Posted June 19, 1997
Joel Gallant asks two interesting questions in his opening-round response. First, he inquires why "we continue to ignore the evidence that needle-exchange programs decrease HIV transmission?" I would ask him why he and other needle-exchange proponents have ignored recent studies showing that these programs do not decrease infection. Gallant also inquires why abstinence is the only prevention message we give our children. To the contrary, I would argue that condoms and "safer sex" have been exclusively celebrated as the only realistic way to avoid infection -- even though studies have concluded that condoms have failure rates of up to 31 percent. Two recent federal studies concluded that the number of sexually active teens has decreased. I believe that it is important to reinforce this trend rather than to undermine it with the unreliable safer-sex message.
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Despite Winnie Stachelberg's assertion about the reporting requirements of the
HIV Prevention Act, nowhere in the bill does it mandate actual name reporting
to the CDC. To state otherwise is incorrect and misleading.
Several readers raised questions concerning who is responsible for the government's failure to develop more effective programs of HIV prevention. Margot pointed out that politicians -- in an effort to avoid spending money for the treatment of "sub-classes" -- have used the specter of human-rights violations to convince homosexuals and drug abusers to resist programs of testing and reporting as a threat to their privacy. I find such a concept repugnant and counterproductive.
Stephen Murray stated that I have no interest in guaranteeing greater legal assistance or treatment for those who are infected. This is untrue. In fact I authored legislation that would have prevented insurance companies from dropping someone because they were HIV-positive. The bill was passed by the House of Representatives in 1995 but was killed by the Senate. Interestingly, the AIDS activists who have consistently criticized my prevention proposals were conspicuously silent and did nothing to help forward this proposal.
I have also worked to secure additional funding for AIDS/HIV research and treatment. I served on the Ryan White CARE Act conference committee, which secured hundreds of millions of dollars each year to provide HIV-related medical care and support services. I authored the Baby AIDS law, which will reduce the incidence of HIV transmission during pregnancy and childbirth. I am an original co-sponsor of the Ricky Ray Hemophilia Relief Fund Act, which would provide compassionate assistance to the victims of hemophilia-associated AIDS. I am also supportive of increasing Medicaid coverage to assist low-income individuals who cannot afford the expensive treatments that can prolong and improve their lives.
While I do not disagree that more funding is important, the fact is that AIDS already receives a vastly disproportionate share of the federal budget compared to other diseases. Since 1993, spending for AIDS prevention has increased by 24 percent, AIDS research by 40 percent, and AIDS treatment by 173 percent. This year alone the federal government will spend nearly $8.5 billion on AIDS-related programs.
Implementing traditional public-health measures to combat HIV would require minimal additional resources and, by curtailing the spread of the disease, would actually save money in the long run. New York's Baby AIDS law is the most recent example of the value of traditional public-health measures. In the first three months of the program, which requires HIV testing of all newborns, thirty-three mothers have learned that they are HIV-positive. These mothers and their babies can now receive the medical treatment that they would have otherwise missed out on. They can also take precautions to avoid infecting others. State health officials have said that they have received no complaints from mothers or hospitals and that the program is going extremely well. AIDS activists fought this proposal both at the state and federal level claiming that it would scare pregnant women away from receiving care and do nothing to help women or their children. They were wrong.And they are wrong about HIV reporting and partner notification.
With the success of the Baby AIDS law in New York and similar programs elsewhere, I am confident that we will eventually fully embrace traditional public-health measures. We are already moving in that direction. A majority of states now have HIV-reporting and partner-notification laws. The American Medical Association, despite protest and pressure from AIDS activists, remains steadfast in its support for the HIV Prevention Act. I expect that the CDC will also become more vocal in supporting similar efforts. Even civil libertarians, among them Senator Ted Kennedy, have advocated reporting and partner-notification programs. In 1990 Kennedy even proposed his own partner-notification legislation stating that "there is a duty to warn."
Until a cure or a vaccine is discovered, prevention is the only way to curtail the spread of HIV. The "prevention" methods that we have used during the past sixteen years in place of traditional public-health measures have failed and the epidemic has flourished unchecked.
As a practicing physician who has cared for countless AIDS victims, I want to prevent as many people as possible from becoming infected with this horrible disease. The means to this end are available. Throughout history epidemics have been stopped by identifying the infected and preventing new transmissions. This was not done in the early years of the AIDS epidemic and now thousands are suffering an dying because of it. Every day that we delay implementing these public-health measures we allow the disease to claim more lives. Remember, nearly everyone who becomes infected today could have been saved. We should do what we can to address issues of discrimination, privacy, and medical access, but these are not and should never be obstacles to safeguarding the public health and saving lives.
Introduction and opening questions, by Cullen Murphy
Round One -- posted on June 3, 1997
Copyright © 1997 by The Atlantic Monthly Company. All rights reserved.