More Than $1 Billion a Year Urged to Help Stem AIDS

Going beyond its recommendations of 20 months ago, a panel of prominent physicians, scientists and public health officials Wednesday called for spending substantially more than $1 billion a year in federal funds by 1990 for AIDS public health and education measures alone, with an emphasis on an increase in treatment facilities for intravenous drug abusers.

This money would be separate from funds earmarked for medical and scientific research to curb the epidemic.

“Federal, state and local governments, together with private sector sources, have made heartening contributions to the effort,” the committee said. “Nevertheless, it is becoming apparent that present funding is insufficient for public health approaches to stem the epidemic.”

The “largest unaddressed need in education is the gross inadequacy of federal efforts to reduce (AIDS) transmission among intravenous drug abusers,” Theodore Cooper, chief executive officer of the Upjohn Co. and chairman of the committee, said at a press conference. “The problem here is enmeshed in the much larger national problem of drug abuse generally and is really both an educational and health care problem.”

The report was compiled by the Institute of Medicine and its affiliate, the prestigious National Academy of Sciences, and was meant to update their earlier report, a major blueprint for a national AIDS strategy issued in October, 1986. The 1986 report, the most comprehensive study of the epidemic at the time, called for $2 billion in AIDS spending annually by 1990--including $1 billion for research and $1 billion for public health and education measures.

The National Academy of Sciences is a congressionally chartered private organization that advises the federal government on matters of science and technology.

Congress has appropriated $304.9 million for AIDS education for fiscal 1988 and has proposed $407 million for fiscal 1989, increments that would fall far short of the institute’s recommended goal of more than $1 billion a year by 1990.

Research Spending

In the area of AIDS research, the updated report urged that spending increases be reassessed when appropriations exceed $1 billion a year to ensure that other federal research programs “are not penalized by a long-term disproportionate growth” of the AIDS budget.

At the current rate, increases in AIDS-related research are expected to meet the institute’s recommended level of $1 billion a year by 1990. The fiscal 1988 budget for the National Institutes of Health is $467.8 million, and the proposed 1989 budget is $587.6 million. About $300 million more is proposed for AIDS research in 1989 by the federal Centers for Disease Control, the Alcohol, Drug Abuse and Mental Health Administration and the Food and Drug Administration.

The committee’s plea for an increased emphasis on the problem of intravenous drug abuse echoed one issued by Adm. James D. Watkins, chairman of the presidential AIDS commission, in his interim report last February, in which he proposed a dramatic expansion of drug abuse programs to establish a nationwide system of “treatment on demand.”

Recommendations on Testing

Watkins is expected to release his final recommendations today, dealing with the more sensitive issues of discrimination and testing, which are scheduled to be voted on by the full commission within the next two weeks. Those recommendations, together with the earlier proposals, will make up the commission’s final report to the White House, due June 24.

Cooper said the Institute of Medicine panel members did not estimate the funding levels necessary for their proposed public health and education measures, only that “we think the $1-billion total is insufficient and inadequate.”

The panel said that “formidable obstacles remain to effective AIDS education” and called for an accelerated government-sponsored public education campaign, including the use of federal money for paid advertising.

The Centers for Disease Control, which runs the federal AIDS public education campaign, is precluded from paying for advertising by Health and Human Services Department regulations, the committee said. It urged that the restriction “be withdrawn immediately.”

The panel added: “The committee believes that the gravity of the (AIDS) epidemic is such that CDC . . . should be allowed to purchase advertising time and space and should be supplied with the funds to do so.”

National Commission Urged

The panel repeated its call for the establishment of a national commission on AIDS with a “long-term mandate to formulate and sustain a coherent national policy.” The panel said the current presidential commission has made “major contributions to the public understanding of . . . AIDS and to the development of a compassionate and informed response to the epidemic” but “unfortunately . . . it is short-lived.”

The panel recommended the formation of a commission to serve in an advisory capacity, with a five-year renewable term, that would “move beyond the mere tracking of relevant AIDS activities and take the lead in setting clear policies for the nation.”

In other proposals, the panel recommended:

--That infection with the AIDS virus--rather than the onset of symptoms--”be considered a disease. . . . Clinically, it is more accurate to describe . . . infection as a continuum of conditions from asymptomatic to full-blown AIDS,” the panel said.

Calls for Anti-Bias Law

--That a federal statute be enacted to prevent discrimination on the basis of AIDS infection or disease.

--That research funding be made available to study ways to alleviate stress in health care workers who treat AIDS patients.

--That there must be continued attention to the development of policies “that will foster the use of condoms” to help curb transmission of the AIDS virus.

--That standards be developed for laboratories conducting testing for AIDS infection.

--That mandatory screening for AIDS infection be limited to blood, tissue and organ donation.