Confronting AIDS Update 1988 (1988) / Chapter Skim
Currently Skimming:
Executive Summary
Executive Summary
Pages 1-26
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
Indeed, the plagues and more recent pestilences offer parallels to the AIDS epidemic. Both the bubonic plague and, in a period closer to our own, syphilis have evoked many of the same questions we now grapple with: tensions between individual liberties and the public good, the responsibilities of physicians toward their patients, the attribution of moral meaning to biological phenomena, the quest for a "magic bullet'' cure, and controversy about the proper educational approach to changing the behavior that spreads the infection.
|
From page 2... ...
drug abusers—and the social response to the disease has been confounded by moralistic assignments of blame. A further compelling reason to direct special attention toward AIDS is that it is preventable by modifying the behavior that brings people into contact with the virus.
|
From page 3... ...
However, it can be concluded that perinatal transmission and transfusion of infected blood are highly efficient vehicles for HIV spread. Studies of infected IV drug abusers also report high rates of infection for this group, suggesting that sharing contaminated needles and syringes, combined with frequent
|
From page 4... ...
among IV drug abusers in New York City and northern New Jersey but much lower (less than 5 percent) in other areas of the country.
|
From page 5... ...
The techniques used to bridge the gaps in information are forms of mathematical modeling. Models project the prevalence and incidence of HIV infection and of AIDS in specific regions or populations, assess the possible consequences of interventions aimed at modifying sexual behavior and drug abuse, help plan care for AIDS patients, and extract the most information from existing data on myriad other features of the epidemic.
|
From page 6... ...
Appropriate venues for education, testing, and counseling about HIV include sexually transmitted disease clinics, drug abuse treatment centers, physicians' offices, hospitals, and health care clinics. Many of the programs designed to combat venereal diseases and drug abuse have a direct bearing on AIDS.
|
From page 7... ...
Information about the modes of HIV transmission must be conveyed in an understandable, yet scientifically accurate form. The message of AIDS education programs must also address sexual behavior and drug abuse.
|
From page 8... ...
Condoms are a generally effective means of preventing the spread of many sexually transmitted diseases, including HIV infection. Manufacturers and regulators of condoms have moved to ensure against product failure, but a greater likelihood of disease exposure lies in "user failure." Health care professionals should advise patients in detail about proper condom use and its importance in both heterosexual and homosexual intercourse.
|
From page 9... ...
The committee believes that, in addition to reviewing statutory protections of medical confidentiality, it will also be necessary at the local level for hospitals and other medical care institutions to review their recordkeeping policies and apprise their staff of their responsibilities to protect patient privacy. The belief that a person's knowledge of his or her HIV test results encourages more healthful behavior is a driving force behind much public health policy related to AIDS.
|
From page 10... ...
· Female prostitutes are frequent targets of proposals for mandatory testing. By engaging in multiple sexual encounters, they tend to contract more venereal diseases than the general public, but the biggest risk factor for prostitutes in the HIV context appears to be IV drug abuse.
|
From page 11... ...
Contact notification is a classic measure in venereal disease programs, but even in states in which laws demand that health officials ask for the identities of the sexual partners of an infected person (i.e., the "index case") , infected individuals are not compelled to disclose that information.
|
From page 12... ...
The committee urges a greater commitment on the part of federal, state, and local governments to the rapid, large-scale expansion of drug abuse treatment slots, both in residential drug-free treatment centers and in methadone maintenance facilities, to offer immediate access to all addicts who request treatment. Currently, no more than 20 percent of IV drug abusers attend treatment programs in any given year.
|
From page 13... ...
Nevertheless, it is becoming apparent that present funding is insufficient for public health approaches to stem the epidemic. Perhaps the single greatest concern is the lack of availability of treatment facilities for IV drug abusers and the lack of support for programs to eliminate or reduce drug abuse or to mitigate the danger of shared injection equipment.
|
From page 14... ...
Even when community agencies have the resources to provide care for IV drug abusers with AIDS, they may not be eager to extend services to them or to their families. The committee believes that more long-term residential facilities or group homes are needed for AIDS patients who are IV drug abusers.
|
From page 15... ...
Doctors and nurses alike have begun to report increasing psychological and emotional strain from working with AIDS patients. Fears of becoming infected, the higher level of care needed for patients who often suffer severe physical and mental deterioration, and the "emotional brutalization" that comes from providing such care are common.
|
From page 16... ...
The committee believes that all individuals have a right to equitable access to adequate medical care and that society has an ethical obligation to ensure such access. In the meantime, Medicaid covers health care for much of the welfare population, including 40 percent or more of AIDS patients.
|
From page 17... ...
However, because the AIDS crisis is disrupting the health care delivery system in many areas of the country, an interim financing solution is needed. The committee endorses an AIDS federal grant program as an interim measure to ensure that AIDS patients and those with HIV-related conditions have access to appropriate and cost-effective care.
|
From page 18... ...
In the meantime, more viruses that strongly resemble HIV are being found in monkeys, cows, and cats, a development that may lead to valuable animal models of AIDS. The HIV replicative cycle offers a number of opportunities for interruption by antiviral interventions.
|
From page 19... ...
Although the best-designed clinical trial would enroll the fewest people needed to demonstrate a drug's effectiveness, persons with HIV infection want very much to participate in clinical trials. The committee believes that, following scientifically sound guidelines, wider access to clinical trials can be gained by broadening their geographic base, by extending trials to previously untapped populations including women, IV drug abusers, and pediatric patients, and by testing all compounds that might possibly be effective.
|
From page 20... ...
However, given the potentially disastrous effects of the AIDS epidemic, FDA has approved human trials for two vaccine candidates in the absence of proof of protective efficacy in animals. There has been appreciable controversy about the wisdom of this move.
|
From page 21... ...
Animal Models of AIDS The development of model systems, in which an animal infected with HIV shows the same symptoms and exhibits the same course of disease progression found in human AIDS patients, is essential to the campaign against the disease. The use of simian immunodeficiency virus (SIV)
|
From page 22... ...
The 1988 NIH budget for AIDS research is $467.8 million, and the proposed 1989 budget is $587.6 million. Approximately $300 million more is proposed for AIDS research in 1989 by the Centers for Disease Control, the Alcohol, Drug Abuse, and Mental Health Administration, and FDA.
|
From page 23... ...
Three patterns of AIDS are differentiated on the world map. In North America, parts of South America, many Western European countries, Australia, and New Zealand, most AIDS cases occur among homosexual or bisexual men and urban IV drug abusers.
|
From page 24... ...
and, at the NIH level, the Office of AIDS Research, will continue to streamline progress within the Public Health Service, but their responsibility is not the overarching leadership that the committee feels is lacking. Finally, private organizations, state and local governments, foundations, volunteer groups, and professional organizations have all made enormous contributions, but the absence of a coherent national policy condemns many of them to "reinvent the wheel" when it comes to AIDS policies and programs.
|
From page 25... ...
, the committee reaffirms the 1986 recommendation that a national commission on AIDS and HIV infection be established. The committee would assume an advisory rather than an operating role and be responsible for: · adopting as its scope a broad view of the epidemic that spans all components of the public and private sectors; · monitoring the course of the epidemic; · evaluating research, health care, and public health needs; · formulating recommendations for altering the direction or intensity of health care, public health, and research efforts as the problem evolves; · setting the tone for educational campaigns; · assuming an advisory and catalytic role in stimulating appropriate action by federal, state, and local government bodies, industry, the academic scientific community, and private foundations and organizations; · encouraging greater U.S.
|
From page 26... ...
The establishment of a national commission signals a major commitment to national leadership for preventing and controlling HIV infection and AIDS. HIV infection is a rapidly moving target; a sustained, well-guided effort is needed if we are to remain attentive to its course and thwart its effects.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.