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Review of Lukas Engelmann, Mapping AIDS: Visual Histories of an Enduring Epidemic (CUP, 2018)

**I wrote this book review during my write-up fellowship in China for Shanghai University, and was told it would be translated into Chinese and appear in the Journal of Social History of Medicine and Health (JSHMH). I've not heard anything about this, however, so I thought I would post it here on my blog. Enjoy!


Introduction

Lukas Engelmann’s Mapping AIDS makes a unique contribution to AIDS historiography, drawing out new concepts and ways to approach primary sources in contemporary history. The work asks ‘what does it mean to see a disease?’ by exploring three genres of images in a series called A Color Atlas of AIDS from 1986 to 2008: patient photography, epidemiological mapping and finally images of the HIV virus itself. While there are some issues with knowledge of context, particularly in Chapter 2, and a few suggestions on presentation of evidence in visual histories such as these, it ultimately makes a significant contribution to our collective knowledge of how AIDS was visualised in different stages of the crisis. It also makes a bigger methodological statement on how creatively contemporary history, with its glut of evidence bases, can weave in visual ‘sociocultural’ sources alongside contextual evidence.


Summary of Contents

Chapter 1: Seeing Bodies with AIDS draws on the history of medical photography to understand how the Atlas’ visualisations of AIDS in the mid-1980s framed the homosexual male, as the first social category associated with the emerging disease. It proposes to think of medical photographs drawing from Hans-Jorg Rheinberger’s concept of an ‘experimental system’, or ‘a medium in which uncertainty is not resolved but rather emphasized.’ (p. 40) This was also a time when other types of photography connected to AIDS in the broader sociocultural milieu were largely a site for practicing identity politics. By analysing how the patient and the disease became separated in a time when the disease was still little understood, Chapter 1 ultimately argues that photography did not provide answers so much as it perpetuated uncertainty and anxiety about the disease and its manifestations, in other words, ‘sustain[ed] the relationship of “who” and “what” in enduring uncertainty.’ (p. 41)

Engelmann argues that AIDS photography inherited the obligation of clinical visual traditions since the mid-19th century, which were to document the unusual and sometimes ‘monstrous’ patient cases. Medical photography as a genre thus always bore the responsibility to make clear what was known and what was unknown. He then relays the history of clinical visualisations. Its ways of seeing were established by the illustration methods of Jean Cruveilhier, also a pathologist, wherein both the ‘characteristic-ness’ as well as the ‘exemplariness’ of a pathology had to be relayed (in comparison to standard ‘normal’ anatomical atlases). 150 years later, the AIDS Atlas drew from similar traditions, but as a less controlled photograph, not an illustration, it left much room for uncertainty. (p. 63)

As an example of his approach to visual sources, Engelmann focuses on how two images of seborrheic dermatitis in the 1986 Atlas were cropped, arranged, edited and captioned: one showing in full the affected chest in a patient to the second, a close-up of the areas displaying ‘follicular accentuation’. (p. 56) The author analyses this as a contrast: of the first, telling a story of an affected individual ‘partially naked and vulnerable to a frightening disease’, to the second, an image erasing personhood, context and experience to focus solely on the disease’s manifestations. Thus, the Atlas was asserting medical authority upon what could be accurately observed and described when the disease was not yet understood at an epidemiological or microbial level (the subjects of subsequent chapters). Engelmann highlights the tensions between photography (an emerging technology) and illustration in clinical settings from the late-19th to the 20th century, focusing especially on some physicians’ anxieties about photography’s potential to reveal too much information. Kaposi, a dermatologist who gave his name to the syndrome that appeared frequently in early AIDS cases, was one such physician-skeptic, who viewed illustration as superior to photography.

When AIDS became a crisis in the US in the 1980s, doctors were familiar with the outward symptoms of the disease, such as Kaposi’s Sarcoma or Herpes but that it appeared within a particular sub-group was new. Thus, medical photography of AIDS in the mid-1980s had to bridge this gap between known (the disease’s manifestations) and unknown (the patient sub-group), ‘marr[ying] this familiarity with the notion of a radically new syndrome appearing in a highly unusual demographic and social circumstance.’ (pp. 42-43) Engelmann demonstrates how these images managed to visualise AIDS’ effects manifesting on the surface, while keeping the images anonymous and not delivering the full portrait of the patient as a person. (pp. 38-40)

Engelmann also pays attention to editorial oversight, though more investigation into why there was a shift would have provided more clarity. During Farthing’s leadership, the AIDS Atlas balanced uncertainty and unusualness with what was known. Friedman-Kien as Farthing’s successor subsequently focused the atlas on Kaposi’s Sarcoma and sexual identity, in a way that Engelmann argues ‘drew the reader’s attention to the problematic implications’ of linking sexual identity with disease. (p. 77) While these are interesting observations, the reader is left wondering why these individuals themselves were not interviewed as part of the story.

Parallel to the earlier editions of the AIDS Atlas were various efforts to rescue visual representations of AIDS. Outside of patient photography, the 1980s was a time when photos of those with AIDS were highly contested. Engelmann gives the anecdote of photographer Nicholas Nixon’s 1988 exhibition at the New York Museum of Modern Art (MOMA), which attempted to ‘bring the individual back into the frame’. (p. 46) However, activist-journalists such as Douglas Crimp staged a protest at the event opening against decontextualised powerless representations of those with AIDS. Engelmann tries to read the AIDS Atlas in its first decade against the grain of controversies over more social-liberal minded representations of the disease such as Nixon’s exhibition: what is the difference between 1980s AIDS visualisations in clinical medicine, art and journalism?

Engelmann ultimately argues in the first chapter that the 1986 Atlas was not designed to elicit public empathy, applying concepts offered by Preda (‘unusualness’ and ‘uncommonness’ of AIDS), Treichler (‘epidemic of signification’) and Epstein (‘politics of lifestyle’), as well as neatly tying in the overall chapter claim on the obligations of medical photography since the 19th century to show what was both usual and unusual. Early AIDS visualisations used this tension to tie together various uncomfortable ‘unknowns’: the patient’s identity and practices, the extent and variation of the symptoms, and of course, the viral origins of the outward manifestations. However, there was a subsequent decline in AIDS photography, reflecting both the spread of the disease amongst general society and its increasing spread across the globe.

Chapter 2: Seeing Spaces of AIDS then moves from clinical photographs to epidemiological mapping. If through patient photography, AIDS first emerged and was rendered legible as a ‘pattern of discrete infections, symptoms, characteristic signs and visceral impressions on bodies of particular persons, defined as a population at risk’, then mapping was the natural next step, imaging how the disease moved among populations across spaces. (p. 97) In other words, epidemiological mapping was meant to ‘count cases and place them into a spatial and temporal order to visualize the disease’s location, to ask why cases have appeared in these places and not in others and to conclude, if the emerging pattern can tell us anything, on what this disease is.’ (p. 97)

In contrast to works on the global governance of AIDS, Engelmann instead focuses on the maps that he argues played a critical role in changing the picture of AIDS in the late 1980s by ‘resolv[ing] the syndrome’s exclusive association with risk groups and bodily identities to enable a seeing of AIDS in space, scaling up the epidemic from the uniformity of an urban niche to a complex pattern of global diversity’. (p. 98) The chapter focuses on three ways in which maps shaped the history of AIDS: first, the conditions under which maps became necessary, second, like Chapter 1, how the traditions of mapping contributed to spatialising AIDS in certain ways, and finally, how AIDS became a disease of the global south. (104)

Drawing from John Harley, Tom Koch and other works on the history of cartography and disease mapping in the West, Engelmann approaches the global epidemiology maps of the AIDS Atlas with the view that, like with patient photography, maps allowed certain ways of seeing disease transmission to be represented, ‘attached to specific values and ethics, while rendering others unseen.’ (100) Amidst the patient photos balancing ‘uncertainty’ about which social groups contracted AIDS, Farthing’s 1986 and 1988 AIDS Atlases also contained a very basic map pointing to areas of the globe that the disease likely originated from, betraying the uncertainty of global and national public health agencies. Subsequently, Friedman-Kien’s Kaposi Sarcoma-focused Atlas did not deal significantly with maps. However, Friedman-Kien’s successor, Donna Mildvan’s AIDS Atlas from 1995 to 2008 was very focused on the global epidemiology of AIDS, wherein ‘the map became a crucial and highly professionalized tool to argue for historical developments, as much as to emphasize prognostic claims about the “future epidemic.”’ (p. 106) Thus, throughout her tenure, the AIDS Atlas provided maps that focused on emerging sub-groups: childbearing women, African American and Latin American communities, etc., partially to encourage caution in readers. Thus, in Mildvan’s editorial oversight, the map navigated the evolving epidemiological state of AIDS in the United States, ‘in which previous perceptions and strategies of containment, like the urban center, the 4Hs and the perception of an immunity of the national body are systematically made unseen.’ (p. 129)

Beyond specific interesting insights about how the AIDS Atlas team incorporated epidemiological mapping throughout the years, this was unfortunately the weakest chapter as there is not yet sufficient knowledge in the historical scholarship of international development and global health, which is the chapter’s main focus after p. 130. Engelmann raises many ambitious questions, such as ‘[h]ow were these visual arguments about space then understood and applied in frameworks of local public health strategies, national AIDS politics and global health institutions such as the WHO?’ However, there is not enough contextual data to answer these questions in depth and there are a few missteps. For example, Engelmann claims that ‘[b]y 1986, when Farthing included the map resembling Gallo’s model, the global dimension of AIDS and the syndrome’s occurrences in European, Latin American and African countries were verified and officially acknowledged by public health institutions around the world.’ (p. 107) But even until 1987, World Bank and WHO as the main international multilateral organisations active in global health (as Packard, Chorev and Cueto have narrated the post-Alma Ata and Selective Primary Health Care era as one of institutional competition between the two) were struggling to establish solid epidemiological data regarding AIDS outside of the United States, certain Western democracies and African countries. Indeed, it was in spite of the ‘uncertainty’ of AIDS that these multilateral institutions worked with the government health agencies in various countries to establish epidemiological, blood banking and testing centres. Another uneasy claim is that because ‘the WHO assumed leadership of crafting an international response characterized by diverse social responses, rather than unified scientific principles, the multitude of spaces and places of AIDS were given greater emphasis.’ (pp. 136-38) But the cited literature on global health mostly focuses on World Bank’s growing influence during this time. In fact, World Bank is not even mentioned in this chapter about global AIDS, despite it being the main financier of AIDS programmes in most countries (whereas WHO would provide public health design). As such, the parts of the chapter that don’t deal centrally with the AIDS Atlas read as a series of interesting yet unconnected anecdotes about Jonathan Mann, Peter Piot, the Koop Everett report, Gallo’s research and modelling, the four Hs, the history of pandemic maps, the debate over AIDS originating in Central Africa, the colonial origins of disease mapping, aspects which we are still uncovering the histories of.

The most interesting sections of the chapter are where the focus is on the broader change in ways of understanding disease that mapping indicated. For example, a fascinating point Engelmann raises but does not follow through on, is that ‘AIDS was the testing ground for many new technical procedures. It was seen by many geographers as an ideal field to approach large datasets with GIS methods. The history of AIDS’s transformation into a global phenomenon is as much characterised by inventive new mapping technologies, as it is shaped by a revision of what was assumed to be the place of AIDS.’ (p. 104) It would have been very interesting to have more about the rise of health economics and statistical modelling and the expansion of computer technology during this time, as much of the discussions between the Bank and WHO concerned demographic and macroeconomic projections of AIDS. The 19th century importance of statistical science is given its place on p. 155 and yet in my view, a more chronologically appropriate topic to relate would have been the rise of statistical economic thinking among multilateral agencies in the aftermath of the first 1973 oil shock. Indeed, it is puzzling why so much effort is expended looking back to the 19th century without referencing the more immediate historical context.

To ask what global epidemiological mapping meant for AIDS, these questions need answers: what did disease mapping mean as World Bank shifted from population to health and nutrition, amidst bailouts and structural adjustment? What did disease mapping mean after the heyday of disease eradication into the era of debt crises in developing countries and after the heated Alma Ata debate over ‘socialist’ approaches to public health in developing countries? To analyse what is unseen, we should first know what is ‘seen’. When a disease program is decided upon, a map actually has very little use because it is like a secondary and arbitrary representation of the data that really matters, which are the epidemiological numbers AND the sociolocial/anthropological understandings of human behaviours. So a map is more like a virtue signal of international diplomacy and cooperation, to say this government took funding from this agency and expertise from this research center, which might all change in a few years. Especially for a disease like HIV, which is sexually transmitted, you really cannot map your way to a solution: you must understand human behaviours, you must provide accurate diagnostics, and you must comprehensively cover your surveillance territory.

If I could challenge Engelmann to continue on with this line of enquiry, I would ask: how were these maps and models by global health agencies used? Who interacted with them, and how were they updated as soon as new information came to light? The author’s claim about the power of mapping being like the power of medical photography is weaker here. The whole debate over AIDS epidemiology (the numbers before the maps) is somewhat glossed over: there is no reference to Chin’s The AIDS Pandemic: The Collision of Epidemiology with Political Correctness (2007), and former UNAIDS epidemiologist Elizabeth Pisani in Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS (2007) is only drawn from for a short descriptive anecdote on sexual practices being a point of contention between UNAIDS and the Chinese government. A more specific question might be: what role did maps play in global health, if any? When much of global health was and is dictated by the amount of funds on the table (Sridhar), when the important decision-making falls on aid recipient governments (Mahajan), when the substantive parts of global health happen in corridor discussions between the higher-ups of multilaterals and finance ministries, then what was the purpose and the afterlife of such maps, beyond being some kind of symbol of cooperation for the participating institutions themselves? I faced the same question when confronted by a collaborative research strand between World Bank and WHO: besides maps being published in agenda-setting documents, did aid recipient nations’ health ministry officials read these, especially when they met the researchers in person to develop tailored AIDS programmes? Did health professionals delivering AIDS data-gathering activities read such maps? What would they do with them? I would argue the opposite: maps were a performance and a formality in global health, designed to tell the general public that someone was in control; and the general public had no input into how these maps would be used.

In sum, the protagonist of the chapter was not clear: is this a story about American AIDS or global AIDS? Combined with a lack of contextual knowledge and unfocused second-hand anecdotes interspersed with commentary on the AIDS Atlas (which could be a bit better organised), this chapter’s argument and analysis were not as strong as the previous one.

The final Chapter 3: Seeing HIV as AIDS moves from mapping to examine the laboratory microscopic diagrams and electron micrographs of the HIV virus itself, ‘leaving photographed patients and mapped social spaces of seeing AIDS as redundancies of the past’ or what Engelmann calls ‘icons of HIV.’ (p. 161) Finally, AIDS becomes visible: in contrast to hesitant attempts to visualise symptoms as in Chapter 1 or seeing the disease transmitted across an ‘ecological sphere’ as in Chapter 2, the viewers ‘believe [them]selves to be in the presence of AIDS when they see (an icon of) HIV.’ (p. 161) This was the final step in shortening the representational difference between the image and the object.

Focusing on the Atlas series under Mildvan (an infectious disease specialist) from 1995 to 2008, Engelmann argues that there was a far more ambitious story of AIDS being told: of a ‘scientific rather than a clinical or a geographic image of AIDS.’ (p. 163) Through diagrams and graphs showing the mechanics of how HIV was transmitted at a cellular level, Engelmann holds that this new mode of imaging presented by Mildvan indicated a mix of two traditions of scientific imaging: the electron micrograph and the microbiological diagram. These final ‘icons’ of HIV emerging in the early 1990s unraveled the narratives built up in previous photos of patients or mapping of AIDS transmission across the globe. Thus, the mid-1990s was a turning point in representations of AIDS: from the uncertainty of the first decade and ambiguous references to the unknown disease’s outward manifestations, to the ‘artificial, scientific and inherently neutral body of the virus.’ (p. 166) This neutral scientific ‘icon’ became the authoritative image of the epidemic’s origin, thus making previous representations redundant, archived as history.

As with the previous chapters, Engelmann proceeds to relate the historical precedents for such shifts in imaging and understanding AIDS. With the introduction of laboratory bacteriology and virology in the late 19th to early 20th century beginning with Robert Koch’s research on the ‘tuberkelvirus’, such microbial imaging changed how infectious diseases, such as tuberculosis, malaria and smallpox, were responded to. Engelmann also dips into the electron micrograph images used in the 1983-84 debate over nomenclature by Levy, Gallo and Barre-Sinoussi/Montangier claiming different origins of the virus causing immune deficiency. He shows in his analyses how the various editions of the Farthing and the Friedman-Kien AIDS Atlases did or didn’t engage with the debate over naming the disease, whether it was HTLV-III/LAV or HIV. He then explores how Mildvan’s Atlas represented AIDS in the aftermath of the discovery of HAART in 1995.

The most powerful and skilful moments of the book where Engelmann’s core argument comes together is in the second half of the chapter. A strong point about seeing and unseeing disease is made in Engelmann’s analysis of why Mildvan’s 1995 Atlas opted to use the electron micrograph image from the 1983 Barre-Sinoussi/Montangier, not only simplifying the complexity and controversy of that research to a simple picture representing the virus causing AIDS, but also constructing its own temporal throughline between 1983 and 1995: ‘[t]he atlas in this way has become a truly historical work, as it established the acknowledged identity of the virus through the cleansed version of the past of its discovery.’ (pp. 200-1) It was through such processes like Mildvan’s 1995 Atlas smoothing over the 1983 controversy over AIDS viral origins that images of AIDS became ‘icons’: ‘These pictures have become iconic, precisely because they replace and diminish other historical, social and political accounts of the epidemic from the mid-1990s.’ (p. 203) AIDS’ complex past simplified and obscured, and what comes out the other end is ‘a cleansed, unified and inherently normalized object of knowledge.’ (p. 203) The chapter ends with a reflection on a prize-winning 2010 visual 3D model, which Engelmann argues demonstrates that the virus is seen in its entirety and was finally completely understood.

Epilogue: The End of the AIDS Crisis? then questions how the histories of AIDS activism were drawn into visual representations when Mildvan’s last AIDS atlas in 2008 included a new chapter on ‘Social Repercussions of an Epidemic.’ Instead of reading this as a ‘neat argument about medicalizing forces in our time’, Engelmann instead points to the Atlas’ need for closure in its final edition: to end the series on a commonly agreed upon narrative, incorporating and yet also smoothing over the complicated history of AIDS activism with the similarly complicated history of contestations over AIDS’ biomedical identity. In doing so, as its final call, the AIDS Atlas ‘takes away the last doubts about the state of crisis of AIDS today.’ (p. 216) Bouncing off of an analysis of this final 2008 edition’s incorporation of AIDS complicated social histories, Engelmann ends with a reflection on how the story of AIDS can be told.

Why a visual history? Engelmann justifies his methodology, arguing that it doesn’t follow the teleological tropes of history needing to be social (ie: gay activism), medical (ie: virus research) or cultural (ie: activist art). A visual approach ‘escapes these partisan perspectives’ by studying sources that ‘don’t belong exclusively to one or another perspective’. Visual sources also allow unpicking simplified narratives of historical causation. Thus, it allows ‘valu[ing] the complex networks of forces that have contributed to the resolution of AIDS, which cannot exclusively be attributed to either science or activism, medicine or prevention politics.’ (p. 219)

So then what is Engelmann’s final assessment of the AIDS Atlas series and its iterations from 1986 to 2008? It was an archive and a ‘repository of the possibilities through which AIDS could be thought and seen’ and could either be the end or the beginning of AIDS. (p. 255)


Broader Critiques

The general concerns regarding Chapter 2 I have related in the summary of contents and this is likely due to issues beyond Engelmann’s control: there isn’t yet a rich social history account of the global AIDS response. Beyond this, I will detail here some critiques that apply to the broader work itself, particularly regarding its mode of analysis. The concluding arguments of each of the above chapters, except 2, are strong and I generally agree with the idea that all crises in their representations reflect their immediate sociocultural milieu: from managing ‘uncertainty’ and then after ‘knowing’, neatly ‘closing the case’. However, I am still not convinced by the defense of visual above other types of sources and would like to know further: what is the point of analysing visual sources in a vacuum without reference to other original primary source data gathered alongside them? Engelmann situates his approach of the visual that ‘[t]he shape of the historical archive has been changed, integrating questions of affect and aesthetics, while elevating photographs, diagrams and “thinking through images” beyond the authority of written texts.’ (p. 28) But sometimes the reader may feel this claim was not upheld in the analysis’ approach to the visual sources.

For example, several times throughout the work, I was left a bit wanting in the absence of oral history interviews and other types of basic data. On the claim in pp. 50-51 that the photos of the 1986 Atlas (amidst parallel protests of artistic representations of disease) were not designed to elicit sympathy or raise awareness, the reader is left wondering: why not just ask? Is there no one left from Farthing and his Colour Atlas of AIDS team, or even people who knew him in the Westminster Hospital in London that the author could have interviewed to enrich this fascinating yet highly subjective interpretation of the purpose of the 1986 AIDS Atlas?

This points to a broader weakness of this kind of contemporary sociocultural/historical work: why are scholars not analysing representations alongside oral history interviews with those involved? What evidence do we have of the impact these visualisations had or how people interacted with them? Analysis in any discipline or sub-field is strong when the understanding encompasses other types of evidence. If this other evidence is ignored or handwaved, then it is problematic. Gathering original data is as much part of the analytic process. As such, it could be argued that Mapping AIDS is not really a story about historical change over time, but rather analysing in depth three snapshots of a crisis to make a claim about historical teleology in visual sources.

This results in some practical issues with the paragraph organisation. The structure of the chapters can be confusing, weaving in reflections from the secondary literature with historical anecdotes and long texts full of descriptions of the source under analysis. Sometimes the image itself being analysed is not inserted and the reader is left wondering what is being described. For a work defending the analytic power of visual sources, the reader somehow emerges without a clear understanding of what was contained in the AIDS Atlas. Perhaps rather than interspersing some photos within the text, an accompanying appendix with a selection of the title pages of all the editions from 1986 to 2008 could have been included. It would also have left the reader with some sense of comprehensiveness in data selection, which is important for scholarship about ‘visual representations’; that all editions of the Atlas were systematically examined and thus the book’s conclusion was reached. For a work that rests on the methodological premise that visual images are just as valuable as textual ones, there are very long blocks of paragraphs describing what might be more efficiently communicated through an accompanying image integrated smoothly alongside the analyses. Engelmann makes claims about what is ‘seen’ and ‘unseen,’ but it is strange that the reader is allowed access to the AIDS Atlas only through his eyes. For example, Chapter 3 starting on p. 196 is an analysis of Mildvan’s Atlas series with the claim that the first edition ‘focused heavily on analysis, management and treatment of HIV, integrating vast clinical, geographical and even political complexity.’ Not only is there no accompanying image or quote that would represent this claim, there is only one reference, and the reader is left to trust Engelmann that this is a correct and comprehensive interpretation.


Conclusion

Nevertheless, Mapping AIDS makes an innovative contribution to the still developing historiography of AIDS. One key strength is that it is an impressively synthetic piece. As much as possible, Engelmann will relate his findings in the AIDS Atlas to concepts from the historiography, from early works by Berridge, Fee and Brown to ones published in the 1990s by Epstein, Stein, Oppenheimer, Montag and Treichler. Mapping AIDS also situates itself well alongside recent works by McKay and Preda, as well as the broader science and technology studies (STS) strand on representations of AIDS, as pushed forward by Stein, Cooter, Watney and Grover. As such, Engelmann’s approach to the AIDS Atlas is well contextualised and the book as a whole brings together AIDS historiography in a unique way.

Building on the above, I believe the main achievement of this monograph is that it uses its visual analytic approach to make a statement about methodology: what do we do with the ‘fading’ and forgotten images of an unfolding crisis? Contemporary history (even modern history) must deal with a postmodern glut of images for historians to contextualise: not every item has led to groundbreaking change and yet we must consider that each is significant and tells an important story. Historians generally have only two tones to describe an event (in order to generate interest or serve funding agendas): it was a disastrous abuse of power or it was a messianic savior of humanity. At the very least, I felt throughout the book the tensions and uncertainty of knowing AIDS in the late 1980s, but I think the book’s achievement is greater than this. Engelmann’s subtle approach, language and tone is evident: he argues that ‘[t]o look at pictures as objects characterized by an interpretive flexibility, we can point beyond the historical analysis of the political and rhetorical oppositions that structured so much of AIDS history. Instead, the pictures provide a historical archive of the obstacles and complexities that were referenced across activism, medicine and politics.’ (p. 10) As we come to an era wherein Instagram posts, tweets, and YouTube reaction videos may well become primary sources telling us something important about historical change, this is a timely question. I think this is the powerful legacy of Mapping AIDS: Engelmann has essentially imparted a post-modern language to describe what must have been an ambiguous and in-between atmosphere. To say the uncertainty is significant enough to warrant historical analysis is a perfect encapsulation of our times: the middle ground that we are actually yearning for, exhausted from going back and forth between ecstatic praise and acrid critique.

As a researcher that prefers to tell histories as part of interlocking socioeconomic processes unfolding at global, national and local levels, I do privilege textual sources particularly grey literature correspondences of ‘very important people’ or oral histories with those actually involved in delivering AIDS programmes because I believe such sources illuminate the mechanics of historical change. Mapping AIDS reminded me that the attempts to capture truth and make certain, while perhaps not relevant for current policy, have an important place in histories of AIDS. By telling a story about how medical authority was asserted to varying degrees of effect and knowledge was claimed using visual representations, Engelmann ultimately proves that ‘[i]n these ruins of AIDS’s visual history an archive of the unseen is buried.’ (p. 36) Just like no single scientific article will cure cancer, no monograph will ever tell a full and complete history of AIDS. While one might question if a similar work would emerge for less well-known crises, Mapping AIDS uses visual images to tell a creative contemporary history of how a particular society encountered an uncertain disease.

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