Patchwork Pandemic is the first ever history of how individual American states responded to the HIV/AIDS crisis—and an eyeopening look at how a fragmented federalist system creates disparities in public health policy.
Public health in the United States has long been rife with inequity due to a federalist system that relies on state and local governments to bear the bulk of the responsibility for addressing crises, as seen in the 1918 outbreak of influenza and, most recently, in the COVID19 pandemic. The HIV/AIDS crisis is a classic example of this enduring problem, though the variation in state responses to HIV has not received the attention it deserves.
Patchwork Pandemic provides the first statelevel history of the AIDS crisis in the United States. It is wellknown that the federal government’s response to HIV was painstakingly slow, partly because the disease disproportionately affected stigmatized minorities—especially gay men and IV drug users. Rebuffed at the national level, AIDS activists and policy elites turned to state legislatures to address a host of concerns stemming from the pandemic, including the high cost of drug therapies, the rampant discrimination experienced by those suspected of infection, and the housing and healthcare needs of people living with HIV.
Anchored in case studies of California, Illinois, and Texas, Patchwork Pandemic argues that the states—not the federal government—were at the vanguard of the political and policy response to the epidemic in the 1980s and early 1990s. But this fractured and decentralized system produced a dangerous lack of coordination between different tiers of the United States government, leading to vast geographic inequities in morbidity and mortality rates. As both HIV/AIDS and COVID19 have starkly exposed, pandemics are not merely a function of individual microbes and pathogens; they also reflect how states and governments wield power.
Table of Contents:
Acknowledgments
Introduction
1. The Structure of American Public Health Policy Before the AIDS Epidemic
2. Clandestine Networks and Closeted Bureaucrats: AIDS and the Forming of a Gay Policy Network in California
3. Anti-Feminism, Bisexuality, and the Protean Politics of Child Protection: The Anti-ERA Movement and the Illinois Response to AIDS
4. An Unequal Epidemic: Sodomy, State Legislative Capacity, and the Texan Response to AIDS
5. A New Federal Role is Born: The Genesis and Enactment of the Ryan White CARE Act
6. Public Health Divided: Devolution, Geographic Inequities, and the Mixed Legacy of the CARE Act
Conclusion
Notes
Bibliography
Index
About the Author :
Stephen Colbrook completed his PhD in policy history at University College London in 2023. His work has appeared in a range of venues, including Modern American History, the Journal of Policy History, Modern British History, and the Washington Post.
Review :
"Stephen Colbrook’s Patchwork Pandemic is terrific and timely. Deeply researched and analytically astute, it penetrates the world of statehouse politics in ways that books on American government rarely do. Essential reading for anyone who wants to understand how the United States handles—and mishandles—public health and pandemics."—Gary Gerstle, author of The Rise and Fall of the Neoliberal Order: America and the World in the Free Market Era
"This book is a landmark in our understanding of how states respond to pandemics. Stephen Colbrook shows how the structures of federalism, combined with the varying efficacy of local activism, led to dramatic differences in US states’ funding for AIDS care. In its skillful integration of state-centered analysis and study of grassroots social movements, Patchwork Pandemic is a model of how policy history should be written."—Beatrix Hoffman, author of Borders of Care: Immigrants, Migrants, and the Fight for Health Care in the United States
"In this painstakingly researched, immaculately crafted book, Stephen Colbrook does far more than provide a comprehensive account of contrasting worlds of policymaking around HIV/AIDS in three US states during the 1980s and 1990s. He uses state-level responses to a public health crisis to shed new light on the workings of American federalism, the politics of pandemic response across the twentieth and twenty-first centuries, and how sexual politics became integrated into state politics in often surprising ways. This book will be required reading for scholars of policy history, public health, US federalism, and the history of sexuality."—Jonathan Bell, author of California Crucible: The Forging of Modern American Liberalism
"A bright new voice. This book makes a powerfully written, impeccably documented, horrifying, and persuasive argument that state legislatures—far more than Congress or cities—shape the vast majority of health care outcomes in this country. The case study’s focus on HIV/AIDS advocacy and policy resistance in California, Illinois, and Texas helps link the rights revolution and anti-feminist mobilizations to policy outcomes and health care across these three states and regions. Brilliant."—John McKiernan-González, author of Fevered Measures: Public Health and Race at the Texas-Mexico Border, 1848–1942
"Offering a new and important perspective on HIV/AIDS policymaking in the United States, Stephen Colbrook’s illuminating book highlights the central role of federalism and the states in shaping responses to one of the greatest public health crises of the 20th and 21st centuries. Extending the literature on state-building, American political development, and HIV/AIDS, Colbrook examines how a fractured governing system grappled with an emergent, devastating, and highly stigmatized disease. This book will appeal to a broad audience, including readers interested in the HIV/AIDS crisis, the evolution of state capacity, and the dynamics of policy development."—Daniel Sledge, author of Health Divided: Public Health and Individual Medicine in the Making of the Modern American State
