The President-Elect of the United States

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Presidential actions should include the following:

Use the newly legislated national commission on AIDS to develop a
forceful and coherent national policy.

• Encourage the enactment of legislation to protect HIV-infected persons from discrimination in the private and public sectors.

• Express your strong support for an aggressive, unambiguous education program (as is occurring in Western Europe) about behavior changes necessary to avoid HIV infection. Use your influence to ensure that government at all levels provides funds for appropriate education in the schools and messages in the media.

Express your belief that testing for HIV infection should only be
conducted when the purpose of the testing is clear, and when the test

results allow effective and humane interventions that would not have been
possible in their absence.

• Recognize this country's special responsibility in international efforts to control the spread of HIV infection.

Your Secretary of Health and Human Services should be directed to:

Develop a comprehensive, private-public (federal, state, and local) national plan for delivering and financing care for HIV-infected and AIDS patients.

• Initiate a forceful program for the prevention and treatment of drug abuse and prevention of the related spread of HIV infection.

• Bolster efforts in surveillance, case reporting, and the gathering of information about risk behavior.

• Ensure that biomedical research (including drug and vaccine development and regulation) continues to follow productive paths.

A crucial element in the task ahead is the tone set by the President. Vigorous measures are required to control the disease and to improve the social conditions (poverty, drug abuse, lack of education, etc.) that sustain it. The nation's leader, speaking from his unique position to inspire action against the disease among all the people, must balance this call to action with a concern for the civil rights of all.

The President-Elect of the United States

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Americans have generated an enormous fund of knowledge about AIDS. We know its cause, we can test for the presence of HIV in the body, and we know what measures would, if successfully applied, slow its spread. Furthermore, the scientific understanding that lays the groundwork for the development of effective vaccine and drug treatment grows daily. Yet despite these triumphs, we have not successfully confronted the epidemic. Your Administration inherits the opportunity to harness our knowledge and turn the tide against AIDS.

HIV Infection and AIDS

INSTITUTE OF MEDICINE
NATIONAL ACADEMY OF SCIENCES

National Academy Press
Washington, D.C. 1988

National Academy Press

2101 Constitution Avenue, NW

Washington, DC 20418

The National Academy of Sciences (NAS) is a private, self-perpetuating
society of distinguished scholars in scientific and engineering research, dedi-
cated to the furtherance of science and technology and their use for the general
welfare. Under the authority of its congressional charter of 1863, the Academy
has a working mandate that calls upon it to advise the federal government on
scientific and technical matters. The Academy carries out this mandate primari-
ly through the National Research Council, which it jointly administers with the
National Academy of Engineering and the Institute of Medicine. Dr. Frank
Press is President of the NAS.

The Institute of Medicine (IOM) was chartered in 1970 by the NAS to en-
list distinguished members of appropriate professions in the examination of
policy matters pertaining to the health sciences and to the health of the public.
In this, the Institute acts under both the Academy's 1863 congressional charter
responsibility to be an adviser to the federal government and its own initiative
in identifying issues of medical care, research, and education. Dr. Samuel O.
Thier is President of the IOM.

Printed in the United States of America

PREFACE

Early in 1988, the Presidents of the National Academies of Sciences (NAS) and Engineering (NAE), and the Institute of Medicine (IOM), with the concurrence of their Councils, decided on the preparation of a small number of "White Papers" for the incoming Administration. The intent was to summarize concisely a few critical national and global issues to which science and technology were central, and to suggest presidential options on these issues.

AIDS emerged at once as a leading candidate for such a paper. The IOM and NAS have been involved with assessing the nation's response to the AIDS epidemic since 1985, and have published two reports (Confronting AIDS: Directions for Public Health, Health Care, and Research and Confronting AIDS: Update 1988) recommending needed action. The second of these two reports, published in June 1988, served as the basis for the AIDS white paper. Drafts of the paper were reviewed and discussed by the IOM AIDS Activities Oversight Committee,* the group that conducted the second IOM/NAS AIDS study and that oversees AIDS activities at the IOM, and by the Councils of the IOM and NAS. The views elicited in those discussions greatly influenced the subsequent evolution of the white paper and its final formulation. The paper was written by Robin Weiss, Director for AIDS Activities at the IOM.

*Members of the AIDS Activities Oversight Committee are Theodore Cooper (chair), The Upjohn Company; Stuart Altman, Brandeis University; David Baltimore, Whitehead Institute for Biomedical Research; Kristine Gebbie, State of Oregon Health Division; Donald Hopkins, Global 2000, Inc.; Kenneth Prewitt, The Rockefeller Foundation; Howard Temin, University of Wisconsin School of Medicine; and Paul Volberding, San Francisco General Hospital.