Report From the Front in Our War on AIDS

The Presidential Commission on the Human Immunodeficiency Virus Epidemic has been permitted to view contemporary American society through what I have called the HIV lens (HIV being the name of the retrovirus that causes AIDS). The commission is very close to the end of its work, with a final report due to the President on Friday. Many of its recommendations, if carried out, could have a beneficial impact on the way health care will be delivered in our nation over the next two decades.

The HIV epidemic and its most visible manifestation, AIDS, has shaken our nation to its core. In 1981 HIV hit a nation complacent in the blind faith of our modern medical science and technology to solve all our health problems. Indeed, the current generation of health-care professionals came of age at a time when the state of health-care delivery seemed to be focused on more sophisticated ways to deal with established illnesses like cancer or heart disease, and had really put at the bottom of the list of possibilities an infectious disease caused by a new virus.

At this early stage in this epidemic, with no cure or vaccine in sight, we find education to change certain human behavior virtually our sole weapon against its spread. As most people now know, you have to work at it to contract this virus. You have to engage in either sexual activity or needle-sharing drug use with an infected person to get the AIDS virus. It is otherwise difficult to contract unless you received a blood transfusion before widespread blood screening began; unless you are an infant infected perinatally; unless you are the victim of a sexual assault, or unless you are involved in an accident in the laboratory or the hospital when an exchange of bodily fluids occurs. You cannot get it from shaking hands. You cannot get it from sitting next to someone at work who has the virus. So, the fact that this virus is difficult to contract is at least one piece of good news.

The presidential commission has spent the past nine months hearing from experts in the health field--more than 600 witnesses in 43 formal hearings, as well as others during numerous site visits. Unfortunately, we have found a nation unready to respond efficiently and effectively to such a deceptive new viral enemy like HIV.

Flaws in our health-care delivery system were exposed to us in vivid detail:

--An overly burdened and costly health- care delivery system with a limited range of options outside of the hospital;

--An interminably slow drug development system, unresponsive to the fast-changing unknowns surrounding this epidemic;

--Absence of an integrated health education and health promotion system in our schools, providing us no ready clearing house for dealing in a fundamental way with our own health--whether in nutrition, substance abuse, teen pregnancy, or whatever (sadly, we still seem to have a penchant for the remedial, the piecemeal, the Band-Aid approach for every new health crisis);

--An increasingly litigious and adversarial relationship between the health-care providers and the consumer, with the unintended result that doctors, vaccine developers and hospitals withdraw their needed services.

In addition, we have seen a society too quick to reject, deny, condemn and discriminate, resulting in a situation that is not in the best interest of either individual or public health.

While our view through one prism of the HIV lens has been a grim one, we have also seen through another prism the spark of human spirit that rises high when faced with the gravest of human tragedy. We have seen the incredible goodness and fundamental compassion of the American people reaffirmed. There are thousands of Americans, ranging from health-care professionals to hospice volunteers to local firemen and emergency workers, who care deeply for everyone who is sick, regardless of the nature of their illness. There are young people who demonstrate personal bravery and integrity in standing up for HIV-infected classmates who have been submitted to the vilest of attacks by bullies inside and outside their schools. There are business leaders, community-based organizations, church and other humanitarian groups who have refused to succumb to the overload of work placed on them, or to the same old tired bureaucratic obstacles thrown in their way at every turn as they move daily to meet the living needs of persons with AIDS.

The HIV epidemic is much more than a medical crisis or a public-health threat. While it is a grave tragedy, it is also a profound challenge. For we can use the epidemic as an opportunity to deal with many of the other problems our society faces and move toward solving them as well.

It has often been said that a society is judged by how well it responds in times of greatest human need. A tragedy such as the HIV epidemic brings a society face-to-face with the core of its established values, and offers an opportunity for the reaffirmation of compassion, justice and human dignity. Many groups in our society have responded to this crisis so as to reaffirm these basic values. It is time for our nation to mobilize such a response in order to regain the ground already taken by the virus and then fight to annihilate this insidious foe.

In its final report to the President, the commission will outline recommendations for a national strategy, an integrated mobilization plan to respond to the HIV epidemic. Many of the recommendations must go well beyond addressing the HIV alone. They simply cannot be addressed in isolation of the many broader, interlocking ills of society. Then, if the President accepts the plan, much work will remain to be done to carry it out. But wouldn’t it be exciting, in the year 2000, to look back at 1988 as the year the nation altered course to a new America, one more interested in serving others than self?