Posted on June 3, 1997
Joel Gallant is exactly right that our response to the AIDS epidemic has been inadequate, and the evidence he cites for why people are not getting tested is on target. The keys to increasing the numbers of people getting tested and to reducing HIV transmission are to offer treatment programs and long-term behavior interventions. An Atlanta study, for example, showed that 96 percent of women chose to be tested after they had been provided with HIV counseling and offered voluntary HIV testing as part of prenatal care.
Testing and treatment for those with HIV needs to be offered on a regular basis to more people as they enter the health-care system. Unfortunately, in this country access to that system is inadequate for many people at risk for HIV. This problem is particularly acute for drug users, given the huge waiting lists that exist for drug-treatment programs and the lack of bridges to drug treatment such as needle-exchange programs and other outreach efforts targeted specifically at the drug-using community.
I was particularly intrigued by Chandler Burr's statement that in order to implement disease-control methods "we need to know who is and who is not infected." The question that statement poses in my mind is, Who are "we"? I believe strongly that people (and their health-care providers) need to know their health status. Proper care and treatment are predicated on this knowledge. What is unclear to me is why the government needs to have this information also. Burr seems to believe that the government, by means of a woefully under-funded and under-staffed public-health system, must force people to "do the right thing" (that is, get tested, notify their partners, change their behavior), because, left on their own, people won't do it themselves. The evidence, as I have cited and Joel Gallant has indicated, does not back up that assumption. When given the opportunity people will "do the right thing." It is the opportunities that are lacking.
I also disagree with Burr's assertion that AIDS and gay activists possess a "whiff of fanaticism" and put forth "unverifiable hypotheses, apocalyptic scenarios, and imputations of invidious motive." No one involved in fighting this epidemic wants anything else but to see it end. If I thought the strategies that Burr and Coburn are putting forth would end this epidemic, I would support them in every way I could.
Coburn implies that the CDC receives the
names of people living with AIDS. Names are reported to state health
departments, which then report case information (but not names) to the CDC.
The Adult Confidential Case Report used by the CDC states clearly that
patient-identifier information is not transmitted to the CDC. This fact is
important, in that Coburn's HIV Prevention Act includes a requirement that
states set up reporting systems for HIV such that names and identifying
information can be shared with other states and the CDC in order to
national partner-notification program. To support that mandate, he implies
that other diseases are reported in this way. The fact is that neither AIDS
nor any other disease is reported to the CDC with patient-identifying
information. Reporting of disease is a state-level function, which is
should remain, without unnecessary costly mandates from the federal
Introduction and opening questions, by Cullen Murphy
Round One -- posted on June 3, 1997
Copyright © 1997 by The Atlantic Monthly Company. All rights reserved.