Confronting AIDS

Update 1988

Publisher: National Academies Press
ISBN: 9780309038799
eISBN Pdf: 9780309535274
Place of publication: United States
Year of digital publication: 1988
Month: January
Pages: 252
DDC: 616
Language: English

Caption

How far have we come in the fight against AIDS since the Institute of Medicine released Confronting AIDS: Directions for Public Health, Health Care, and Research in 1986? This updated volume examines our progress in implementing the recommendations set forth in the first book. It also highlights new information and events that have given rise to the need for new directions in responding to this disease.

Confronting AIDS
Copyright
Preface
- ACKNOWLEDGMENTS
Contents
Executive Summary
- INTRODUCTION
- HIV INFECTION AND ITS EPIDEMIOLOGY
  - The Spectrum of HIV Infection
  - Modes and Efficiencies of HIV Transmission
  - Prevalence and Incidence of Infection in the United States
- UNDERSTANDING THE EPIDEMIC'S COURSE
- ALTERING THE EPIDEMIC'S COURSE
  - Antidiscrimination Protections
  - Education
  - Screening and Testing for HIV Antibody
  - Other Public Health Measures
  - AIDS and IV Drug Abuse
  - Resources for Public Health Measures
- CARE OF PERSONS INFECTED WITH HIV
  - Care Needs of Special Patients
  - Health Care Providers
  - Costs of Health Care for Persons with AIDS
  - Financing Health Care for Persons with AIDS and Other HIV-Infected Individuals
  - Possible Financing Mechanisms
- THE BIOLOGY OF HIV AND BIOMEDICAL RESEARCH NEEDS
  - HIV Biology
  - Drug Development and Testing
  - Vaccine Development and Testing
  - Roundtable on Drugs and Vaccines
  - Animal Models of AIDS
  - Resources for the Campaign
- INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION
- A NATIONAL COMMISSION ON HIV INFECTION AND AIDS
1 Introduction
- REFERENCES
2 HIV Infection and Its Epidemiology
- HIV: THE ETIOLOGIC AGENT OF AIDS
- PROPORTION OF INFECTED INDIVIDUALS WHO WILL DEVELOP AIDS
- THE SPECTRUM OF HIV INFECTION
- MODES AND EFFICIENCIES OF HIV TRANSMISSION
  - Heterosexual Transmission
  - Efficiencies of Transmission
  - Relative Efficiencies of HIV Transmission
- PREVALENCE AND INCIDENCE OF HIV INFECTION IN THE UNITED STATES
  - HIV Prevalence in Groups at Recognized Risk
  - HIV Prevalence Among Selected Segments of the General Population
  - Incidence of New Infections
  - National Estimates of HIV Infection
  - The Program of HIV Surveys and Studies
- AIDS CASES IN THE UNITED STATES
- THE DEMOGRAPHIC IMPACT OF AIDS
- FUTURE RESEARCH NEEDS
- REFERENCES
3 Understanding the Course of the Epidemic
- THE USES OF MODELS
- DATA NEEDS
- REFERENCES
4 Altering the Course of the Epidemic
- FEATURES OF PUBLIC HEALTH PROGRAMS
- ANTIDISCRIMINATION PROTECTIONS
- EDUCATION
  - Content of the Message
  - School-Based Education
  - Effect of Educational Programs
  - Gay and Bisexual Men
  - AIDS and Condoms
- HIV ANTIBODY SCREENING AND TESTING
  - Technical Considerations
  - Informed Consent and Confidentiality
  - Voluntary Testing
  - Mandatory Screening
    - Blood, Tissue, and Organs
    - Hospital-Based Screening
    - Premarital Screening
    - Female Prostitutes
  - Home-Based Testing
- OTHER PUBLIC HEALTH MEASURES
  - Duty to Warn
  - Contact Notification
  - Reporting of HIV-Seropositive Cases
  - Personal Control Measures
- AIDS AND IV DRUG ABUSE
  - Intervention Innovations
  - Distribution of Sterile Needles and Syringes
- RESOURCES
- REFERENCES
5 Care of Persons Infected with HIV
- CARE NEEDS OF SPECIAL PATIENT GROUPS
  - IV Drug Abusers
  - Infants and Children
  - Patients with Dementia or Other Neuropsychological Deficits
- HEALTH CARE PROVIDERS
  - Ethical Aspects of Providing Care
    - Occupational Risks
    - Professional Obligations
    - Health Care Worker Screening
  - Health Care Provider Training
  - The Psychological Burden of AIDS Patient Care
- HEALTH CARE COSTS FOR HIV-RELATED CONDITIONS
  - Direct Costs of Care for AIDS Patients
  - Indirect Costs of HIV-Related Conditions
  - Cost Implications of Projected AIDS Cases
  - Research on Health Care Costs
- FINANCING HEALTH CARE FOR HIV-RELATED CONDITIONS
  - Sources of Financing
    - Medicaid
    - Medicare
    - Private Health Insurance
  - Alternative Financing Mechanisms to Improve Health Care Coverage
    - Ensure Access to and Maintenance of Private Health Insurance Coverage
    - Modify Existing Medicaid Programs
    - Establish State Risk Pools
    - Modify Medicare Eligibility Criteria
    - Develop an AIDS Federal Grant Program
  - Development of a Financing Strategy
- REFERENCES
6 The Biology of HIV and Biomedical Research Needs
- HIV BIOLOGY
  - Viral Taxonomy and Disease
  - Control of Viral Gene Expression
  - Regulation and Production of HIV
  - Interrupting Infection by HIV
  - Natural History of HIV Infection
  - The Importance of Basic Research
- DRUG DEVELOPMENT AND TESTING
- VACCINE DEVELOPMENT AND TESTING
- ROUNTABLE ON DRUGS AND VACCINES
- ANIMAL MODELS OF AIDS
- RESOURCES
  - Facilities
  - Reagent Distribution Center
- FUNDING FOR RESEARCH
- REFERENCES
7 International Aspects of AIDS and HIV Infection
- THE WHO GLOBAL PROGRAMME ON AIDS
- RATIONALE FOR U.S. INTERNATIONAL INVOLVEMENT
- THE U.S. CONTRIBUTION TO INTERNATIONAL EFFORTS
- REFERENCES
8 A National Commission on HIV Infection and AIDS
A Summary and Recommendations from Confronting AIDS: Directions for Public Health, Health Care, and Research
- STATUS OF THE EPIDEMIC
  - Infection and Transmission
  - Clinical Manifestations of the Disease
  - Statistical Dimensions of the Epidemic
- THE FUTURE COURSE OF THE EPIDEMIC
- OPPORTUNITIES FOR ALTERING THE COURSE OF THE EPIDEMIC
  - Public Education
    - Preventing HIV Infection Among IV Drug Users
  - Public Health Measures
    - Surveillance
    - Mandatory Screening
    - Voluntary Testing
    - The Role of Coercive Measures in Public Health Efforts
  - Funding for Education and Other Public Health Measures
  - Discrimination and AIDS
- CARE OF PERSONS INFECTED WITH HIV
  - Health Care Costs Resulting from HIV Infection
  - The Financing of Health Care for HIV-Related Conditions
- FUTURE RESEARCH NEEDS
  - Basic Research
  - The Natural History of HIV Infection
  - Epidemiologic Approaches
  - Animal Models
  - Antiviral Agents
  - Vaccines
  - Social Science Research Needs
  - Funding for Research on AIDS and HIV
- INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION
  - Rationale for U.S. International Involvement
  - Risks of Infection Outside the United States
  - International Research Opportunities
- GUIDANCE FOR THE NATION'S EFFORTS
  - What Is Needed?
  - Establishment of the Commission
- MAJOR RECOMMENDATIONS
B CDC Classification System for HIV Infections and Revised Case Definition for AIDS
- CDC CLASSIFICATION SYSTEM FOR HIV INFECTIONS
  - Introduction
  - Goals and Objectives of the Classification System
  - Definition of HTLV-III/LAV Infection
  - Classification System
- REFERENCES
- REVISION OF THE CDC SURVEILLANCE CASE DEFINITION FOR AIDS
  - Introduction
  - 1987 Revision of Case Definition for AIDS for Surveillance Purposes
  - Commentary
    - References
- Appendix I
  - Laboratory Evidence For or Against HIV Infection
- Appendix II
  - Definitive Diagnostic Methods for Diseases Indicative of AIDS
- Appendix III
  - Suggested Guidelines for Presumptive Diagnosis of Diseases Indicative of AIDS
- Appendix IV
  - Equivalent Terms and International Classification of Disease (ICD) Codes for AIDS-Indicative Lymphomas
C Correspondents
D Biographical Notes on Committee Members
Index