BOOK REVIEW : Politics and AIDS: Fatal Combination : DRAGON WITHIN THE GATES: The Once and Future AIDS Epidemic, <i> by Stephen C. Joseph,</i> (Carroll & Graf) $19.95; 228 pages

Stephen Joseph is one angry doctor. “Dragon Within the Gates” is the story of his experiences as New York City’s health commissioner between 1986 and 1990. On his watch, the dragon--AIDS--overwhelmed his city.

Recalling the way politics obstructed efforts to stem the tide in New York, Joseph (now dean of the School of Public Health at the University of Minnesota) pleads for more aggressive actions as a new wave of AIDS moves into the ghettos and barrios of smaller communities.

In some ways a parochial tale--the administrations of Mayors Koch and Dinkins are of limited interest--the message is national. AIDS is a modern epidemic, a disease examined first through a filter of civil liberties and only secondarily through a microscope, a public health crisis in which social policy came first and biomedical knowledge followed.

Although AIDS is new to the textbooks, Joseph reminds us, the epidemic is not altogether different from everything that came before. Public health specialists knew what had worked in the past, but their suggestions were overruled. Joseph reiterates that AIDS could have been limited and still can be limited if antibody testing were encouraged, confidentially guaranteed and an effort made to contact partners of those infected.

Oddly, Joseph probably encountered AIDS before it even had a name, 20 years ago in Central Africa. He recalls seeing people there suffering from a strange wasting condition, progressive infections and bizarre malignancies.

When he encountered the same symptoms in New York, the disease had a name and its viral agent had been identified. But Joseph had not yet learned that cultural politics plays a major role in coping with disease.

He saw AIDS as a communicable disease spread through the exchange of body fluids, either by sexual contact or through the bloodstream, and he proposed to fight the disease with traditional epidemiological methods. He did not factor in the special nature of one of the first pockets of infection, the homosexual community.

Joseph was unprepared for opponents who saw the closing of bathhouses, the reporting of sexual contacts and the threat of detention or quarantine as an assault on their civil liberties. He did not fully understand how laws passed in the name of public health could seem to the newly enfranchised like a step down the slippery slope toward the reinstitution of sodomy laws and discrimination.

Likewise, as AIDS raged in the shady world of shared needles among poor, usually minority, addicts, rumors spread that AIDS was a deliberate effort to annihilate black people--outrageous but understandable, after the infamous Tuskegee study allowed black men to die of syphilis when medicine could have saved them.

Joseph acknowledges these fears and suspicions but is impatient with them. Why couldn’t civil libertarians understand that the public health had to be protected?

He describes his understandable frustration trying to establish a policy of informing foster parents if babies test positive for HIV--denied on the grounds that the biological mothers’ privacy would be compromised. He insists that none of his suggestions is coercive or would have violated the confidentiality of infected people, but it is obvious that the streetwise didn’t believe him.

Why should they? Even as he lobbied to provide clean needles to addicts and condoms to prisons, the likes of William F. Buckley proposed tattooing infected homosexuals and drug addicts. A positive test meant risking jobs, health insurance and friends.

Joseph is understandably furious with ACT UP, the AIDS activists who hounded and demonized him for reporting the actual number of cases, which were fewer than at first believed, and for suggesting reasonable epidemiological measures.

Research moved forward under pressure from all sides, and within a few years treatments became available to improve the quality and extend the length of lives of the infected--but only when done early. This, according to Joseph, increases the urgency of identifying the infected as soon as possible.

Short of a cure, what is most needed, he says, is a way to render those carrying the disease no longer contagious, as has been done for carriers of TB and leprosy.

Meanwhile, he warns, the epidemic is spreading fastest among those least likely to seek or find help. The greatest increase is among poor women and children who become infected through their involvement with drugs or with people who are addicts.

For the short run, Joseph advocates testing high-risk individuals and tracking and contacting the sexual partners of those known to be carriers.

For the long run, he sees the elimination of drug trafficking as the only hope. Until that happens, he predicts that AIDS will level out among the cautious middle class of whatever sexual proclivities but continue to thrive among the poor, destroying the family structure of minorities in our inner cities, crippling our social services and hospitals and causing immeasurable human suffering.