products; and, organizational reform in the aftermath of HIV. This introduction provides the reader with signposts needed to navigate the chapters to follow, framing similarities and differences highlighted throughout the bulk of the book.

These five core issues are drawn to the front of discussion in the first eight chapters, Part I, which detail the politics of blood in the United States, Japan, France, Canada, Denmark, Germany, Italy, and Australia. Each chapter is thoroughly researched and provides the reader with a good deal of historical information about early responses to an unknown emerging threat. In each case study, the reactions of hemophiliacs are juxtaposed with those of government officials and blood industry employees. They chronicle the emergence or absence of protest or scandal, outline governmental responses and policy choices, and describe the search for justice after the identification of HIV. The authors and editors have chosen to highlight AIDS as an iatrogenic (as opposed to a sexual) issue, yet linkages between the gay and hemophiliac communities are touched upon occasionally. They remind us, in a somewhat understated way, of how much we all hoped a transmissible agent did not cause AIDS. In the prominent debates about closing bathhouses and back room bars many gay men balanced personal sexual freedoms against the "unknown,”

Page 381 begins here

and worries about giving up hard-won advances for the gay/lesbian community were commonly expressed. Oftentimes, when we look back at the history of HIV and blood products, we think about the costs of screening for surrogate markers and heat treatment and seem to balance that same "unknown" against profits. Stephan Dressler writes, "As long as pharmaceutical companies place the safety of their products second to sales figures and market shares, and as long as government agencies and politicians are lax about product safety, another scandal can be foreseen" (p. 209). Without minimizing the corporate role in the tragedy, the book as a whole reminds us of how significantly advancements in the treatment of hemophilia had improved lives. In short, what could have been told as eight stories of corporate greed has been told in a much more complex and nuanced way. It recalls that hemophiliacs were unwilling to return to the bad old days before Factor VIII in much the same way that the gay community resisted returning to a pre-Stonewall state of social and political closetude (see pp. 293-321). The level of complexity, balance, and the project's overall breadth, are at once the book's strength and the source of what this reviewer's what-I-wish-this-book-did critique. Each chapter could very easily germinate into a complete book. I look forward to their publication.

The three chapters in Part II offer a less historical and more analytic discussion, encompassing cultural perspectives on blood, the politics of blood and AIDS activism, and the economics of information. All three chapters are interesting, useful, and provide insight into the stories told in the first eight, but the overall quality of these chapters is more uneven, probably (I surmise), because they attempt to do an enormous amount of work in a very tight space. Dorothy Nelkin's chapter, "Cultural Perspectives on Blood," ranges widely yet somewhat haphazardly across images from film, literature, and popular culture. As with the first eight chapters, this could surely develop into a book on its own. Curiously, in a subsection entitled "Blood as the Essentialist Substance," Nelkin discusses the powerful mythologies of blood associated with such disparate belief systems as medieval witchcraft, Japanese folklore, and Roman Catholicism. Why these images are described as essentialist is somewhat puzzling, especially when the discussion turns to blood as a symbol of community which is defined as "beyond its essentialist meaning" (p. 279). The information and analysis offered here are useful and provide much food for thought, but could be more carefully organized and meticulously drawn. The insights of this chapter might also have been applied to the few moments in this book that struck me as troubling; moments when the contributors and editors, through poetic use of language, assigned malevolent agency to the Human Immunodeficiency Virus. Describing the virus as refusing to "honor national boundaries" (p. 3), making a "silent entry" (p. 21), or as a "predator" (p. 128), exaggerates the abilities of the virus and returns us to a cultural period from which have yet to fully escape, a moment which by proxy assigns dangerous motives to people living with AIDS. Although the virus may have entered the Twentieth Century twirling its moustache, most people with HIV have no such dishonorable, clandestine, or predatory intent.

David Kirp's discussion of the "Odd Couple" of AIDS, hemophiliacs and gay men, is particularly useful for the parallels it draws between social movement coalescence and these groups' responses to AIDS in the early years of the crisis. It is important to recognize, as Kirp does and as noted above, that neither group wanted to return to the "bad old days," defined as pre- Stonewall or pre-Factor VIII, and that this mind set had an important influence on policy decisions made early in the crisis. It overstates the importance of a single historical moment, however, to assert that "Until the epochal events at Stonewall,

Page 382 begins here

homosexuals were not organized because of their well-founded fears about the consequences of public exposure" (p. 298), or to suggest that Stonewall brought liberation to the gay community (p. 297). Gays and lesbians were fighting and organizing for years prior to the events of June, 1969 (recall the Daughters of Bilitis, the Mattachine Society, the research subjects of Dr. Evelyn Hooker, the publishers who won the right to mail homoerotic materials in a 1958 U. S. Supreme Court case; the list goes on). At the same time, we need not look far today to find people we'd be hard pressed to call liberated (e.g., James Dale, Dr. Hensala, Matthew Shepard). As with Nelkin's chapter, such overstatement was undoubtedly necessary to compress a useful history into a small space, thus the overstatement is overshadowed by the insights of the chapter.

The concluding chapter ties the volume together nicely and provides an overview of the rich material preceding it. Theodore R. Marmor, Patricia A. Dillon, and Stephen Scher here give readers a rich cache of analytic gems that should generate a good deal of future research. The intersections among paternalistic political culture, centralization, political identity, and a propensity for scandal strike this reader as a site for interesting future work by political scientists of all shapes and sizes. On the whole, BLOOD FEUDS is a much-needed contribution to our historical and comparative understanding of AIDS. The expanding globalization of AIDS and all that it entails makes this volume an important step in what will undoubtedly have to be a long and ever-widening research agenda.