A ‘Divide and Conquer’ Attitude on AIDS Threatens Us All

This month we marked a sad milestone in our nation’s history--the official reporting of the 100,000th case of AIDS. The Centers for Disease Control has also reported that as of Aug. 1, more than 59,000 Americans have died of AIDS-related disease.

We know that the immediate future will bring more news of infection and death. By the end of 1992, the Centers for Disease Control estimates, more than 365,000 Americans will have been diagnosed with AIDS, and an estimated 263,000 Americans will have died.

The Centers for Disease Control also estimates that more than 1 million Americans have already been infected with the HIV virus. Most do not know that they carry this virus. It is this hidden pool of infection that makes HIV infection so unique and an urgent challenge. Infection can last for years before symptoms appear. During that time the virus can be spread unknowingly.

I fear that many Americans have become hardened to these figures. But the reality we face is mind-boggling. Unless we succeed in changing behavior, we may be confronted with hundreds of thousands of more cases in the next decade and on into the next century.

Our first order of business must be to ensure that each and every American takes notice of this problem. Denial is an open avenue to the spread of the disease.

AIDS is a problem everywhere--one that affects people not just in Los Angeles, Miami, New York and San Francisco, but also in rural America. Any effort to stop the spread of AIDS must include the informed cooperation and constant concern of all Americans.

AIDS must be of particular concern to our racial and ethnic populations. Black Americans represent 26% of adult AIDS cases and 53% of pediatric cases; Latinos 15% of adult cases and 23% of pediatric cases.

We must increasingly develop accurate and credible information campaigns that will successfully reach and motivate Americans who have been missed by our previous efforts. That means we must develop culturally sensitive and relevant and materials that can be carefully targeted to an identified group.

For example, the racial and ethnic categories are too broad. There are many different and varied subgroups within these categories. Geography is one explanation; culture is another. For instance, the black experience in Mississippi is decidedly different from the black experience in New York City or in the Caribbean. Cuban Americans in Florida are distinctly different in culture from Puerto Ricans in New York City or Spanish-speaking Latinos in Los Angeles barrios.

In fact, sometimes our method of labeling, cataloguing and conceptualizing only creates more problems. We ride roughshod over cultural distinctions that are vital to successful communication. We may ignore sensitivities at a time when successful communication is a matter of life and death.

We must identify what works and what doesn’t for each segment of our population and then develop a public information campaign with the close cooperation and advice of community leaders for each segment of the population in our societal “melting pot.”

While the political process can play a positive role in any successful resolution of the AIDS crisis, we must fight to keep the focus on public health. Fear and division must be dissolved through understanding and cooperation. Compassion must rule the day.

Finally, I must add that discrimination against individuals infected with the virus is unacceptable. This is a point that has been made again and again, especially in the final report of the President’s Commission on the HIV Epidemic and by President Bush. HIV infection cannot be spread by casual contact. There is no medical reason for discrimination.

This Administration is committed to enacting legislation that will prohibit such discrimination. For example, we are working with Congress on legislation, the Americans with Disabilities Act, which includes under its scope Americans with HIV infection. Passage of this law will protect these people from discrimination.

Compassion, not prejudice, is needed. AIDS began early in this decade as a disease that threatened to divide Americans. It threatens to divide us today. It has been said before, and I will say it again: there can be no us” and “them” in confronting AIDS--only “us,” all of us, together.

In the end, the AIDS epidemic, painful and difficult as it may be, can offer us lessons--in science and in spirit, generosity and compassion. AIDS must not “divide and conquer.” To the contrary, it must bring all of us together. We must care about one another, and help care for one another. We must learn one another’s problems. We must, in a profound sense, speak one another’s language.