A Review of Hope and Mortality: Psychodynamic Approaches to AIDS and HIV: Mark J. Blechner. Hillsdale, NJ: The Analytic Press, 1997. 258 pp.

WHEN THE HIV EPIDEMIC STRUCK the urban centers where gay men for decades had fled to find themselves in community, no one could have imagined the intensity of the horror, suffering, and loss that would spread throughout the world. Past lethal influenza epidemics terrorized the world through random exposure and uncontrollable airborne transmission, but, like bubonic plague, they ravaged the world and then burned out. The HIV pandemic, however, has become the unending reminder of the complexities of human sexual and drug-using behavior. At another time in history, such a virus as HIV might have been contained by the cloistered social grouping in which it arose. Now, however, the world is truly a single social as well as biological ecosystem, and the HIV pandemic is a warning that civilization rises and falls on the backs of the infirm, impoverished, uneducated, and unempowered.

The particular virological aspects of HIV, transmitted through universal human behaviors that have historically defied anything but individual control, as well as the length of time from infection to manifestation of the disease, reveal the complex interplay between social setting, individual history, and psychological state. Although some might divide the world into those infected and those not, implying a distinct line defining psychological health, a more honest appraisal of the HIV pandemic as a