Book Review
The AIDS manual, 3rd edn
Albion Street Centre
ISBN: 978-0-8643-3089-5; 1994; 262 pages; Maclennan and Petty, Sydney;
Peter G Kerr
School of Nursing Studies, University of South Australia, Underdale campus, Adelaide SA
In the words of Julian Gold, 'The goals of the manual are to provide a practical guide to HIV diagnosis and management for health care workers and students and to be used as a resource reference for all areas of activity where persons with HIV/AIDS may be involved' (p.xvii).
The manual does not try to provide all the information on a field as broad and dynamic as HIV/AIDS. Instead, the editorial committee has attempted to bring together the words and thoughts of HIV/AIDS experts in their field. It is noteworthy that all but one of the listed contributors have an employment address in NSW and all but two of these are from Sydney.
Of the contributors, the vast majority are male, helping to reinforce the idea that the field of HIV/AIDS is male dominated in Australia. Following some years of debate on the male domination of HIV research and the negative impact this has had on the development of knowledge with regards the impact of HIV/AIDS on women, and the development of models of care which focus on the experience of women; it continues to be disappointing to read texts on HIV/AIDS with a continued male agenda bias, particularly when women are responsible for an increasing amount of HIV disease literature.
Further to the above, the section which addresses 'HIV and women' covers some of the clinical and ethical areas of concern for clinicians working with women with HIV disease, but fails to adequately address: the effects of HIV disease as it impacts on women specifically; their perceptions of HIV/AIDS; the difficulties experienced by many women to negotiate safer sexual behaviour; and the very different societal roles which women play and the impact this has on the conceptualisation of an HIV positive diagnosis for themselves, their sexual partners and/or their children. The section addressing 'Psychosocial Issues and HIV Disease' also fails to point out the experience difference with regards to gender.
Without labouring the point too long, within the section titled 'HIV and Women' and sadly sub-titled 'Prostitutes and HIV' it appears that Clezy and Giles had some trouble in their attempt to both protect sex workers from increased marginalisation, while providing evidence that some Australian males had been infected through sexual contact with Asian sex workers. The feeling generated for this reader was that Australian sex workers are less likely to transmit HIV, while Asian sex workers are to be handled with care due to evidence of Australian male infection through Asian sex worker contacts. The point of client domination in condom negotiations where poverty is a contributing factor seems to have been sorrowfully missed. So too has the point that sex worker promotion of condoms is only half the story.
This reader is constantly surprised at what appears to be a 'them and us' context employed by health care workers. The majority of writing around HIV infection and health care worker exposure, explores base line testing, following occupational exposure with what appears to be an expectation that the health care worker who has an exposure to HIV through their work will produce a HIV negative base line measurement. This text does not disappoint me. I would like to have seen further discussion on management of the health care worker who presents with a HIV antibody positive base line test following occupational exposure, other than the very brief statement, 'It should never be assumed that the person will be negative and therefore pre-test counselling will not be necessary or that the staff member will necessarily agree to be tested' (p.134).
Some sections of the text are well referenced, some sections provide listings of further readings while other sections provide neither. One area that is sadly missing both reference and further reading lists, is the section covering 'The Nursing Management of HIV Disease'. In the Preface, Julian Gold attempts to explain away the need for extensive references due to lack of space and the use of 'recognised expertise'. One text seldom does absolute justice to a topic and this text is no exception. Further reading on the topics addressed is essential and a reference list, regardless of size, helps the reader enormously, particularly when considering that every reference listed will lead the reader to yet more reading through its own reference list.
The AIDS Manual is not a text for those who like illustrations to compliment the written word. The best the text provides is a series of figures covering the areas of epidemiology, virology, immunology, and clinical assessment, with 8 pages of photographic plates near the end of the text illustrating a limited selection of clinical signs.
The text concludes with a short historical overview of AIDS and a concise HIV/AIDS service directory which covers many of the services provided in each Australian state and territory. In short, the text provides brief information on a large range of topics with regards HIV disease. The title could give the HIV/AIDS inexperienced reader the impression that this one text will provide many of the answers to a diverse range of questions. In fact, if we were to look at the area of nursing management of HIV disease alone, major texts have been published going far beyond the 7 pages devoted here.
I would suggest that this text be used as a quick reference point for initial direction, relying on more comprehensive texts for an advanced understanding of HIV disease and client management.
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