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National Coalition on AIDS 3/29/90 [OA 6854] [2]
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National Coalition on AIDS 3/29/90 [OA 6854] [2]
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Originally Processed With FOIA(s):
FOIA Number:
Systematically Processed; 1998-0091-F
1998-0091-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
Library Staff.
Record Group/Collection:
George H.W. Bush Presidential Records
Collection/Office of Origin:
Speechwriting, White House Office of
Series:
Speech File Backup Files
Subseries:
Chron File, 1989-1993
OA/ID Number:
13710
Folder ID Number:
13710-010
Folder Title:
National Coalition on AIDS 3/29/90 [OA 6854] [2]
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FACSIMILE
TRANSMISSION
REQUEST
FROM: (NAME, ORGANIZATION $ PHONE $
)
DDRESSEE: (NAME, ORGANIZATION,
CITY, STATE & PHONE#)
Bob SIMON
JeRRy BeckeR
White House
245-1856
456-2930
OTAL PAGES
FAX MACHINE PHONE NUMBER( IF KNOWN)
DATE
CHARGE SYMBOL
12
456-6218
3/22
EMARKS
F RETRANSMISSION IS NECESSARY CALL: HQS COMMCEN FTS 8-245-6277 CAC 202) WASH
INSTRUCTIONS TO COMMCEN: (CHECK ONE)
MAIL COPIES BACK TO ROOM
/BUILDING
CALL EXT
WE WILL PICKUP/INCLUDE ROOM NUMBER
RETAIN COPIES IN FILES
COPIES NOT PICKED UP WITHIN 24-HOURS WILL BE RETURNED VIA MAIL.
PRODUCT MIS. COMM. CEN.
$2683.22 PM 2:30
SERVICE
SEPT. OF HEALTH
I
4123 3.22.1990
FROM
March 22, 1990
FOR BOB SIMON, WHITE HOUSE SPEECHWRITING
FROM: JERRY BECKER, HHS SPEECHWRITING. 245-7470
SUBJECT: Draft of Secretary Sullivan's speech to National
Leadership Conference on AIDS.
I am directed to send you this draft of recommended remarks for the
Secretary's use at the March 29th conference. They have been
reviewed internally and are to be submitted to the Secretary later
today.
Thanks very much.
P. 2
3.22.1990 4:23
FROM
RECOMMENDED REMARKS FOR SECRETARY LOUIS SULLIVAN, M.D.
PLEASE NOTE REFERENCES TO INTERNATIONAL TRAVEL ON
PAGE 7.
SECRETARY'S WORKING COPY: March 22, 1990
EVENT:
National Leadership Conference on AIDS
AUDIENCE: 400 Business and Labor Leaders; some AIDS advocates
TIME/DATE:
8 a.m. Thursday, March 29th
PLACE:
Crystal Gateway Marriott, Arlington
FORMAT:
18 Minutes
WRITER: JERRY BECKER, 245-7470
THIS DRAFT IS FOR THE SECRETARY'S REVIEW.
THIS SPEECH WAS REVIEWED AND APPROVED BY OASH, HCFA, OGC, ASMB,
AND SSA. ASPE REPORTED NONCONCURRENCE, SAYING THE SPEECH IS
INACCURATE, DISJOINTED, INAPPROPRIATE AND DOES LITTLE TO ADDRESS
THE DEPARTMENT'S ACTIVITIES ON HIV/AIDS.
2 'd
4:23 3.22.1998 1990
FROM
1
(The Secretary will be introduced by David Rogers, M.D., Chair,
National Community AIDS Partnership.)
Thank you very much, David. It is a great pleasure for me
to be with you this morning. I consider this audience to be
among the leaders in the fight against HIV infection and AIDS. I
am delighted to join those from business, labor, and others who
play a critical role in our nation's efforts to address the AIDS
epidemic. Together, we will make progress.
While AIDS is still a fatal disease, we can now call it a
treatable disease, at least to the extent that we can delay the
onset, or slow its progress. But "treatable" is not good enough
for me. My goal is to make AIDS a curable disease. The irony is
that AIDS is a preventable disease.
I was asked to speak on AIDS and the federal agenda. since
I time my speeches by the clock, not the calendar, there are
limits to what I can cover. I will focus on what we are doing at
Health and Human Services through our Health Care Financing
Administration and the Public Health Service. I will offer some
thoughts on international travel by those with HIV infection, and
I will share with you the advice I give to health care
professionals on their approach toward people with HIV and AIDS.
First, I want to talk about HCFA, our Health Care Financing
Administration.
t
3.22.1990 4:24
FROM
2
HCFA plays a major role in financing health care services to
people with AIDS. It does so under the Medicaid and Medicare
programs.
Most of the money HCFA spends on people with AIDS is spent
through Medicaid, a medical assistance program jointly funded by
the federal government and the states. Almost all people with
AIDS who qualify for disability under the supplemental Security
Income program are automatically eligible for Medicaid in most
states. Forty percent of those with AIDS are served by Medicaid.
In fact, about one-fourth of the total cost of direct medical
care for all those with AIDS is met through the Medicaid program.
We estimate that about one percent of the people with AIDS
are covered under Medicare. It is reasonable to assume that
because AIDS is now treatable, the number of people with AIDS who
benefit from Medicare coverage of physician, hospital, and other
medical care expenses, could increase over the coming years.
During this fiscal year, federal expenditures for people
with AIDS -- through Medicaid and Medicare -- will total $780
million, more than twice the amount provided only two years ago.
State Medicaid expenditures are expected to total $630 million
this year.
S 'd
4:24 3.22.1990
FROM
3
For 1991, we seek over $1 billion to help those with AIDS
through Medicaid and Medicare. In fiscal year 1992, spending on
this aspect of our program is expected to go over $1.3 billion,
and to nearly $1.7 billion in 1993. Let me emphasize that this
federal spending is just through Medicaid and Medicare -- an
essential part of what we do at HHS, but only part of what we do.
We have continuing research programs underway to guide us in
serving those who need help. Within HCFA, our Health Care
Financing Administration, we will attempt to forecast the cost of
AIDS based on information about the types of illnesses those with
AIDS experience, their eligibility under Medicaid and Medicare,
and the use they make of the services we offer. In addition, we
will study the economic consequences of AIDS and HIV infection
for Medicaid and Medicare programs under a variety of different
policy assumptions.
In treating AIDS, in attempting to move it from a fatal
disease to a treatable disease and, yes, even to a curable
disease, we are relying extensively on our Public Health Service.
Your tax dollars have worked wonders there. Funding for the
fight against HIV/AIDS through the Public Health Service was
increased from $6 million in 1982 to almost $1.6 billion in this
fiscal year. Next year, we expect to spend almost $1.7 billion.
9
4225 3.22.1990
FROM
4
What has the Public Health Service done for people with
AIDS? Let me count some of the ways:
The National Institutes of Health expanded AIDS clinical
trials programs; funded 18 community based trial centers to gain
a broader base of participation; and developed the rapid drug
discovery program that is now capable of screening 40,000 new
compounds annually.
The Food and Drug Administration accelerated the review
process of experimental therapies; expanded the use of
investigational new drugs (INDs) to make experimental therapies
more widely available.
The Health Resources and Services Administration funded
development of innovative health care delivery demonstration
projects which includes models of coordinated care for pediatric
patients and families. It also has demonstration programs to
provide drug users coordinated primary health care and drug abuse
treatments.
The Centers for Disease Control expanded public education
programs through newly developed targeted education programs for
schools and college aged youth for those in and out of school.
2 'd
3.22.1990 4:25
FROM
5
It also expanded support for counseling, testing and partner
notification to provide early diagnosis and education of people
at risk.
Our Alcohol, Drug Abuse and Mental Health Administration
developed research programs on the most effective behavior change
methods so as to work with people to reduce or eliminate their
risky behavior. These are some of the things PHS does.
I am proud of our department. The men and women at HHS work
together. Those in the Health Care Financing Administration work
with those in the Public Health Service to make certain that we
fully coordinate our efforts to respond to the crisis of AIDS and
HIV infection. In addition, HCFA helps state agencies coordinate
their Medicaid efforts, and works with hospitals and other care
providers to improve reimbursements under Medicaid and Medicare.
As a well-integrated department, Health and Human Services
is able to meet the needs of a diverse population with a variety
of coordinated services -- all provided by one Cabinet-level
department. These include disability benefits through Social
Security and Supplemental security Income cash benefits; Medicaid
and Medicare benefits; approval of drug therapies; innovative
research in the basic sciences; and education for health
promotion and disease prevention.
8 di
4:26 3.22.1990
FROM
6
There are many ways to save a life and to improve the
quality of that life. It takes many different skills. We find
them all at HHS, and we are proud of the progress that has been
made in helping people with AIDS. We are the lead federal agency
in the war against AIDS, and while there are far too many
casualties, I am convinced that in time we will win this war.
Let me return to one aspect of our program I just mentioned
-- education. The simple fact is -- education works. If you,
remember nothing else I say here, remember this: Education
works. It prevents disease. Knowledge of how HIV and AIDS are
spread will prevent infections in those not yet infected. And it
will help prevent fear and prejudice caused by misinformation.
We must share with others what we already know: HIV and
AIDS cannot be spread through casual contact, such as in the
workplace. I am a doctor, and I know what I am saying.
Our experts have been watching for evidence that HIV/AIDS is
spread through casual contact. There is no such evidence. So
let me repeat, and let me emphasize: HIV and AIDS cannot be
spread through casual contact.
It is spread by unprotected sexual activity, including high-
risk sexual activity, by sharing contaminated needles, and from
an infected mother to her baby.
6
4:26 3.22.1998 1990
FROM
7
One issue that has received special attention recently is
travel. I believe we should explore every solution, including a
legislative solution, if necessary, to remove discriminatory
barriers and make international travel by HIV-infected persons
easier. We will explore all possible alternatives. We will be
faithful to the health of the American people, fair to those
infected, and guided by our understanding of the scientific
facts, and not societal fears.
There is one more point I would make today. Most of our
health professionals are doing an outstanding job in treating
people with HIV and AIDS. They are knowledgeable, caring,
compassionate. And they are properly cautious. Let me focus on
two professions, dentistry and medicine.
Thirty percent of those with HIV infection find their first
symptoms in the oral cavity. Their dental health problems are
often painful, severe, complicated, and costly to treat. I find
it fascinating and reassuring that of some 180,000 dentists in
the nation, only one dentist has been found to be HIV-positive
because of occupational transmission. The American Dental
Association says this dentist often did not wear gloves, even
though he had obvious breaks in the skin on his hands. Moreover,
ADA says that he followed infection control procedures only
intermittently. That is one dentist out of some 180,000.
01.0
3.22.1990 4:27
FROM
8
I will note that a second dentist was found to be HIV-
positive during a screening; however, not enough information is
available to confirm that this case is due to occupational
transmission. I must also add that there are 89 dentists
reported with AIDS, but they have risk factors that are not
related to their profession.
Now let me turn to physicians. There is evidence that in
choosing residencies, some medical students may be moving away
from specialties and locations in which the care of AIDS patients
is concentrated. A survey of recent medical school graduates
reported that one-in-four said they did not want to treat AIDS
patients because of the risks.
We need more qualified and compassionate people to treat
people with AIDS, not fewer.
AIDS is different from other diseases to which physicians,
dentists, nurses and other health professionals are at risk.
While we have always gone where communicable disease is rampant,
those diseases over the past half century have almost always been
seen as treatable. AIDS is just now becoming treatable.
P.11
4:22
3.22.1998
1990
FROM
a
I am proud of all of our health professionals, and yet I
know that there are some whose compassion antennae require
adjustment when treating people with HIV and AIDS. The health
care industry is being tested. Medicine, dentistry, nursing and
all of the other health care professions are not private
professions. They are a franchise granted by society.
Health professionals must remember that they were given the
opportunity to become successful and respected care givers
because society has underwritten the real costs of their
education. There is a compact between medical professionals and
all of those who provide grants and gifts from the public and
private sectors. That compact requires health care professionals
to be of service to society. so if there are some health
professionals who must heal themselves of the horror and hatred
in their hearts before they can free a nation of its fear of
AIDS, then let the healing begin.
There are times when a legislative remedy is one solution to
discrimination. That is why I join the President in his call for
the House to match the Senate in approving legislation that will
help prevent overt discrimination against those with HIV
infection or AIDS, and other types of disability.
P.12
4:28 3.22.1998
FROM
10
Yet law alone cannot solve all of our problems. No one
sector of society can stem the tide of infection, provide all of
the care and treatment, all of the research and all of the
education required to put HIV/AIDS in perspective and prevent
their spread. This is a job that must be done at many different
levels, by many different people. Yes, the federal government
has its role, but so do state and local governments, and so does
the private sector, voluntary societies, and those who advocate
the rights of people with AIDS.
Martin Luther King, Jr. once said that, "the ultimate
measure of a man [or woman] is not where he [or she] stands in
moments of comfort and convenience, but where he [or she] stands
in times of challenge and controversy."
I know where you stand. You are there with the baby with
HIV infection. You are with adult men and women who suffer from
AIDS and, yes, still die from it. You stand with those who seek
treatment and are well enough to return to work and resume their
productive place in society. You stand with the providers and
researchers.
In the midst of the battle, you stand at the front of the
line, and I salute you.
####
3113
4128
3.22.1998
FROM
THE WHITE HOUSE
WASHINGTON
March 20, 1990
TO: CHRISS WINSTON
Attached are some points which may prove
helpful in drafting the AIDS speech.
This particular group is high-powered,
and has been largely organized as a
means of involving the business
community in the fight against AIDS.
I think Burt Lee can vouch for them.
Thanks.
fin Jim Cicconi
NATIONAL
LEADERSHIP
COALITION
1990 MAR 20 AM 10:
ON AIDS
19 March, 1990
BOARD OF DIRECTORS
Officers
John R. Taylor
Chairman & CEO (Ret.)
The Principal Financial Group
Via Messenger
Chair
J. Richard Munro
Chairman & CEO
Time Warner Inc
Jim Cicconi
Vice Chair
The White House
David N. Sundwall, M.D.
Vice President
Washington, D.C.
AmHS Institute
Vice Chair
Karen Ignagni
Dear Jim:
Assoc. Dir., Occupational Safety and
Environmental Affairs, AFL-CIO
Secretary
Thanks for your interest in the National Business Leader-
Michael Pollard
Partner
ship Conference which President Bush will address March 29th.
Michaels & Wishner, P.C.
The program for the conference, and a one-page description
Treasurer
B.J. Stiles
of our goals and purposes are enclosed.
President
Members
You agreed to take a look at suggested highlights for the
Gwynn C. Akin, Ph.D.
speech. I've done such a draft, which is attached.
Syntex Corporation
Lewellys F. Barker, M.D.
American Red Cross
One component not in this draft is a roster of companies,
Nora Kizer Bell, Ph.D.
CEOs, and business group which warrant specific acknowledg-
University of South Carolina
Erline Belton
ment for their outstanding responses to AIDS. I did not
Digital Equipment Corporation
include such citations, as someone advised that it was against
Edward N. Brandt, Jr., M.D., Ph.D.
College of Medicine, Oklahoma University
White House policy to include such specific citations without
Health Sciences Center
prior approval from such sources. I assure that we could
Sharon Canner
National Association of Manufacturers
obtain such approval, or direct the appropriate office at
Glenn E. Haughie, M.D.
the White House to the source if that is the preferred mechan-
International Business Machines Corp.
ism. Generic thank-you's aren't quite sufficient for AIDS,
William R. Hendee, Ph.D.
American Medical Association
and I know that those in the vanguard of providing business
Stephen E. Herbits
and civic leadership will find their jobs far easier if
Joseph E. Seagram & Sons, Inc.
Presidential acknowlegments are possible.
Stanley G. Karson
Center for Corporate Public Involvement
Larry Kessler
Some of those in the vanguard are cited in the enclosed
AIDS Action Committee of Mass.
publication, Business and Labor Speak Out on AIDS. But
Bryan Lawton, Ph.D.
Wells Fargo Bank
there are others.
Sam S. McKeel
The Sun-Times Company
Stephen T. Moskey
Thank you for any counsel you can provide.
Aetna Life & Casualty
T.M. (Terry) Mulready
Cordially
Pacific Bell
Emilio R. Nicolas, Jr.
KMEX-TV, Los Angeles
Beny J. Primm, Jr., M.D.
Addiction Research Treatment Corporation
Mervyn F. Silverman, M.D.
B.J. Stiles
American Foundation for AIDS Research
President
The Rt. Rev. William E. Swing
Episcopal Diocese of California
Larry H. Williford
BJS/st
Allstate Insurance Company
Enc.
1150 17th Street N.W.
Suite 202
Washington, D.C. 20036
202/429-0930
FAX: 202/872-1977
NATIONAL
19 March 1990
LEADERSHIP
COALITION
ON AIDS
National Business Leadership Conference on AIDS
March 29, 1990
I.
The AIDS epidemic is far from over; we face great challenges
ahead. We must work together.
This is a painful, difficult disease and we're losing far too
many Americans.
You heard the specifics earlier this morning from Secretary
Sullivan, Dr. Fauci, and Dr. Curran. Just as important are the
panels (of the Quilt) which hang around us today. Like each of
you, Barbara and I have lost too many friends to AIDS, and
these celebrations of their lives remind us that each number we
hear is about a human being.
Although AIDS is a fatal disease, we will have far more people
living and working longer with AIDS. That means the
opportunity to live and work together, and to help one another.
II.
Private sector responses to AIDS have been outstanding, but the
job isn't finished. We must do more.
Business and labor have stepped forward, and in some
communities you have been among the pioneers. Yet, it seems
that only about 20 percent of the largest companies are doing
much about AIDS, and we must get others to follow your lead.
Most of the business response has been from the nation's
largest companies, but as the epidemic spreads and worsens,
small and medium sized businesses will also be affected.
Corporate giving to AIDS has grown, and I am pleased to know
that private foundations and corporations have given over $100
million to support thousands of AIDS projects. But now is not
the time to slack off or abandon these important commitments.
I believe that the next $100 million- or more--will bring us
closer to winning this battle.
Press and media have been important allies in getting the AIDS
message to everyone. But some are tired of the story, or
believe there isn't a new angle or hook. Please don't stop
now. The message is too urgent. The lives of countless
Americans depends upon understanding how the HIV virus is and
is not transmitted, and the mass media plays a critical role in
helping change behaviors and attitudes.
The churches, synagogues, and spiritual leaders of America are
getting involved, and I hope that more will come forward. We
need you to help ensure that people with AIDS aren't rejected
by their families and neighbors: to help provide care--to
literally offer food, clothing and shelter for those suffering
from AIDS. I call upon America's religious leaders--lay and
clergy--to increase the love and compassion SO badly needed and
to dispel the anger and rejection directed toward those with
AIDS.
We must all resist the instinct to blame the sufferer, and
instead find solutions for the suffering.
III. Federal, state and municipal resources have been marshaled to
provide critical support, but the job isn't finished. We in
government must do more, too.
We are committed to federal support for all the core components
of the epidemic: research, education, care and services, and
treatment.
We must ensure that no person with AIDS or affected in any way
by AIDS is subjected to discrimination. That is one of the
foremost messages from Admiral Watkins and his colleagues on
the Presidential AIDS Commission, and this Administration is in
complete agreement. I want to restate my full support for
passage of the Americans with Disabilities Act still pending
before Congress, and ask you to join me in seeking swift
passage of this important bill.
Although we remain opposed to categorical approaches to solving
problems, I believe that the special impact of AIDS on parts of
our society are SO burdensome and costly that I am today
announcing support, in principle, for legislation to help
locales especially burdened by AIDS, and for individuals with
AIDS who fall outside the health care system in this country.
We have the mechanisms to respond promptly to disasters like
hurricanes, earthquakes, and tornadoes. We must consider how
to provide similar assistance for those hardest hit by the AIDS
epidemic.
I return to the importance of education, and commend you in the
business community who are providing excellent HIV information
for your employees, their families, and the communities in
which they live. Today I am asking each Member of the Cabinet
to identify how we as government employers can increase our
effectiveness in helping to educate all federal government
2
employees about AIDS. The guidelines already developed by the
Office of Personnel Management are excellent; we now need to
make them known throughout the government workforce.
In conclusion, I want to strongly endorse the work of those here
today, and those you represent, in marshaling support from the private
sector to help us resolve the pain, fear, and stigmatization surrounding
AIDS. This nation has never shirked a challenge of this magnitude, and
we will not turn our back on this one.
We have the mechanisms at our disposal. This Administration does
care and is resolved to work together with you and others in containing
this threat to our personal and social welfare.
We will work diligently with the Congress and leaders of both
parties to pass the Americans with Disabilities Act, and to develop any
other legislation required to ensure that persons with AIDS do not
suffer discrimination.
We welcome the work of the National AIDS Commission and look
forward to close communication with one another as they continue to
examine what is needed to resolve this painful, costly, and complex
epidemic.
We urge you who are here today to return to your places of work,
and take this message to your co-workers and bosses: The AIDS epidemic
is not over, and we cannot sit back and leave this challenge to others.
We must do our share.
3
NATIONAL
LEADERSHIP
COALITION
ON AIDS
BOARD OF DIRECTORS
Officers
NATIONAL BUSINESS LEADERSHIP CONFERENCE
John R. Taylor
Chairman & CEO (Ret
ON AIDS
The Principal Financial Group
Chair
March 29, 1990
J. Richard Munro
Chairman & CEO
Time Warner Inc.
Purpose of this meeting:
Vice Chair
David N. Sundwall, M.D.
1) To convene 400 top business executives, labor leaders,
Vice President
AmHS Institute
and others in a one-day session to address the impact
Vice Chair
of AIDS in the 1990s, with special focus on the
Karen Ignagni
Assoc. Dir., Occupational Safety and
consequences for the business community.
Environmental Affairs. AFL-CIO
Secretary
Michael Pollard
2) To provide a platform for the President to address the
Partner
Michaels & Wishner, P.C.
nation on this critical subject.
Treasurer
B.J. Stiles
3) To marshal further support from the private sector to
President
respond to the growing needs stemming from the AIDS
Members
crisis.
Gwynn C. Akin, Ph.D.
Syntex Corporation
Lewellys F. Barker, M.D.
Goals for this meeting:
American Red Cross
Nora Kizer Bell, Ph.D.
University of South Carolina
1. To underscore the considerable impact of AIDS on all
Erline Belton
Americans, and to highlight the necessity for an
Digital Equipment Corporation
Edward N. Brandt, Jr., M.D., Ph.D.
ongoing response to the epidemic.
College of Medicine, Oklahoma University
Health Sciences Center
Bottom line: AIDS is not over; even more will be
Sharon Canner
National Association of Manufacturers
required from all of us in the decade ahead.
Glenn E. Haughie, M.D.
International Business Machines Corp.
2. To acknowledge the role which the private sector has
William R. Hendee, Ph.D.
American Medical Association
played in reducing infections; providing support; and
Stephen E. Herbits
creating a compassionate and favorable response to all
Joseph E. Seagram & Sons, Inc.
those affected by AIDS.
Stanley G. Karson
Center for Corporate Public Involvement
Larry Kessler
Bottom line: Many in the private sector--especially
AIDS Action Committee of Mass
corporate America--are likely to back away from
Bryan Lawton, Ph.D.
Wells Fargo Bank
continuing attention to AIDS unless there is strong
Sam S. McKeel
Presidential encouragement and new incentives.
The Sun-Times Company
Stephen T. Moskey
Aetna Life & Casualty
3. To send participants in this meeting back to their
T.M. (Terry) Mulready
offices with a clear Presidential mandate, and some new
Pacific Bell
insights which will provide their bosses and colleagues
Emilio R. Nicolas, Jr.
KMEX-TV. Los Angeles
with a renewed understanding of the nature and scope of
Beny J. Primm, Jr., M.D.
the epidemic.
Addiction Research Treatment Corporation
Mervyn F. Silverman, M.D.
Bottom line: Don't back away; get more of your
American Foundation for AIDS Research
The Rt. Rev. William E. Swing
associates and neighbors involved. Don't go it alone;
Episcopal Diocese of California
work with others, especially public health and
Larry H. Williford
Allstate Insurance Company
community service organizations, religious leaders, and
other business and labor groups.
1150 17th Street N.W.
Suite 202
Washington, D.C. 20036
202/429-0930
FAX: 202/872-1977
The National Business Leadership Conference on AIDS
March 29, 1990
Crystal Gateway Marriott, Arlington, VA
Tentative Agenda
7:30 a.m. - 8:30 a.m.
Registration
Continental Breakfast
8:30 a.m.
Welcome and Introduction
Speakers:
Lawrence H. Williford
Senior Vice President
Allstate Insurance Company
John R. Taylor
Chair, Board of Directors
National Leadership Coalition on AIDS
David E. Rogers, M.D.
Chair
National Community AIDS Partnership
AIDS and the Federal Agenda
Speaker:
The Honorable Louis W. Sullivan
Secretary
Department of Health and Human Services
A Critical Look at AIDS in the '90s
Research and Treatment Issues
Speaker:
Anthony S. Fauci, M.D.
Director
National Institute of Allergy and Infectious Diseases
The Numbers and What They Mean
Speaker:
James W. Curran, M.D., M.P.H.
Director, Division HIV/AIDS
Center for Infectious Diseases
Centers for Disease Control
AIDS From A CEO's Perspective
Speaker:
Robert D. Haas
Chairman and Chief Executive Officer
Levi Strauss & Co.
SPECIAL KEYNOTE ADDRESS (CONFIRMED)
Speaker:
PRESIDENT GEORGE BUSH
Tentative Agenda, Page Two
Luncheon
Luncheon Speaker
J. Richard Munro
Co-Chairman and Co-Chief Executive Officer
Time Warner, Inc.
Belinda A. Mason
President, National Association of People
With AIDS, and Member, National Commission
on AIDS
Health Care Costs and the HIV Epidemic
Speaker:
Carl J. Schramm
President
Health Insurance Association of America
Labor Responses to AIDS
Speaker:
John J. Sweeney
International President
Service Employees International Union
Living and Working with AIDS
Interviewer:
Renée Poussaint
News Anchor
WJLA-TV
Panelists:
Erline Belton
Manager, Corporate Employee Relations
Digital Equipment Corporation
Cleve Jones
Founder
The NAMES Project
Phil K. Morrow
Founder and President, IMDT, Inc.
Board of Directors, AIDS Services of Dallas
3:30 p.m. Close
EDITED. BY
Elizabeth Fee
AND
Daniel M. Fox
AIDS
THE BURDENS OF HISTORY
Guenter B. Risse
Epidemics and History
55
54
The certificate was routinely requested from all children under the age
susceptible children who lacked natural immunity.106 "Perhaps twenty-
of sixteen before embarkation for travel at all ferry and rail terminals as
five years from now our present prophylactic efforts may appear to have
well as steamboat piers. Those who managed to leave without such
been too troublesome, over strenuous, or even ill advised," conceded
cards were not allowed to disembark at their destination.99
one editorial in a medical journal. 107 With the epidemic now abating, it
Although thousands of certificates were issued in the following weeks,
was safe to criticize such measures. In nearby Oyster Bay irate fathers
many communities around New York City refused to accept them.
interrupted a town council meeting on August 28 demanding the return
Some demanded similar documents from the accompanying adults, and
of their children who had been removed to isolation hospitals. The local
other communities, such as those in Connecticut, quickly escorted ar-
quarantine was branded as another instance of "propaganda to terrify
riving families out of town and abandoned them in open fields. One
the people." 108
child from Brooklyn, who possessed a health certificate, came down
One cannot avoid noticing a sobering skepticism which overtook
with polio in Rochester, forcing Emerson to reiterate that the examina-
public health officers, medical practitioners, and scientists as the polio
tion given prior to issuance of a permit card could not detect disease
epidemic of 1916 came to an end. The New York City Health Depart-
during the early stages of incubation.¹⁰
ment had tried in part to control the outbreak by teaching the public
Given the presence of large numbers of healthy carriers, Emerson ac-
everything known about the disease with the help of professional groups,
tually questioned the ban on travel out of New York City. In his view,
volunteer organizations, the press, and leaflets. After all, responsibility
such quarantine measures were futile and had no effect on the spread of
for infectious diseases had significantly shifted in the twentieth century
the epidemic. "I know that nothing has developed so many automobile
from the environment to individuals, their way of life, and behavior. But
detours, such ingenuity in the violation of the laws, and such whole-
public education alone was certainly not enough; it only heightened the
hearted disrespect for reasonable sanitary law and its enforcement." 101
fears of many, failed to reach-others because of ethnic and social bar-
Strangely enough, Emerson's opinion about quarantines outside New
riers, and, moreover, failed to stem the epidemic.
York was totally at odds with his strong belief in their utility within
Emerson was persuaded to adhere to sanitary principles and isola-
tion methods employed since the Renaissance. As he wrote: "Health of
the city.
Emerson's reference to travel detours was pertinent. Anxious parents
the individual is a public asset in which the civil government has an in-
planning summer outings or more extended vacations flooded the Auto-
terest and for the protection of which broad police powers may be exer-
mobile Club of America with requests for routing around the more than
cised." Such functions were specifically authorized by law, then exe-
five hundred quarantines imposed by towns and villages bordering New
cuted and enforced for the public good at the expense of individual
York City. In many instances guards with red flags were posted at the
rights. Environmental sanitation, quarantines, and isolation of the sick
entrance of such towns, stopping every automobile and carefully search-
were among the key objectives of such a campaign.
ing for concealed children. Those carrying anybody under the age of
None of the approaches was entirely successful. "As to the lessons we
sixteen had to report to police stations or health offices.¹⁰² "I hardly
have learned during the epidemic," declared one physician, "we have
need to recall the countless instances of inconvenience, hardship, yes,
learned very little that is new about the disease, but much that is old
real brutal inhumanity which resulted from the application of the general
about ourselves.' 110 Scientists were still debating the nature of the agent
quarantine," admitted Emerson.¹⁰³ No wonder so many people "devel- 104
causing polio and its method of transmission. Physicians, while express-
oped a most perverse ingenuity in discovering automobile detours."
ing appreciation for the great clinical opportunities furnished by the epi-
During the month of August, reported cases of polio began to ebb,
demic, argued about the usefulness of spinal fluid examinations and
and doubts were increasingly voiced concerning the success of Emer-
convalescents' serum treatments.¹¹ Five hundred children with varying
son's quarantine measures. The vector theory of the stable fly was dis-
forms of paralysis presented formidable challenges to those entrusted
credited;¹⁰ dissemination of polio was now thought to occur mostly via
with their rehabilitation.
unrecognized carriers through person-to-person contacts. It was also
And then there was public health. Isolation and quarantine had ap-
thought that the decline in polio cases resulted from the depletion of
peared to help stem the onslaught of polio. But, did they really, or was
52
Guenter B. Risse
Epidemics and History
53
disclose," wrote one editorialist.88 Indeed, the poor lacked the airy,
trying to educate families at risk proved only partially successful. The
clean, and cheerful rooms which Emerson recommended for the domes-
pitch was directed to the children of immigrants themselves, who appar-
tic treatment of polio cases. They seemed unable or even resistant to fol-
ently grasped the importance of the measures before their parents; be-
lowing the rules of hygiene which presumably contributed to a disease-
cause of cultural and language barriers, these parents were less amena-
free environment. "Defilers of the streets are to blame," commented one
ble to the sanitary gospel. "Results obtained among adults were largely
writer.89 Even New York's mayor stressed cleanliness. "There is no oc-
due to fear of authority and the force of the department and not to vol-
casion for alarm or panic," read Mitchell's statement published July 9
untary action on their part," commented one newspaper editorial.94
"Careful observance of the simple directions given by the Health De-
There was, of course, resistance to the actions of the Health Depart-
partment as to personal and household cleanliness will go far to prevent
ment. As the seemingly conflicting messages of environmental hygiene
further spread of or exposure to infection."
and personal contagion took hold, fear began to grip the wary. "Many
Not surprisingly, poor Italian families bearing the early brunt of the
a family of children was housed for weeks, often in tight-shut rooms,
epidemic were suspected of having introduced polio from their home-
the children's pale faces pressed against the window panes, mute evi-
land, although inquiries by Emerson to the quarantine station at Ellis
dence of their unreasonable imprisonment," recalled Emerson.⁹⁵ Others
Island failed to confirm such an impression. Both the immigration au-
slammed the door in the faces of visiting nurses, who were suspected of
thorities and American consular staff in Italy declared that no polio
carrying polio from one family to another. One nurse stationed at a pe-
cases had been reported in that country. In spite of such reassurances,
diatric clinic in Brooklyn, who had repeatedly reported cases of the dis-
suspicion lingered and quickly included Lower East Side Jews and Poles,
ease as well as violations of the sanitary code in "Pigtown," received a
who also furnished a disproportionate number of polio cases. Certain
life-threatening "black hand" letter and from then on had to be escorted
neighborhoods appeared to be especially dangerous. One of them was
by a policeman between her home and place of work.
"Pigtown," an Italian section of Brooklyn around Albany Avenue and
The Red Cross, in turn, provided its nurses for home visits because
Maple Street.91
they apparently generated less fear among mothers who worried that
As the toll from the epidemic mounted in July, the New York Health
their children would be summarily confiscated and removed to hospi-
Department increased its "war" against the crippling scourge. Among
tals. The latter were rumored to be hotbeds of polio infection easily
the newly recruited "forces" were 21,000 citizens organized by the city's
transmitted to arriving children and health personnel. Even many pri-
police commissioner under the banner of "Home Defense League." Its
vate schools and colleges refused to admit students on trivial grounds."
members spread out to every precinct, where they worked thirteen-hour
By mid-July publicity surrounding the polio epidemic in New York
shifts accompanying policemen on patrol and searching for violations of
City prompted a major effort by neighboring communities and indeed
the sanitary code. Grocery stores, fruit markets, and street vendors
the rest of the nation to confine the city's children within the metro-
came under strict surveillance. One hundred and fifty gangs with water
politan area, thus avoiding a possible spread of the disease to other
trucks were placed into service. All theaters and movie houses were
cities and villages. Towns on Long Island, a favorite summer destination
closed to children under the age of sixteen.⁹²
for countless New York families, placed billboards at their city lim-
Public acceptance of and cooperation with such a health campaign
its urging city dwellers with children to return home. Hotel-owners ad-
were critical, and Emerson was quite aware of the difficulties awaiting
mitting them overnight were heavily fined. At numerous railroad sta-
him if he failed to persuade the community through educational means
tions families traveling with children were turned back or placed under
about the importance of sanitary and quarantine measures. "Anything
observation.⁹⁸
which causes antagonism of the public to the policy of reporting and
With assistance from the U.S. Public Health Service, the New York
removal to isolation hospitals, develops deception, hiding of cases, and
Health Department agreed to issue one-day health certificates or trav-
such methods of obstruction as to frustrate to a great degree any ap-
eler's identification cards, certifying that the child was free of symptoms
proach to successful separation of the sick from the well."93 But how
and did not come from an infected household. The same document
could the public be convinced? Repeated visits by public health nurses
could also be obtained from a private physician after an examination.
Guenter B. Risse
50
Epidemics and History
51
Mothers were advised to bring all febrile children, especially those with
Because the spread of the disease was unpredictable-ignoring class dis-
"weak legs" or to send for a doctor.⁷⁷ All physicians in affected areas
tinctions and geographical boundaries-the idea of an environmental
were urged to cooperate. Moreover, the authorities offered diagnostic
factor responsible for transmission of the disease was quite appealing.
lumbar punctures and spinal fluid examinations free of charge.
Moreover, experiments carried out in 1912 by Milton Rosenau, a pro-
As the house-to-house searches were stepped up with the help of ad-
fessor of preventive medicine at Harvard, suggested that flies, especially
ditional inspectors and nurses, quarantine procedures went into effect
the biting stable fly, could transmit polio. Although the importance of
to isolate the suspected victims of polio.⁷⁸ Many children were promptly
this possible vector was still under investigation, the Health Department
and forcibly separated from their parents and removed to specially out-
could not ignore it.83 All scientific studies concerning infantile paralysis
fitted pavilions at nearby hospitals for proper diagnosis and treatment.
were problematic at this time. Although a virus believed responsible for
Initially, most patients arrived at Kingston Avenue and Queensboro hos-
the disease had already been isolated in 1909, virology was still in its
pitals.⁷⁹ Only two visits to the sick by members of the family were
infancy; given the contemporary climate of fear, no one could take any
allowed over the next eight weeks. Confirmed cases of the disease were
chances.84
made public, and their names as well as addresses were published daily
The New York Health Department therefore embarked on a vigorous
in the newspapers. Parents were urged to read the lists and keep their
cleaning campaign. Four million gallons of water were dumped daily
children far away from the infected places. Houses yielding victims of
on the city's streets, paradoxically before the garbage was hauled away.
the disease were immediately placarded. Like a scarlet letter, the clearly
Refuse and ash piles accumulating in halls of tenement houses and on
visible sign was placed outside on the street front and in tenement build-
sidewalks had to be removed. All stray cats and dogs were collected;
ings on the street door, entrance hall, and apartment door. Inspectors
according to the Society for the Prevention of Cruelty to Animals, three
checked on the yellow signs daily, trying to discourage their removal,
hundred to four hundred fifty cats and dogs were put to death daily in
which was subject to a heavy fine.80
early July. Flyswatters and screens to fend off the gregarious stable fly
Well-off parents, of course, could keep their sick children if they
and its less aggressive domestic cousin were widely dispensed. Parents
could provide them with a separate room and adequate nursing as well
were urged to keep their homes spotless, and to go over all woodwork
as medical care. Such isolation lasted eight weeks and required compre-
daily with a damp cloth, sprinkling floors with damp tea leaves or
hensive cleaning of the premises, provision of separate bedding and
shredded newspaper before sweeping; to take daily baths; and of course,
utensils, and careful disposal of bodily discharges. If a child died at
to keep covers over each garbage pail.85
home, coffins were immediately sealed and burial occurred without a
Homeowners caught depositing refuse on the streets were fined.
church ceremony. Houses were thoroughly fumigated and new wall-
Brooklyn, an early locus of the epidemic, became the black sheep in the
paper installed. All surviving siblings under the age of sixteen were
eyes of Commissioner Emerson. He accused its citizens of lacking enough
quarantined in the house for the next two weeks.8¹
civil pride to keep their streets clean, suggesting that perhaps they were
To ensure public support for such draconian isolation measures,
responsible for the abundance of cases there.86 An army of thousands of
Haven Emerson and his Health Department prepared half a million
volunteers began patrolling the neighborhoods on foot and on motor-
yellow leaflets for distribution. New Yorkers were told that polio was "a
cycles, checking for violations of the Sanitary Code. By July 11 the au-
catching disease," its method of spread "not yet definitely known." Its
thorities had already charged 148 individuals with violations; even-
germ was present in discharges from the nose, throat, and bowels of ill
tually 2,266 such summonses were listed.87
and even healthy persons, and therefore it was essential for children to
As most public health measures increasingly focused on environmen-
stay away from crowds in parks, swimming pools, movie houses, and
tal filth and garbage, polio began to be viewed as another plague of pov-
stores. Fresh air, wholesome food, shower baths, and general cleanliness
erty primarily affecting the same marginal slumdwellers who had been
were recommended as the best prophylaxis.82
blamed for previous epidemics. "If we could get rid of ignorance and the
The role of filth in poliomyelitis and its implications for public and
filth and superstition that go with it, there would be little need to hunt
personal hygiene was ambiguous but attractive to public health officials.
down the mysterious germs that no filter can stop and no microscope
48
Guenter B. Risse
Epidemics and History
49
thing seems to be resuming its wonted appearance." The sky, clear be-
public health authorities everywhere carefully monitored its appear-
cause of idle factories and unused domestic fireplaces, gave way again to
ance. This was especially true during the summer months, when polio
"the dense cloud of smoke which always lays over the city."
was known to strike. Authorities in New York were especially on alert
As in the previous case of plague, the cholera epidemic of 1832 con-
because the city had already suffered two serious epidemics of the dis-
stitutes another paradigm for social responses to disease. Here again,
ease in 1907 and 1910. The new administration of Mayor John P.
the poor-often immigrants-were the primary victims both of the dis-
Mitchell was proud of its Health Department. This unit was composed
ease and of the blame. In this view, moral failings thought to be respon-
of competent professionals and led by Haven Emerson, a former medi-
sible for poverty and dissipation provided a fertile substratum for chol-
cal practitioner who had treated the last cases of cholera. Successful
era to break out among those marginal sectors of society "different"
campaigns against unsanitary boarding rooms, subway and streetcar
from the hard-working, God-fearing majority. Public health measures
crowding, as well as trade in patent medicines had bolstered the depart-
sought to clean up the environment, thus reassuring the anxious public,
ment's morale. In the eyes of its officials, a declining infant mortality
but the activities were selective: Slums such as the Five Points area con-
rate testified to the city's sanitary standing. Its combined population
tinued to wallow in garbage and to be without fire protection. Epidemic
from all five boroughs was estimated at 5,570,000.73
disease served once more as a focus for the expression of religious, po-
All but forgotten in the midst of an election year, the war in Europe,
litical, and cultural biases within society.
and a Mexican-American crisis prompted by Pancho Villa's raid, the
first cases of polio in New York were reported on June 6. All of the sick
children came from a densely populated section of Brooklyn near the
POLIO
waterfront, primarily populated by Italians. Visiting nurses making a
The third and final case study presented in this chapter deals with the
house-to-house search soon discovered another twenty-two victims of
serious epidemic of poliomyelitis, or infantile paralysis, which erupted
the disease, some ill for several weeks but not severely enough to de-
among inhabitants of New York City in the year 1916. The disease had
mand medical attention.74
been rare before 1907, although minor episodes occurred in Austria
There was no denying it. Polio had returned to New York. In the fol-
(1898) and Scandinavia (Norway and Sweden, 1904). In Rutland, Ver-
lowing days 327 new cases were disclosed in Brooklyn alone, with a
mont, an outbreak of polio was reported in 1894 which took the lives of
mortality rate of about 20 percent. Before it was all over in November,
132 people before striking New York in 1907 and killing an estimated
New York City reported a total of 8,927 true cases of polio and 2,343
2,500 persons. After 1907 polio epidemics became increasingly more
deaths, with the two less-populous boroughs, Richmond and Queens,
frequent. Between 1910 and 1914 alone about five thousand deaths and
actually showing the highest case rates. Nearly half of the victims-
thirty thousand cases were reported in the United States.⁷¹
4,500, were seen in or admitted to the city's hospitals. Nationwide, the
As in previous instances, human actions contributed decisively to
poliomyelitis epidemic of 1916 affected 27,000 people in 26 states and
the creation of a favorable ecological setting for poliomyelitis. Iron-
caused about 6,000 deaths.⁷
ically, the culprits were improved public sanitation and personal hy-
One of the first tasks of the New York Health Department was to
giene, slowly achieved after decades of cholera and typhoid fever. Such
ascertain the dimensions and geographic contours of the new epidemic,
relative cleanliness presumably reduced the transmission of wild and
a coordinated process based on numerous field reports provided by an
ubiquitous polioviruses that had hitherto routinely infected most in-
army of inspectors and nurses. As one publication stated: "It is the
fants and young children without producing paralytic complications.
health officer's task in an epidemic to know where all cases are in his
As a consequence, these groups became increasingly unprotected and
bailiwick. Detection and disclosure of new cases was paramount to
susceptible to the crippling form of disease. In fact, many children be-
achieving control of the epidemic, and it could only be carried out with
came polio victims soon after being weaned and thus deprived of ma-
the help of the medical profession and the public. Neighborhood health
ternal immunity.72
stations were at the forefront of these search-and-report missions. Some
Ever since poliomyelitis had become a reportable disease in 1910,
infants brought in for regular visits could not hold on to their bottles.
HUMAN
SERVICES.
USA
HEALTH&
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
OF
DIRECTMENT
National Institutes of Health
Bethesda, Maryland 20892
Building :
31
Room
:
(301) 496-
7A03
2263
March 7, 1990
Mr. Robert Simon
The White House.
Old Executive Office Building
Washington, DC 20500
Dear Mr. Simon:
As per our recent telephone conversation, I am enclosing an outline for
my presentation at the National Leadership Coalition on AIDS, which will be
held at the Crystal City Gateway Marriott on March 29. In addition, I have
enclosed an article which I recently wrote entitled "AIDS: The Challenge to
Biomedical Research."
I hope that you find these materials useful. If I can be of any further
assistance, please feel free to contact me. Thank you and best personal
regards.
Sincerely,
Anthony S. Fauci, M.D.
Director
National Institute of Allergy
and Infectious Diseases
ASF:1r
Enclosures
Brief Summary of Presentation
Anthony S. Fauci, M.D.
As we enter the 1990s, the number of reported cases of AIDS continues to
mount and the urgency to develop effective strategies to prevent and control
HIV infection becomes more pronounced. The United States Public Health
Service estimates that by the end of 1992 there will be approximately 365,000
cumulative cases of AIDS in this country, with close to 263,000 cumulative
deaths. Yet there is reason for cautious optimism that the shape of the
epidemic can be changed.
From a scientific perspective, progress in understanding this disease
process has moved forward at an impressive rate. The fundamental
manifestations of the disease have been documented and the general contours of
the epidemic delineated. Basic research efforts have led to the discovery of
the causative agent (HIV), as well as insights into the targets for the virus
in the body, the body's responses to infection with the virus, and the
pathogenic mechanisms whereby the virus produces its deadly effects. A
nation-wide clinical trials program has been established to test experimental
AIDS therapies, and several trials of potential AIDS vaccine candidates are
currently underway.
While a cure for AIDS or a vaccine against HIV infection remains
elusive, steady progress in survival and in the quality of life for HIV
infected individuals is being achieved. As scientific advances offer many
more options for treating HIV infected individuals more effectively and
earlier in the course of disease, HIV infection is coming to be seen as a
potentially chronic, manageable disease.
In his presentation, Dr. Anthony S. Fauci will review important
accomplishments and the current status of biomedical AIDS research efforts.
With an eye towards the many challenges HIV infection/AIDS will present for
the 1990's, Dr. Fauci will focus on the promising new avenues for scientific
pursuit and, importantly, the prospects for therapeutic intervention.
Outline of Dr. Anthony S. Fauci's Speech
to the
National Leadership Coalition on AIDS
March 29, 1990
Crystal City Gateway Marriott Hotel
Crystal City, Virginia
AIDS: Considerations for the 1990s
I.
Issues for the 1990s:
A.
The changing profile of the HIV epidemic
B.
Basic research
C.
Therapeutic intervention
D.
Vaccine development
E.
Special considerations for the 1990s
II.
The changing profile of the epidemic:
In the 1990s we can expect an even greater concentration of new HIV
infection among IV drug abusers, particularly in the inner city areas.
This will lead to a situation in which there will be a disproportionatly
greater burden of HIV infection among minority populations. Since an IV
drug using population will be the major target of new infections in
1990s, by definition this will lead to a greater number of
heterosexually transmitted cases, cases among women, as well as HIV
infection among newborns. At the same time as the rate of infection
will increase in IV drug users, there will very likely be a decrease in
new infections among homosexual and bisexual men. Nonetheless, there
will still be large numbers of homosexual men who are already infected
who will become sick in the 1990s.
III. Basic research:
New opportunities in basic biomedical research regarding HIV infection
will be discussed.
IV.
Therapeutic intervention:
A.
Drug development
B.
Clinical trials
C.
Early intervention:
A greater emphasis has already been placed on treating individuals
who are HIV infected who have not yet developed symptoms or those
who have very few symptoms. Most recently in the summer of 1989 a
number of clinical trials have indicated that at least one drug
(AZT) is beneficial in delaying the onset of symptoms in
individuals early on in their infections. This has already led to
a philosophy which will be further realized in the 1990s of early
intervention of HIV infection.
D.
Access to therapy:
The Public Health Service is already implementing a mechanism for
expanded access to therapy simultaneous with the conduct of
clinical trials.
V.
Advances in vaccine development:
Over the past year there have been a number of important advances in the
development of vaccines for HIV infection. Of note is the fact that in
at least three separate studies in an animal model (monkey) of AIDS
there have been clear-cut indications that a vaccination with the whole
killed monkey virus can lead to protection against challenge with the
live virus. This has important implications for the possible
development of a vaccine for HIV in humans in the 1990s.
VI.
Special considerations for the 1990s:
The large numbers of individuals who have been infected with HIV have
brought into focus a number of important problems in society which must
be addressed, including the widespread use of drugs in society and the
lack of adequate health care services for a number of segments of
society.
119369
0
P
Y
STATE 8 A UNITED
TROOI
from ORM
SEAL
Feb.16,1990
Aboard Air Force One
Dear Steven, Leonard,
Ray, John, Chris,
Joseph a William -
I read and re-read
touching letter of
your Feb. 6 the - so did Banbara.
we do care and we
learned from our visit
mth you - we learned
lot about courage
a and also a lot about hope
May T hands for your letter
Good Luch and
Over
hs Bul
900221
Mr. Stephen Welch and Friends
Department of Health & Human Services
cool
Public Health Service
National Institutes of Health
Building 10, Room 11C442
Bethesda, Maryland 20892
w2 are thing to Maine to
see our dauplite but 2
wanted to send my lowe also.
us do look you and worry
about you.
Zarbara Buse
Mr. Stephen Welch and Friends
Department of Health & Human Services
Public Health Service
National Institutes of Health
Building 10, Room 11C442
Bethesda, Maryland 20892
THIS IS A BEAUTIFUL LETTER.
TO SHIRLEY GREEN'S OFFICE TO MAIL OUT.
SERVIC
see attached ID 101953
HEALTH
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
3
National Institutes of Health
Bethesda, Maryland 20892
Building : 10
Room
: 11B-13
(301) 496- 7196
February 6, 1990
President Bush
White House
Washington, D.C. 20500
Dear Mr. President:
Two days before Christmas Eve, in the midst of what must have been an extremely taxing
and exhausting week for you, with the situation in Panama demanding your attention and
leadership, you took the time to meet with seven of us, living with HIV infection, on the 11th
floor clinic of the National Institutes of Health. What a gift you gave each of us that day.
Living with AIDS and HIV infection can be like living in a world without hope. The only
ultimate truth that we know about living with AIDS is that in time, it has the potential to
devastate us. In the meantime, each of us looks for hope in very personal ways. We seek
comfort and warmth from those that we love. We seek new answers through participation in
experimental drug studies. We seek to enjoy the simplest of pleasures in everyday life. We
seek to make peace with ourselves and those who don't understand us. We seek a voice, a
compassionate voice that can address the concerns of hundreds of thousands of people that will
die from a disease that we have discovered does not discriminate.
That is the gift that you gave us on the Friday of your visit. You have given us hope of
a strong voice and leadership in the area of AIDS research and education, and of continued
compassion and concern as America learns to live with people living with AIDS.
From our hearts our thanks to you and Mrs. Bush for a gift that we will hold dear all the
days of our lives.
Sincerely,
Hephey Well
CEShipherd
Stephen Welch
Chris Shepherd
Joseph Smith
Leonard Jackson
Joseph Smith
Ray by all
Ray yall
John Rooney John Rooney
William William Talley Jalley
George Bush for President
CONTACT: ALIXE GLEN
(202) 842-1988
FOR IMMEDIATE RELEASE
CONTACT: 202/456-6772
Monday, June 1, 1987
REMARKS FOR
VICE PRESIDENT GEORGE BUSH
THIRD INTERNATIONAL CONFERENCE ON AIDS
WASHINGTON D.C.
MONDAY, JUNE 1, 1987
now It
is truly an honor to address this distinguished group
today. And I want to offer my sincere thanks to the Department of
Health and Human Services and the World Health Organization for
their work in making this conference possible.
Coming as you do from around the globe, united in purpose,
what you accomplish here is of vital importance to every nation on
earth. It is no exaggeration to say that the health and well-
for
being of literally millions of men and women depend on you.
The cause that unites us, of course, is our battle against
AIDS, a new and mysterious disease. The number of victims is
almost doubling every year. As of a year ago the United States
had a total of 16,000 cases of AIDS reported since 1981. Today
that total is over 36,000. Over one-half of those victims have
died of the disease. And the tragedy is that the rest may, too.
By this time next year we will have added more than 23,000
new cases of AIDS. And by the end of 1990, the U.S. Public Health
Service predicts a quarter of a million Americans will have
contracted AIDS.
When we in the United States first began to confront the
AIDS epidemic six years ago, the victims were easily categorized.
There were the homosexuals, the bisexual men, the I.V. drug users,
and the recipients of blood and blood products. And these groups
still account for 9 out of every 10 cases here in the United
States.
But now we're receiving more and more reports of the AIDS
virus infecting heterosexual men and women who are not I.V. drug
users. In fact, their heterosexual activity seems to be their
only risk factor. Close to four percent of all reported AIDS
cases in this country are reported to result from heterosexual
contact.
733 15TH STREET, N.W., SUITE 800, WASHINGTON, D.C. 20005
TELEPHONE: (202) 842-1988
Paid for by George Bush for President
2
On the face of it, four percent does not seem like much.
But that number is expected to increase dramatically during the
next five years.
It is projected that by 1991, most people in certain cities
in America will know someone who died of AIDS.
in every corner of the world. It does not discriminate. It is an
So make no mistake about it. AIDS is spreading and killing,
equal opportunity merchant of death.
Cases of AIDS have been reported in 112 countries. The
World Health Organization estimates that as many as 100 million
people will become infected with AIDS during the next decade.
As if these figures are not appalling enough, there is more.
A large number of individuals who do not knowingly practice
high-risk behavior are also being infected by the AIDS virus --
people like the wives of bisexual men, the spouses of I.V. drug
users, and the husbands and wives of promiscuous spouses, and,
saddest of all, babies born to I.V. drug users or otherwise
infected mothers. Tragically, some infants are being abandoned,
left to die alone in hospital nurseries.
susiness
What can be done to help? Well, first and foremost we
desperately need a cure or a vaccine. I chair the President's
Task Force on Regulatory Relief and earlier this year we worked
with the Food and Drug Administration to accelerate the
availability of experimental drugs to AIDS patients. We did this
to encourage more research and development on potential AIDS
vaccines by the private sector.
Meanwhile, our government will spend $766 million this year
and close to $1 billion next year on AIDS. And as we look into
the 1990's we may have to spend even more.
But money alone won't stop AIDS.
Those at high risk must be educated on how to avoid
contracting the disease. The only guaranteed way to halt the
spread of AIDS, given what we know now, is a change of behavior.
And those at risk will not change unless they know the terrible
dangers they face.
As a world community, we have a tradition of taking a
straight-forward approach to health warnings. When, through
careful scientific research, a health hazard is identified,
warnings are issued by health officials, and most people take
steps to reduce their risk to disease or danger.
-more-
3
Research, warning, risk reduction -- three phases that have
served us well in the past, and must continue to serve us well in
combatting the AIDS crisis.
If we know that dirty needles and certain kinds of sexual
behavior can transmit AIDS, we have an obligation to make the
public aware of the risks involved.
= am not a scientist or a researcher or a medical doctor.
But as an elected official, I think an important role of the
federal government is to provide timely, factual, and impartial
information about this deadly, insidious disease.
I have spoken with the Secretary of Health and Human
Services, Dr. Bower, Surgeon General Koop, and many others about
the possibilities of finding a cure or a vaccine as soon as
possible. And I applaud the efforts they've made to educate the
American people about AIDS.
In April, I toured the research facilities at the National
Institutes of Health. I visited an AIDS patient, and talked to
him about what he was going through. I saw firsthand what this
disease can do. It is brutal. It is unforgiving.
We must wage an all-out war against the disease. Let me
repeat: an all-out war against the disease -- not against people.
Not against the victims of AIDS, but an all-out war against the
disease itself.
The most important thing we can do is to tell our people the
facts about AIDS and what they can do to protect themselves from
it and to prevent it from spreading any further.
We've got to put into the hands of parents and students and
people throughout America essential facts about AIDS in a
thoughtful, sensitive manner. I recognize some of the countries
represented here have already successfully completed nationwide
mailings. I hope we can learn from your experience and find
creative ways to distribute some of the very good material that
has been developed.
I believe that education is primarily a local matter.
Parents and the community should control what goes on in their
schools. That system has worked well for more than 200 years and
I don't want to change it. I don't want the Federal government to
mandate some insensitive educational program.
Most schools now offer some kind of sex education during the
junior high or middle school years. Depending on local standards
and after a meeting of the minds with parents and school
officials, education about AIDS should be incorporated into the
curriculum. If the curriculum is well-planned and thoughtfully
-more-
4
carried out, we can teach children the facts about sexually
transmitted diseases -- and AIDS in particular.
This kind of education can and should be non-threatening.
It should teach traditional values. It should teach morality. It
should help develop the child's own sense of personal
responsibility. And it should strengthen the concept of the
family.
When it comes to educating our young people about AIDS, we
must all work together -- parents, educators, religious and
community leaders, medical doctors and scientists.
As difficult or as awkward as it may seem, parents must
assume much of the responsibility for educating their children
about AIDS. They need to talk to their children in a way that
only a parent can -- with a special love, compassion, respect, and
understanding.
Not long ago, my wife Barbara and I received a telephone
call from our second oldest son, Jeb. He was concerned about the
threat of AIDS and how to explain to his children the dangers of
this terrible disease. It seems that Jeb's 11-year-old son,
Barbara's and my grandson, had come home from school one day
asking about AIDS. That really brought home to me the absolute
necessity of educating our young people.
Right now, education is our best weapon against this
dreadful disease. In some respects, education is our only weapon.
And let me repeat again the crux of our battle. It is a
battle against a disease and not against people. We must remember
that the sick and the dying require our care and our compassion,
no matter how the illness was contracted.
Which brings us to perhaps the most controversial subject in
dealing with AIDS: testing. Who should be tested?
This issue raises some difficult and troublesome questions
for me. It puts in conflict the need for more information and
knowledge to benefit the majority versus our basic Constitutional
right to privacy.
We have often had these questions where two of our basic
rights or needs come into conflict. We use our political process
and our government to resolve these conflicting interests.
Testing is an extremely complex issue for that very reason.
But it is the responsibility of the political leadership to decide
among competing principles. Ultimately, we must protect those who
do not have the disease.
-more-
5
Thus, we have made the decision that there must be more
testing. As the President said last night, the federal government
will soon require testing for prisoners, immigrants and aliens
seeking permanent residence. Tests are already being conducted in
the military and in the foreign service. Additionally, we are
encouraging the states to offer routine testing for those who seek
marriage licenses and for those who visit sexually transmitted
disease or drug abuse clinics. We are also encouraging states to
require routine testing in state and local prisons.
Of course, any mention of testing must be hurriedly followed
by the word, "confidentiality." If society feels compelled, in
some circumstances, to test its citizens, then it is absolutely
imperative that those records are kept appropriately confidential.
It is also imperative that help be available to those who test
positive.
In closing, let me say we need money for research and
treatment. We need education. We need testing, but only
accompanied by quarantees that everyone is treated fairly.
We all have a duty -- and I don't use that word loosely.
Elected officials must use their position as a bully pulpit to get
out our message about the dangers of AIDS. And the experts -- all
of you -- the doctors and the researchers who deal with this
disease on a daily basis must not let up until a cure is found.
Although our respective roles are different, we do share one
common responsibility. And that is to remain understanding,
caring and compassionate toward those afflicted with AIDS. We
must not succumb to the demagoguery or the irrational ideas of
some out there. The fight against AIDS is not a partisan fight.
It is not a witch hunt.
It is our duty to do all we can not only to find a cure and
a vaccine, but also to make sure we never create a climate in
America, or in any other country, where friend turns against
friend, where countryman turns against countryman.
All of you here today are working toward a common goal, a
common purpose that pits mankind, with all of our genius and
expertise, all of our high technology and laboratories, and all of
our great educational institutions against a microscopic virus
that has declared war against our bodies.
The challenge is upon us. And it is a challenge we must
meet.
Good luck to all of you. I hope you have a tremendously
productive and fruitful conference. We're counting on you.
#
#
FROM: Hans Kuttner
Two audiences:
GB on the record on AIDS: Presidential leadership for
compassion.
Business and other institutional executives who have
come to the conference to decide if this is something
they have to worry about.
Significance of the NLC speech
Marks the transition of AIDS from being new and
different to being an ordinary part of the fabric of
American life.
-
More and more infected people will experience HIV
infection as a long-term, chronic disease.
-
And this requires thinking about the disease in
our institutions' and our society's long term.
Key fact of this stage: AIDS is not going away anytime
soon. It will be a chronic condition of society and
individuals afflicted.
Take Away Line for Firms
AIDS isn't a one-time crisis. It is something more and
more firms can expect to experience, either through an
employee or family member of an employee. You need to
be ready.
Cancer Analogy
O
We have to face AIDS just like we did with cancer a
decade ago. Once we were threatened by cancer. No
longer. Need a sense of compassion so that those who
suffer, either personally or as family members, do not
feel alone.
Leadership at all levels
President: Asking Americans to show their best
instincts -- be compassionate and caring.
-
American people are responding in the traditional
American way: they are being compassionate.
-
This is another opportunity to help people in
need. [pts of light]
In our communities: Having a response proportional to
the problem.
San Francisco, itself a thousand points of light in
response to the AIDS epidemic there, shows what can be
accomplished when those lights shine. The volunteers
who provide so much community-based care make it
possible for cost per AIDS victim to be substantially
lower than in other high incidence cities like New York
or Los Angeles. Communities must come together; a
thousand points of light isn't a frill, its a
necessity.
In our workplaces: Letting co-workers know they are
safe when someone with HIV works nearby.
03: 13. 90 10:10 AM * IMMED. OFFICE ASH
P02
FROM: HHS Dr. asst Mason's Sec. for office Health
DRAFT
Draft Talking Points
President's Presentation to the Business Leaders Forum on AIDS
March 29, 1990
POLIO
Welcome
Opening, Capsule summary of the AIDS epidemic as a problem
without precedent in our time. We have had numerous other
epidemics of infectious diseases, but this problem at this
point in our history is unique -- and it demands a unique
response from all of us.
It is important to focus not just on AIDS but on HIV, the
virus that causes AIDS, since people become infected long
before they develop symptoms and become 111.
Acknowledge role of business in the fight against AIDS. Thank
business leaders who have been involved to date for the work
they have done. Cite examples of the efforts and programs
that business and labor have developed.
Reiterate that unlike many of the diseases that strike our
elderly population and cause disability or chronic illness,
AIDS affects primarily people in the prime of life -- those
who are in the labor force or being groomed for the corporate
structure. More than 115,000 persons in the U.S. with AIDS,
95% of the total reported, are in people aged 20-59.
Many more adults who are infected are in the work force now,
and it is essential to have more involvement of the business
community in addressing the issues that will be raised and
developing the programs that will be needed.
The AIDS epidemic is not over. Dr. Curran has presented
information this morning about the trends of the epidemic. We
can all be encouraged that current projections suggest that
the numbers will not be as large as we thought just a year
ago. But the epidemic is not over.
We have lived with AIDS for almost a decade. It took almost 2
years to diagnose and report the first thousand cases. It
took another 3 years to report the first 10,000 cases. In the
last 12 months we had more than 36,600 cases reported from our
States and territories. It is predicted that even more cases
will be diagnosed during the next 12 months and on into the
decade of the nineties.
03213.90 10:10 AM *IMMED. OFFICE ASH
P03
DRAFT
Page 2 -- Draft Talking Points
A few cities and States have been particularly hard hit, with
thousands -- or even tens of thousands of cases reported --
but there is no area of our country that has not been affected
to at least some degree. We all must be involved. None of us
can afford to say that AIDS is not our problem.
In particular, the response of the business community is
critical because you work with and employ so many of those who
are already infected and who will become ill in the future;
those who may be at risk because of behavior choices they make
and who need the information to reduce their risk; and those
who will be concerned about whether it is safe or proper to
become involved or to extend a helping hand. Employees trust
and act on information provided by their company and their
boss. You in business are in a unique position to influence
the response of this country to the AIDS epidemic in the
decade ahead. We need an educated population to prepare for
the future -- and for adults, education in the workplace and
by example is the best answer.
The AIDS epidemic is having a major impact on our society and
our health care system. We have a unique health-care system
in the U.S. that has developed the most sophisticated care
available in the world. It is a system that is built on a
diversity of patterns of care and sources of support.
Business and the business-related health insurance programs
have been an integral facet of that system.
No system is without problems, however. AIDS has magnified
some of the weaknesses and flaws in our system, particularly
that of equity of access. In my State of the Union Message in
January, I asked Dr. Louis Sullivan, my Secretary of HHS --
who has already spoken to you -- to lead a Cabinet-level
working group t address this issue. Last year, Dr. Sullivan
formed a task force in HHS to address a similar set of issues.
It will not be easy, but we are making progress on this front.
Business also will be a part of the answer, because as we
develop more effective therapies for people with HIV infection
and AIDS -- therapies that delay or prevent many of the
complications and the progression of the disease -- we will be
able to keep people in the workplace and functioning normally.
They will continue to be productive members of our society.
Business has a real interest in seeing this come true.
03. 13. 90 10:10 AM * IMMED. OFFICE ASH
P04
DRAFT
Page 3 -- Draft Talking Points
We have other pieces of the puzzle that need to be put in
place also. We still need to solve the problem of
discrimination against people with AIDS. I support -- my
administration supports -- the Americans with Disabilities Act
that was passed by the Senate last year. We need to see it
passed by the House this year. This type of broad-based
legislation was strongly recommended by Admiral James Watkins
and the Presidential Commission on the HIV Epidemic that he
chaired. [Acknowledge Secretary Watkins, who should be in the
audience, and Dr. Burton Lee, also a member of the
Presidential Commission].
O Closing, In closing, I want to reiterate that this epidemic
is important and that our response to it is important.
The leaders of the National Commission on AIDS have been
keeping me informed about the progress that they have been
making. I am asking them as part of the work that they do to
meet with leaders of the business community and together to
explore and recommend ways in which business can address this
epidemic and our response to it.
We all must work together and pledge our commitment to stop
the spread of new infections through education and behavior
change, and to provide the support and services needed by
those who are already infected and their families. Together,
we can make a difference!
OVERVIEW ON AIDS
AIDS was recognized as a discrete disease in 1981. Since that
time the size and scope of the epidemic has grown rapidly.
As of November 1989, 115,158 AIDS cases have been reported to the
Centers for Disease Control, including 1,947 cases in children
less than 13 years of age. of this number 68,441 of the reported
individuals have died, including 1,059 children.
Based on current projections, there are approximately
1 million people in the U.S. infected with HIV. Data available
suggest that by 1992 the cumulative number of diagnosed AIDS
cases will be 365,000 with nearly 263,000 cumulative deaths.
The Federal Government has played a major role in addressing HIV
infection and AIDS since the disease was identified in 1981. In
fiscal year 1989, total Federal spending for HIV/AIDS was $2.25
billion, with HHS receiving $1.98 billion (88% of total Federal
AIDS budget), and the PHS receiving $1.29 billion (57% of total
Federal AIDS budget) (Budget table attached).
DEPARTMENTAL ACTIVITIES
The Departmental components with major HIV/AIDS activities and
responsibilities are:
Within PHS:
:
The Alcohol, Drug Abuse and Mental Health Administration
(ADAMHA) supports research on neurological and behavioral
aspects of HIV/AIDS and intravenous drug abuse.
--
The Centers for Disease Control (CDC) supports surveillance,
epidemiologic studies, monitoring of trends, and public
information and education, including efforts to target High-
risk groups. The CDC-supported National AIDS Information
Clearinghouse mails nearly 1 million pieces of HIV/AIDS
information per week.
The Food and Drug Administration (FDA) provides for
evaluation and approval of new drugs and vaccines that
proved safe and effective against HIV infection and clinical
manifestations of AIDS and assures the safety of the blood
supply.
The Health Resources and Services Administration (HRSA)
supports 20 AIDS service demonstration projects designed to
provide innovative ways of providing care to AIDS patients.
In addition HRSA, in conjunction with NIH, established 13
pediatric AIDS demonstration centers to develop community-
based, family centered care for AIDS infants and their
families.
12. 21. 89 01:18PM *DHHS/IOS 245-7591
PO3
The Indian Health Service (IHS) provides AIDS related
services and health care for American Indian and Alaskan
Native populations in the United States.
The National Institutes of Health (NIH) supports basic,
applied, preclinical and clinical research efforts.
Principal activities include research on the virology of HIV
and its variants, natural history of the disease, AIDS drug
discovery and design, clinical trials, vaccine development,
training for health professionals and international
research. Currently, the NIH supports 35 Clinical Trials
Units, 16 Drug Discovery Groups, 6 Vaccine Evaluation Units.
Within HHS:
:
The Health Care Financing Administration (HCFA) funds direct
treatment costs for AIDS patients through its Medicaid and
Medicare Programs.
The Social Security Administration (SSA) provides cash
assistance to individuals with HIV-related illinesses
through Disability Insurance and Supplementary Security
Income programs.
The Office of Human Development Service Administration
(OHDS) funds foster care demonstration grants to states to
address the problems of HIV-infected infants who are
abandoned at hospitals.
INTERNATIONAL ACTIVITIES
Because HIV/AIDS is a global issue, the Department has worked
with relevant agencies to coordinate international efforts
directed toward epidemiology, prevention, treatment and
information sharing.
Various PHS agencies along with the Office of International
Health have worked with the U.S. Agency for International
Development, Department of State, The Pan American Health
Organization, and the World Health Organization's AIDS-related
efforts.
In addition, the U.S. has entered into bilateral agreements with
countries such as the U.S.S.R., Japan, France, India, West
Germany and Thailand.
SOI/SHHG* 01:19:10 68 21. 121
PO4
ID
0
A
Total Federal Government Spending
HIV/AIDS
(dollars in millions)
1902
1983
1984
1985
1906
1987
1988
1989
1990
Change 89:90
Public Health Service
$6
$29
$61
$109
$234
$502
$962
$1,289
$1,582
+$293
(+23%)
Medicaid (Federal share)
1
10
30
70
130
200
330
490
670
+160
(+37%)
1 2. 12. 2 21. 1. 8 9 0 1 : 1 8 P * D H H S / I 0 *DHHS/IOS S = 4 5 7 5 9 1
Other HHS
1
1
6
18
38
3
106
199
825
+126
(+63)
Subtotal, HHS
a
39
Q7
197
402
707
1,398
1,978
2,577
+502
(+30)
Veterans Administration
2
5
7
11
23
56
64
142
179
+37
(+26%)
Defense Department
-
I
-
-
79
74
53
96
107
+21
(+24)
Agency for International Dav.
-
1
-
-
2
17
30
:40
41
+1
(+3%)
Other Federal Government
-
{
1
-
1
3
4
5
8
+3
(+60%)
Total, Federal Spending
a
44
104
209
507
910
1,569
2,251
2,912
+661
(+29%)
phs:214e
AIDS UPDATE
Key PHS Accomplishments:
1981
- Recognized AIDS as a new disease.
1982
- Established that the disease was spread through
sexual intercourse and transfusions of contaminated
blood, sharing of needles by drug abusers and from an
infected mother to her baby during pregnancy or at the
time of birth.
- Developed the first of numerous guidelines to protect
the public against infection in the workplace, schools,
and the community at large and to let them know that
the disease is not spread by casual concact WHEN a..
infected individual.
1983
- Established a toll-free national AIDS hotline.
1984
- Identified human immunodeficiency virus (HIV) as the
cause of AIDS.
1985
- Licensed HIV antibody blood tost which allowed blood
to be screened, greatly improving the safety of the
blood supply.
1986
- Established an HIV prevention program in every State.
1987
- Approved in record time & new drug application for
one significant drug therapy - Azidothymidine (AZT).
- Initiated testing of two experimental AIDS vaccines
in human volunteers.
- Established the National AIDS Information
Clearinghouse.
1988
- Distributed 107 million copies of Understanding AIDS,
an educational booklet, to every household in the
United States.
- Greatly expanded the existing national network of
centers conducting the clinical trials of promising new
drugs for the treatment of AIDS and HIV infection.
1989
- Third wave of "America Responds to AIDS" public
education campaign is initiated.
- Approved Aerosol Pentamidine as a treatment against
Pneumocystis carinii pneumonia and issued guidelines
for use as a prophylactic agent.
POB
1SSL-S SOI/SHHG* 68 21. 12.
THE WHITE HOUSE
WASHINGTON
Date:
To:
NOTE. -- -
POTUS has not
yet of this seen. Office Beverly is currently Ward
preparing a draft for
his signature.
TERESA DONOVAN
Presidential Correspondence
Office
Room 94, x7610
March 1, 1990
President George Bush
The White House
Washington, D.C. 20500
Dear Mr. President:
We are writing as members of the Mayor's HIV Task Force in
San Francisco and as religious leaders who are deeply
concerned about our community.
As you know, the AIDS epidemic has taken an extraordinary
toll on our city. AIDS has already claimed more San
?
Franciscans than all the wars in this century -- World War
I, II, Korea and Vietnam -- combined and tripled.
Our response to this crisis has been a model for the
nation. Individuals, businesses, health care workers,
churches and synagogues have built a compassionate system
of care and support which has helped people with AIDS live
with dignity and receive quality medical care.
The message we must deliver today is that this system of
support and care is crumbling. Even with renewed
commitments from each of us, our community will need more
help from outside sources to keep up with growing
caseloads and skyrocketing costs of health care and
services.
For all the suffering and sacrifice that the epidemic has
brought us, we know that more people will live and die
with AIDS in the next decade than did in the last.
What is needed is direct aid to communities like ours
which have been hardest hit by the epidemic. We need
immediate help just to provide basic services: housing for
those who are ill with no place to go, medical care to
prolong the productive lives of those infected with the
HIV virus, and outpatient services which reduce costly and
unwanted hospital stays.
The AIDS epidemic tests our willingness to define the word
"community" in its broadest sense. AIDS is not a problem
of one neighborhood, city or sector of our society. All
of us are affected and all of us must respond.
We urge you to actively support legislation which would
provide substantial additional assistance to communities
most profoundly affected by the AIDS epidemic. Thank you
for your attention to this urgent concern.
Sincerely,
Robert Kirscher
Dr. Robert Kirschner, Rabbi
Temple Emanu-el
P.O. Box 18247
San Francisco, CA 94118
Most Reverend R. Quinn
+ Jmn R.Jurin John
Archbishop of San Francisco
445 Church Street
San Francisco, CA 94114
+ William E. Sing
Rt. Reverend William E. Swing
Episcopal Bishop of California
1055 Taylor Street
San Francisco, CA 94108
my ng editor of The Jewish Daily
Pierce Corson of the Philader-
Responsibuity
Mission Society in
A
special
phia Methodist Area. and Ralph
Mrs. Frank Higgins. a Chicago
and Bishop Raymond A. Lane, su-
be conducted at 11 A. M. tomor-
Memoeller, German Protestant
WS.
policewoman who 13 director of the
n 1928 when the latter paper
G. Luff. president of the Ocean
perior general of the Maryknoll
row at the Broome Street Taber-
eader, said tonight he believed the
3 merged with The Jewish
Chicago Crime Prevention Bureau,
Missioners.
nacle. 395 Broome Street. The
Flussian church would participate
City Tabernacle Association,
will conduct panel sessions on
rning Journal, Mr. Danzis joined
Rev. Gustavo Verdesi will preach.
in a world-wide Christian unity
staff of The Day. of which he
Ocean City, N. J. will visit
"Family and Youth." Other Sea-
School Plans Sessions Here
The Rev. Dr. Theodore Cuyler
movement if permitted by the
came editor in 1950. He served
Heidelberg. Germany. soon to
stons will be devoted to Carl Scout-
Speers will interrupt his vacation
Kremlin to do SO. Dr. Niemoeller
this capacity until 1952. when
confer with Army chaplains and
mg. mission work. scholarships,
The Summer School of Catholic
to preach from his pulpit at 11
recently visited Moscow.
became an editorial staff mem-
officers on occupation problems.
activities on behalf of the blind
Action. which has scheduled its
A. M. tomorrow at the Central
and the federation's educational
Before going to Germany,
New York City sessions for Aug.
Presbyterian Church, Park Ave-
r.
He was a former vice president
Bishop Corson. who 13 president
and Internary projects.
nue and Sixty-fourth Street. His
DDT SPRAYED ON RAHWAY
18 to 23 at Fordham University,
the Jewish Writers Club (Peretz
of the Council of Bishops of the
Cardinal Spellman will speak at
has 83 its theme this year "God's
topic will be "Mid-Summer's
grein). Mr. Danzis had traveled
a dinner at 15 P. M. Thursday.
Methodist Church, will preach in
Law the Measure of Man's Con-
Dream."
Drive Against Insects Conducted
tensively in Europe. Asia and
Wesley's Chapel. Mother Church
Other speakers will be John F.
Inct The school, which was
as Anti-Polio Measure
itin America. and had made
Breanan of the State Board of
of Methodism, London, on Aug.
started in 1931. has traveled 120,-
Christian Science Services
ree trips to Israel, publishing ac-
24. At. the end of the month. the
Regenta and Mrs. James Sheeran
(100 miles and currently has
Special 10 THE NEW YORK TIMES.
unts of his travels in Yiddish.
church representatives will go
of Mineola, 1. 1. a co-founder of
twenty-five lay and clerical in-
The topic of the Lesson-Sermon
RAHWAY, N. J., Aug. 15-
Surviving are his widow; a son,
to Stuttgart. Germany. as fra-
the federation Mrs James F
insurators on a trip of 8,000 miles,
in Christian Science churches tc-
Manned by a Union County Mos-
dney: a daughter. Mrs. Helen
Looram of Elmhurst. Queens,
it sping at ten cities for the
morrow will be "Soul." The Golden
quito Exterminating Commission
ternal measengers to the Kirch-
haikin. and a grandson.
entag Assembly of all German
chairman of the federation's
Text is: "I have longed for Thy
crew, a spray truck today started
servions,
Protestants, and also to Zurich,
partment of mothen pictures, will
With the completion of this
salvation, () Lord: and Thy law :3
"fogging" DDT throughout this
ASKELL BEARERS NAMED
Switzerland, to address Meth-
introduce the speakers.
year schedule, cities
my delight. Let my soul live, and
city in an attempt to combat in-
odist hering
will have been visited. including
it shall praise Thee: and let Thy
fantile paralysis, which killed
Bishop Corson will lease from
Catholle Students to Meet
in Canada. A group of courses
judgments help me." (Ps. 113
three persons here in a month.
oover, Dewey and Lehman
New York International Airport,
will
end
in
Boston
today.
and
the
174, 175.)
The spraying started in the
Listed for Rites at West Point
Dillewid, Queens, on Tueaday
from The of fifteenth the Catholic national Students MIA tenth group will be given Aug 25
convents
Whittier Street-Koening Place sec-
and will he joined in London by
don Crusade will be held Aug 21. to 20 in Chicago The key speaker
Archbishop Makary Elevated
tion, where there have been five
Special to THE New York TIMES
Mr. Luff.
21 at the University of Notre in all the cities has been the Rev.
cases of the disease.
ALBANY. Aug. 15 Former
Dame, In Notre Dame near South Dannet A Lord, editor of "The
Archbishop Makary of New
The operation. authorized by the
resident Herbert Hoover and
Rend. Ind. with 2000 delegates Queen Work," published in St
York, exarch of the Moscow P1.
Rahway Common Council as a
AID SOUGHT FOR CHINESE
peeted Among the on the Locat An estimated 140,000 stu-
triarchate since 1948. has been
step toward eliminating a possible
mor Dewey will be honorary pall-
earers tomorrow at the funeral
agenda 11 table forum, will have attended the
elevated to be Metropolitan of the
cause of polio through the killing
Patriarchal
Russian
Orthodox
of flies. mosquitoes and other in-
I Lieut. Gen. William N. Haskell,
U. S. Group Wants $1,000,000 to
with representatives of the tech this year.
Church in the Aleutian Islands a.-
sects, should be completed by to-
nical assistance agencies of the
ormer Commanding General of the
Help 20,000 in Hong Kong
North America The vice-exarch
morrow. a County Mosquito Com-
United States Government and the
Humanists to Meet
few York National Guard.
Archbishop Adam, who return
mission spokesman said.
Other honorary bearers will be
Twenty thousand Chinese Intel
United Nations participating
Es-man
Catholick
The
first
international
congress
this week after a six-week trip ::
Mayor James E. Egolf said to-
lenator Herbert H. Lehman, Lieut.
lectuals who have sought refuge
prelates Among to the speak will be Arch on humanum and ethical culture
Moseow by air to give an official
day that the commission had agreed
in Hong Kong are being woold by
bishop Karl Affer Cincinnati, will be held Aug 21 to 26 111 Am- routine
report.
NYT
to do the job without charge.
len. Willis D. Crittenberger, com-
handing General of the First
the Communists to bring their
skills back to their homeland. an
Army: Lieut. Gen Robert C. Rich-
American back from the British
ardson Jr, retired: Maj. Gen. Karl
RELIGIOUS
8-16-52
colony declared yeaterday He 13-
i. Hausauer, chief of staff to the
serted that they should be anded
lovernor and Commanding General
DIVINE SCIENCE
PRESBYTERIAN
PROTESTANT EPISCOPAL
by the Allies 113 they a tremen-
ABSOLUTE SCIENCE
if the New York National Guard:
dous resource against communism
DIVINE UNITY
firam C. Todd. Alvin E. Blomquist
in Asia.
(ABSOLUTE SCIENCE)
REV HELEN ZAGAT
and Duncan G Harris of New
The Brick Church Cathedral
Harold L. Oram. special repre-
HEAR DR. JOSEPH LARSON
Herital
Hall
154
57th
It.
the Divine
services Required Sept. 3
Park Avenue 91st Street
York. and Richard K. Mellon of
sentative of And Refugee Intelled-
Pet Plaza 1400
THE REV PAUL WOLKE. D D Minister
R 9. & 11 (Morn Prayer &), Holy Communion
Ligonier. Pa.
11 A M -DR MILLARD C ROBERTS
tuals, Inc. which 14 headed by
"Fruit Out of Season
Isa Mellwraith. Organial
10. Morning Prayer
4, Evensong
Also Lieut. Gen. Cornelius W.
Preacher at 11 and 4
Representative Walter H Judd.
Church illie Truth
The Rev Stanley A. H. Eley
Wickersham, retired: Maj. Gen.
Broadway Presbyterian
Prebendary of St. Paul London
returned Thursday after surveying
Weekdays 15. 8 (and Wednesday 10).
Howard McC. Snyder, retired: Brig.
the possibilities of bringing them
Broadway at 111th Street
Cathedral Tours: Sundays. 12:30 and 5
Gen. Troup Miller: Maj. Gens. John
BAHAT WORLD FAITH
DR. ERVIN SEALE
DR JOHN 11 McCOMB Minister
Weekdays. 11. 12, 2. 3, 4
K. Herr and Frank P. Lahm. re-
help.
REV WILLIAM McLEISTER Guest Preacher
Minister
Pastor. Mount Lebanon
Mr. Oram said his organization
119
tired: Brig Gens. William H. Kelly,
ENGINEERING AUDITORIUM
United Presbyterian Church. Pittsburgh. PL
ST. JAMES'
Madison Ave.
at 71st Street
would try to raise $1,000,000 to-
SUNDAY.
West PRINTST that sen and Bill
11 A M AND 8 P
Wed., 8:15 P M -MR MOLEISTER
Rev ARTHUR LEE KINSOLVING. D.D., Rector
Charles E. Saltzman. Hampton An-
ward this end in a nation-wide
HARRY JEFFRIES
Prayer and Bible Hour
8. Holy Communion 11. Morning Prayer
derson and Gerard W. Kelley and
HAHAT
IN
Sermon at 11: The Rev. James F. Martin
campaign this fall. He said his
Speaker
RADIO BROADC SUN 9 30.10 A.
Guest
Col. Alfred D. Reutershan.
WINS. 1010 ON THE DIAL
group would concern itself with
BAPTIST
Sunday 11 A M on
ST. MARY THE VIRGIN
139 West
Magr. George C. Murdock, for-
registration of the qualifications of
The Anthropomorphic God"
46th St.
mer chaplain of the United States
FIRST BAPTIST CHURCH
Central Presbyterian
Low Masses: 7 and 9
High Mass with Sermon (Fr. Taber). 11
the refugees. in conjunction with
Missa secunda-Hassler
Military Academy, will represent
Street
a survey by the Nationalist Chi-
PASTOR 11 WHITING
First Church of Religious Science
Park Avenue at 64th Street
REV THEODORE CUYLER SPEERS D =
Evening Prayer. Address. Benediction. 8
Cardinal Spellman at the requirem
nese Government on Formosa as to
M Bible School
Display Advertisement This
11 A M-DR SPEERS will preach
Catholic Worship- Preaching
mass at 12:30 P. M. in the Catholic
Services A M and M
MID-SUMMER S DREAM
Liturgical Music
which ones are needed there.
by the REV DONALD MacKAY
SECOND CHURCH RELIGIOUS SCIENCE
Chapel at West Point.
Because of overcrowding on For-
FRIDAY Meeting
Dr. Paul Martin Brunet
ST.
MICHAEL'S
99TH STREET
mosa, he said, only about 5,000
Sun..
Fifth Avenue Presbyterian
OFF BROADWAY
REV. WILLIAM CORKER. RECTOR
Caluary Baptist 123 57
53
ST.
3, H.C. 11. M. P. Sermon-Rev. J. M. Waterman
WALTER S. GLADFELTER
Gotham Motel
refugee intellectuals could be ac-
11 A. M.
Fifth Ave at 55th St.
commodated there.
Dr. John Summerfield Wimbush, Pastor
RICHES WITHIN YOUR REACH
John Sutherland Bonnell.
ST.
STEPHEN'S
69th
Street,
near
Bway
Special to THE NEW YORK TIMES.
Thurs MP. M., How to Heal Yourself & Others
Rev.
Dr.
Wilson
Suttom
M
PHILADELPHIA. Aug. 15
11 A The Importance of Secret Thoughts
8. 11 A. M.-The Rev. Dr. Samuel H. Prince
(M) A M The Double Crosser"
Walter S. Gladfelter, assistant Pro-
HILLEL DIRECTOR NAMED
10 M A ...
INTERDENOMINATIONAL
30 M -How to Obtain Eternal Life
10 and Station WMGM
The Rev. Hamish C. MacKenzie, M.A.
Fifth Avenue
fessor of Business Administration
Megs
THE ASSEMBLY-
of Scotland, preaching at both services
St. Thomas.
& 53rd Street
at Temple University. where he
Rev. ROELIF H. BROOKS. S.T.D., Rector
had been on the faculty for twen-
Rabbi Frimer of Chicago Chosen
Madison Avenue Baptist list St.
GUILD OF CHRIST
8 and 9 A. M.-Holy Communion
CHURCH OF THE CORDIAL WELCOME
First Presbyterian Church
11 A. M. Morning Prayer: Rev. J. C. Francis
by New York Foundations
HOTEL WELLINGTON 147 w 55TH ST.
Daily 8:30 A.M., Holy Communion
ty-two years, died Wednesday
REV DR J EARLE EDWARDS. Guest Preacher
Sunday 11 M -Spiritual Maturity
SERVICES 11 A M AND 4 P M
5TH AVE. BET 11th and 12th STREETS
Thursday. 11 A.M.. Holy Communion
SERVICE
night in the York General Hos-
CHARLES 11 WATTS. Speaker
11 A M.-REV GEORGE C CAMERON
pital. He was 62 years old.
Rabbi Norman Frimer of Chi-
THE RIVERSIDE CHURCH
Wed M New Mind and Heart
of Dundee, Scotland
LITTLE CHURCH AROUND THE CORNER
cago has been named regional
AIMEE LEVY. Speaker
P. M -LAWN SERVICE
Transfiguration
One East
Mr. Gladfelter, whose home was
MR. CAMERON
director of the B'nai B'rith Hillel
at 122nd Street
29th Street
in this city, was graduated from
JEWISH
Temple in 1927 and received a
Foundations in the New York area
DR. ROBERT J. McCRACKEN, Minister
Madison Avenue Church
Rev. RANDOLPH RAY. D. D., Rector
Holy Communion 8 and 9 (daily) 8
and director of Brooklyn College
11. Choral Eucharist and Sermon-Fr. Griesmyer
master's degree from the Univer-
11 A. M.-DR. JOSEPH R. SIZOO
New Brunswick Theological Seminary,
Cong. Rodeph Sholom
Madison Ave. at 73rd Street
Hillel Foundation. The founda-
Rev. Frank Grebe. Preaching
of Pennsylvania.
and
cultural
New Brunswick ANOUGH
St.,
Fri
5
30
Sat.
A.M.
11
A
M The Diligence of Your Hands
83rd
8 M Through Jesus Christ Our Line"
PART NEWMAN
-
9
1
The Marish of
Margaret A. Hamburg, M.D., and
Anthony S. Fauci, M.D.
AIDS: The Challenge to Biomedical
Research
T
HE SUDDEN, UNEXPECTED EMERGENCE of the acquired
immunodeficiency syndrome (AIDS) has become the focus of
extraordinary attention and concern. First recognized as an
entity less than eight years ago, this infectious, debilitating, and
ultimately lethal disease represents the most severe stage of a spec-
trum of infection with the human immunodeficiency virus (HIV). It
has appeared, in epidemic proportions, in an era when advances in
medicine and public health have fostered great confidence in the
ability of biomedical science to conquer disease. The prematurely
complacent belief that infectious diseases would no longer threaten
the developed world has been abruptly and definitively shattered by
the onset of AIDS.
As of December 1988, the United States has had more than 81,000
documented cases of AIDS and close to 46,000 deaths from the
disease.¹ In the United States, 1 million to 1.5 million individuals are
thought to be infected with HIV but have not yet developed clinical
symptoms.² In the entire world, current estimates indicate that there
are presently more than 250,000 cases of AIDS and somewhere
between 5 million and 10 million individuals infected with HIV.³ It
Margaret Hamburg is Special Assistant to the Director of the National Institute of Allergy and
Infections Diseases at the National Institutes of Health in Bethesda, Maryland.
Anthony Fauci is Director of the National Institute of Allergy and Infectious Diseases at the
National Institutes of Health in Bethesda.
19
Daedalus
Apring 1989
Vol 118, No. 2
20
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
is even more sobering to examine projections for the future. Account-
ing for both the rates of progression from infection to disease and the
rates of new infection, the United States Public Health Service
estimates that by the end of 1992, this country will have had a total
of approximately 365,000 cases of AIDS and close to 263.000 AIDS
deaths. In 1992 alone, it is projected that there will be 80,000 new
cases of AIDS diagnosed in this country-nearly as many cases in
one year as have occurred in our entire experience with the disease
to date.⁴
As the number of reported cases of AIDS mounts, the magnitude
and severity of the problem becomes increasingly evident, and the
urgency of developing effective strategies to prevent and control HIV
infection more pronounced. From a scientific perspective, progress in
understanding this disease process has moved forward at an impres-
sive rate. Since the initial descriptions of the syndrome in the early
1980s, the fundamental manifestations of the disease have been
documented and the general contours of the epidemic delineated.
Basic research efforts have led to the discovery of the causative agent
(HIV), the development of a blood test for the virus, as well as insight
into the targets for the virus in the body, the body's responses to
infection with the virus, and the pathogenic mechanisms whereby the
virus produces its deadly effects. In recent years, a nationwide clinical
trials program has been established to test experimental AIDS
therapies, and several trials of AIDS vaccine candidates are currently
under way.
Yet despite these advances, no definitive cure or effective vaccine is
yet available, and the toll of the epidemic continues to rise. The more
knowledge is accumulated about the virus and the disease it produces,
the more complex the picture becomes. In this article we shall attempt
to outline the important accomplishments and the current status of
basic and clinical AIDS research efforts and to identify certain of the
promising new avenues for scientific pursuit, as well as obstacles to
progress and some of the special problems that have arisen.
THE INITIAL CHALLENGE: THE SEARCH FOR A CAUSE
In the late 1970s, a rare type of cancer and a variety of serious
infections were recognized to occur in increasing numbers of previ-
ously healthy young men who resided predominantly in New York
AIDS: The Challenge to Biomedical Research
21
and California. Most of this initial group of patients had Kaposi's
sarcoma, an unusual skin tumor generally not seen in this age group,
or Pneumocystis carinii pneumonia, a rare lung infection that virtu-
ally never occurs in individuals with normal immune function. 5 First
formally described in 1981 as a disease affecting homosexual and
bisexual men, AIDS was later reported in intravenous drug users,
hemophiliacs, and recipients of blood transfusions. It was also noted
that the sexual partners of AIDS patients could contract the disease. 6
Despite the lack of an established cause for AIDS at this time,
efforts to respond to the challenge of this new disease process were
vigorous and drew upon many disciplines. Review of the medical
literature, autopsy records, and tumor registries revealed no prece-
dent for the striking new incidence of such cases. Epidemiologic
studies in the United States and abroad were initially undertaken to
define the affected populations and to search for clues to the cause of
the disease. Such research activities, along with natural-history stud-
ies of the disease, provided important insights into modes of trans-
mission, patterns of disease occurrence and progression, as well as
possible cofactors.
Immunologic evaluation of AIDS patients revealed severe defects
in their immune systems, making them susceptible to unusual cancers
and so-called opportunistic infections, which a normal immune
system would protect against. The damage to the immune system was
observed to result predominantly from the selective depletion of a
certain subset of white blood cells referred to as T4 lymphocytes.
These T4 lymphocytes play a critical role in orchestrating the entire
immune system and are essential to the body's defense mechanisms.
It was presumed that the immune defect in these patients was
acquired, but the mode of acquisition was undetermined.
In 1983, a previously undescribed T-lymphotropic virus was
concurrently isolated from AIDS patients by Dr. Robert Gallo at the
National Institutes of Health and by Dr. Luc Montagnier at the
Pasteur Institute in Paris. Early on, the virus was multiply designated
as human lymphotropic virus (HTLV) III, lymphadenopathy-
associated virus (LAV), and AIDS-associated retrovirus (ARV).
Now officially called the human immunodeficiency virus (HIV),
considerable evidence demonstrates that this organism, an RNA
retrovirus belonging to the lentivirus family, is the causative agent of
AIDS. Little is known with certainty about the biologic and geo-
22
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
graphic origins of this virus, but this would appear to be the first time
in recorded history that it has spread widely in the human popula-
tion. Related viruses have been observed in animal populations but
do not produce disease in humans. A distinct but related virus
(HIV-2) does cause disease in humans, and it is now being actively
studied.⁹
RESEARCH ON HIV INFECTION AND AIDS
The initial recognition of AIDS as a distinct entity created the need
for intensive scientific study directed at this new disease. Truly rapid
advances have been achieved, due in large part to the extraordinary
foundation in basic science research developed over the past few
decades. The remarkable expansion of knowledge in the areas of
immunology, virology, microbiology, molecular biology, and drug
and vaccine development have enabled AIDS scientists to proceed in
a rational and expeditious manner.
Broadly viewed, biomedical research on HIV infection and AIDS
can be divided into five major scientific categories: (1) the study of the
distribution of HIV infection and AIDS in the population (epidemi-
ology) and the pattern of disease progression (natural history); (2) the
identification and characterization of the virus that causes AIDS (the
etiologic agent); (3) delineation of the mechanisms by which the virus
destroys the immune system and produces disease (pathogenesis);
(4) the development and testing of potential therapies for HIV
infection and its complications; and (5) the development and evalu-
ation of potential AIDS vaccines.
Modes of Transmission and the Epidemiology of Infection
The routes of HIV infection have been studied extensively. Research-
ers have isolated HIV from a number of body fluids, including blood,
semen, saliva, tears, urine, cerebrospinal fluid, breast milk, and
cervical and vaginal secretions. However, epidemiologic evidence
strongly indicates that HIV is transmitted through only three primary
routes: sexual contact (including anal and vaginal intercourse) with
an infected person, exposure to infected blood or blood products,
and passage from an infected mother to her infant before or during
birth. 10
AIDS: The Challenge to Biomedical Research
23
Current U.S. statistics reveal that the majority of sexual transmis-
sions of HIV have occurred between homosexual or bisexual men,
representing approximately 62 percent of all AIDS cases. Exposure to
HIV-infected blood through the sharing of needles or other drug-
related paraphernalia is another source of HIV infection, and intra-
venous drug abusers comprise approximately 20 percent of the
present cases of AIDS. An additional 7 percent of HIV cases occur
among individuals who are both homosexual and intravenous drug
abusers. Heterosexual HIV transmission in the United States ac-
counts for roughly 4 percent of all reported AIDS cases. About
3 percent of the AIDS cases occurred through transfusion of infected
blood or blood products, although the current practice of screening
blood donors and testing all donated blood and plasma for HIV
antibodies has virtually eliminated this route of transmission. 11 HIV
transmission in breast milk is an extremely uncommon mode of
spread, although it has been sporadically reported. 12 There is no
scientific evidence to support the idea that the virus is transmitted
through ordinary nonsexual contact. 13 Claims that HIV can be
transmitted by insect transmission have been repudiated by both
laboratory and epidemiologic studies. 14
Careful, ongoing epidemiologic surveillance studies are essential to
monitoring levels of HIV infection and trends in new infection among
groups recognized to be at increased risk (such as homosexual males
and intravenous drug abusers), various demographic subgroups
(based on sex, age, and race or ethnic group), and the general
population. Considerably more needs to be learned about the con-
tributing factors and quantitative risks of HIV infection through
various transmission modes, including type of sexual contact,
mother-to-infant transmission, patterns of intravenous drug abuse,
receipt of blood or blood products, and occupational exposures to
blood or infected fluids. Such data are of critical importance to
assessing the mechanisms of transmissibility of the virus, its biologic
determinants, and/or the cofactors influencing individual susceptibil-
ity to infection. Both the biomedical and the public-health implica-
tions of such information are enormous.
Following infection with HIV, a person may experience an acute,
transient, mononucleosis-like febrile illness but generally remains
virtually asymptomatic for several years before progressive immuno-
logic deterioration results in the opportunistic infections or cancers
24
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
that characterize the diagnosis of AIDS. 15 The period between initial
infection with HIV and the development of AIDS can be quite
variable. Recent data indicate that 15 percent to 46 percent of
HIV-infected individuals will develop AIDS within seven years of
infection. 16 Over the longer term, statistics on HIV disease progres-
sion remain to be determined, but many scientists fear that in the
absence of the discovery of effective therapeutic interventions, virtu-
ally 100 percent of those infected with the virus will eventually
develop acute AIDS. Furthermore, although asymptomatic HIV-
infected individuals may appear healthy, a growing body of evidence
suggests that they progressively experience subtle but important
subclinical defects of immune function.
There is increasing recognition that the clinical syndrome of AIDS
represents the terminal stage of a spectrum of HIV infection. Once
the diagnosis of AIDS is made, the clinical course generally follows a
relentless decline, with death occurring within one or two years.
However, earlier diagnosis, the development of the antiviral agent
Zidovudine (AZT), and improvements in the treatment of the
complications of HIV infection are leading to prolonged survival for
persons with AIDS. 17
In addition, intensive research efforts are being focused now on the
critical period between initial infection and the fully developed
disease. New insights may enable early interventions to arrest or slow
progression of HIV infection prior to the development of AIDS.
The Nature of the Virus
Following identification of the causative agent of AIDS (HIV-1),
intensive efforts to investigate the nature of the virus, its functions,
and its effect on human cells began. Knowledge has accumulated
at a pace unprecedented for research on disease-causing micro-
organisms.
As seen through an electron microscope, the HIV RNA retrovirus
appears as a dense cylindrical core encasing two molecules of the viral
genome (genetic material). A spherical outer envelope surrounds the
central core. 18 The genetic material of the virus has been cloned and
sequenced and its precise structure delineated. For the most part, the
specific functions of the viral genes as well as the functions of the
proteins encoded by those genes have been identified and studied. 19
Such understandings serve as the basis for many important AIDS
AIDS: The Challenge to Biomedical Research
25
research endeavors, including attempts on a molecular level to
interfere with specific functions of the virus and to influence infectiv-
ity by manipulating specific components of the virus. Scientists are
also using information about the nature and function of the HIV
genome to provide a framework for the development of potential
AIDS vaccines and to attempt to develop antiretroviral drugs in a
targeted fashion designed to interfere with the ability of the virus to
replicate itself or cause infection. In addition, isolation of the virus
has made possible the development of HIV blood-screening tests.
This has important public-health applications for safeguarding the
blood supply, as well as for diagnostic and surveillance purposes.
Significant progress has also been made in understanding the life
cycle of the virus. Similar to other viruses, HIV cannot reproduce
without taking over the biosynthetic machinery of the host cell. Like
all retroviruses, HIV possesses a special enzyme, reverse transcrip-
tase, which is capable of making a DNA copy of the viral RNA. This
enables the virus to reverse the normal flow of genetic information
from RNA to DNA (referred to as proviral DNA), which is then
incorporated or integrated into the genetic material of the host. Once
integrated, the virus can remain in a latent state for a variable, often
lengthy, period until activated.²⁰
That HIV is a retrovirus, with this unique ability to insert its genes
into the genetic machinery of the host cell, greatly complicates the
task of developing effective therapies and vaccines. HIV can remain
dormant or latent, shielded from either pharmacologic or immuno-
logic attack. While developing therapies for viral diseases has always
been problematic, devising an antiretroviral therapy may prove even
more difficult.
Nonetheless, the HIV replicative cycle offers several opportunities
for effective intervention. One area of investigation concerns the
critical step in HIV infection whereby the virus binds to a host cell
receptor to gain entrance to the cell. It has been demonstrated that a
molecule called CD4-expressed predominantly on the surface of T4
lymphocytes-serves as a receptor for HIV. 21 Thus, the T4 cell
represents a major target for HIV infection: however, other cells
expressing the CD4 surface molecule are capable of binding and
becoming infected with HIV. Various mechanisms have been pro-
posed to interfere with this process of virus-receptor binding and
entrance into host cells. Several are under active study. 22 Another
26
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
area of investigation involves interfering with the activity of the
enzyme reverse transcriptase, thereby disrupting a crucial initial step
in the replicative cycle of the virus. Other potential targets of
vulnerability of the virus include interference with proviral DNA
transcription (the process by which genetic information contained in
DNA is translated into an RNA message), disruption of the subse-
quent protein synthesis, processing, and assembly and the final
stage of viral replication in which mature virions bud off from host
cells. 23
The Attack on the Immune System
HIV infection can result in a wide range of immunologic and clinical
abnormalities. Although multiple components of the immune system
are at least indirectly affected in individuals with HIV infection, it is
the impairment of the responses mediated by the class of lymphocytes
called T4 cells that appears to produce the most significant clinical
consequences. 24 Because the T4 cell is pivotally involved in virtually
all immune responses, a major host defense defect results from
T4-cell depletion and renders the body highly susceptible to oppor-
tunistic infections and neoplasms. It has recently been demonstrated
that certain other types of white blood cells called monocytes and
macrophages, including bone marrow precursor cells, can be infected
without marked cell damage. 25 The monocyte, which moves rela-
tively freely throughout the body, may serve as a reservoir for HIV
and may play a significant role in the propagation of HIV infection
and the development of AIDS. It is now well established that the
brain is also a target for HIV. 26 Present evidence suggests that many
of the central nervous system manifestations of HIV are produced by
infected monocytes that travel into the brain and indirectly damage
neuronal tissue. Research reveals no evidence to support direct
infection of nerve cells by HIV.
The development of a new technique called polymerase chain
reaction (PCR) will greatly enhance the ability of scientists to detect
the presence of HIV genetic material in cells. This technique involves
selective DNA amplification and makes it possible to multiply
otherwise undetectable fragments of DNA. Using PCR, it is possible
to determine the presence of HIV viral genes in blood samples in
which as few as 1 in 1 million lymphocytes is infected. 27 The
AIDS: The Challenge to Biomedical Research
27
expanding use of PCR in AIDS research will result in important new
insights into the nature and extent of HIV infection.
Considerable progress has been made in understanding the patho-
genic mechanisms of HIV infection, including the receptor whereby
the virus gains entry into the cell and the subsequent intracellular
events of the virus life cycle and replication. The disease complica-
tions that result from the virus-induced destruction of immune cells
have also been fairly extensively delineated. Nonetheless, some of the
most basic mechanisms by which HIV exerts its lethal effects on host
immune cells remain unknown. In test-tube experiments, HIV can be
demonstrated to rapidly kill the cells it infects. It is not clear,
however, that such a phenomenon can fully explain the profound
depletion of T4 cells observed in patients with AIDS, since only a
small percentage of the T4 cells in the peripheral blood (perhaps less
than 1 in 10,000) is found to express the virus at any given time.
Several proposed explanations for this apparent discrepancy are
currently being explored. 28 A better understanding of the process of
cell destruction by HIV will therefore be important to the develop-
ment of effective interventions.
Because the clinical syndrome of AIDS follows infection with HIV
after a variable, often long, period, there is a pressing need to learn
more about this interval between initial infection and acute disease. It
may well be that our best prospects for treatment and control of HIV
disease will come through interventions during this critical time.
Toward this end, intensive efforts must be directed toward unraveling
the mechanisms of immune-system dysfunction and the factors that
influence or control disease progression.
Laboratory experiments have demonstrated that when certain cells
are infected with HIV, latent infection may ensue, with the viral DNA
becoming integrated into the DNA of the host cell without virus
production. 29 In addition, infection may be chronic in a given cell
with a low level of virus production or expression. A variety of
activation signals, including other viruses as well as substances
produced by immune-competent cells following stimulation, appear
to contribute to the conversion of a latent or a chronic infection to a
productive one. 30 Modification of these activation signals-either
pharmacologic or otherwise-may have important implications for
28
Margaret A. Hamburg. M.D., and Anthony S. Fauci. M.D.
potential strategies to limit the progression of HIV infection and
of AIDS.
The Search for a Treatment
Researchers are in the midst of a major effort to discover, develop,
and test potential therapies for HIV infection and AIDS. These efforts
have focused on two major areas: (1) antiviral drugs with a direct
effect against the causative agent, HIV, and (2) immunomodulators
that act to reconstitute or enhance immune-system function in
patients with HIV infection and AIDS. Efforts to develop and
improve-approaches to treat the specific opportunistic infections and
cancers associated with AIDS are also moving forward.
The successful development of antiviral and/or immune enhance-
ment therapy represents a challenge of enormous magnitude. Basic
scientific understandings must obviously underlie the process of
rational development of therapeutic agents. Unlike any other known
pathogen, HIV infects the very cells of the immune system that are
intended to direct the immune system's attack against such invaders.
In addition, because the virus becomes intimately associated with the
host cells during the course of its life cycle, the task of finding a safe
and effective therapeutic agent is even more formidable. It will be
necessary to discover a means to interrupt the life cycle of the virus
within the cells it invades without killing the cells themselves and
destroying the already threatened immune system. Also, cell-free
viruses must be eliminated, and the spread of the virus to uninfected
cells prevented. Furthermore, recent studies indicate that there may
be several important reservoirs for HIV in the body that will be
difficult to eliminate without causing fundamental damage to the host
cells involved. For example, cells of the monocyte-macrophage line,
important components of the immune system, can not only be
infected but can also support HIV replication while harboring the
virus from the body's immune surveillance. Circulating monocytes
and macrophages appear to play an important role in the dissemina-
tion of HIV throughout the body, including the brain. 31 Recent
studies suggest that bone-marrow precursor cells of monocyte lineage
may be an additional reservoir of HIV. 32 In the search for effective
therapy, due consideration must be given to ensuring that the agent(s)
can penetrate into the involved sites. For example, as the brain is an
important target for HIV infection, any effective anti-HIV agent.
AIDS: The Challenge to Biomedical Research
29
should be able to cross the blood-brain barrier. Other practical
considerations in AIDS drug development must include cost, dosing
schedule, and the route of administration.
Preclinical Drug Development-Researchers attempting to dis-
cover and develop anti-HIV. drugs are pursuing two approaches:
screening large numbers of existing compounds for activity against
HIV and targeting drug development with information gained about
unique properties and critical functions of the virus to design agents
that interfere with structural components or the life cycle of the virus.
To date, literally thousands of compounds have been studied in the
test tube for activity against HIV. Of these, several have been
identified to show significant anti-HIV activity and have advanced to
clinical trials in humans. 33 Nonetheless, there is fairly broad scientific
consensus that definitive therapies for HIV infection will derive from
precise, targeted drug development based on intimate knowledge of
the virus, its life cycle, and the delineation of specific sites and
mechanisms for disrupting viral replication or viability. This may be
a painstaking and difficult process, requiring the talents of virologists,
molecular biologists, pharmacologists, physical chemists, and crys-
tallographers, among others, and may take years to show results.
Clinical Trials of Experimental Drugs-Clinical trials are designed
to investigate the beneficial and adverse effects of drugs that show
promise in the laboratory or in preliminary clinical studies. Because
of the experimental nature of such potential therapies, it is essential
that they be carefully and scientifically studied for safety and efficacy
before being widely distributed. Many clinical research efforts are
under way, including a major, nationwide clinical trials network
established by the National Institutes of Health (NIH) to study
potential antiretroviral and immunomodulatory treatment ap-
proaches in persons infected with HIV, as well as specific therapies
(including prophylaxis) for the opportunistic infections and malig-
nancies associated with HIV infection.
At the present time, AZT, a compound that interferes with virus
replication, is the only drug licensed by the Food and Drug Admin-
istration (FDA) for the treatment of HIV infection. Its potential use as
a therapeutic agent against HIV was originally demonstrated in the
test tube by the screening procedure mentioned above. Carefully
conducted clinical trials subsequently demonstrated that AZT admin-
30
Margaret A. Hamburg, M.D., and Anthony S. Fauci. M.D.
istration could significantly prolong life for certain individuals with
AIDS, although its use can be associated with considerable toxic side
effects, including bone-marrow suppression. 34 A number of related
antiviral compounds are being investigated now to see if they might
be equally effective with fewer side effects. Other drugs, both alone
and in combination with lower doses of AZT, are also being tried in
the hope of achieving greater benefit with reduced toxicities.
In many ways, combination therapy represents the most promising
new approach to the treatment of HIV infection. For example, the
agent 3'-dideoxycytidine (ddC) has good antiviral activity without
AZT's marrow-suppressive effects, but it has the dose-limiting tox-
icity of producing what is called a peripheral neuropathy with severe.
damaging pain in the feet. By alternating AZT-treatment with ddC.
patients may be able to receive therapy for longer periods of time, at
higher doses, and with fewer side effects. Similarly, bone-marrow
suppression might be lessened through the combination of drugs like
AZT with compounds that can boost blood-cell counts, such as
erythropoeitin or granulocyte-macrophage-colony-stimulating, factor
(GM-CSF). Another intriguing approach involves combining antivi-
ral therapy with immunologic reconstitution, either with biological
response modifiers that can boost immune response such as alpha-
interferon and interleukin-2 or through bone-marrow transplanta-
tion techniques. 35 This approach provides a potential two-pronged
attack aimed at suppressing viral replication at the same time that the
damaged immune system is restored.
Several drugs have shown evidence of therapeutic value against the
major opportunistic illnesses seen in AIDS. Important examples
include the use of aerosolized pentamidine to prevent Pneumocystis
carinii pneumonia (the leading cause of death among AIDS patients),
as well as the use of the antiviral drugs foscarnet and ganciclovir
(DHPG) in controlling the progression of cytomegalovirus retinitis.
Studies of these and other potential therapies are currently under way
to evaluate definitively their safety and efficacy. Altogether, dozens of
agents for use in HIVinfection and AIDS are currently being tested in
clinical trials in this country and around the world.
There is a growing emphasis on exploring means for early thera-
peutic intervention in HIV infection in order to limit or prevent
progression to full-blown AIDS. A number of important studies are
near implementation or are already under way to examine the
AIDS: The Challenge to Biomedical Research
31
influence of experimental therapies in early stages of the disease, in
infected but asymptomatic individuals, and even in pregnant women
who are HIV-infected (so as to prevent infection in the fetus).
Considerable attention is also being directed at finding treatments
that will prevent the onset of certain opportunistic complications of
HIV disease.
The advances currently being made in drug discovery, develop-
ment, and therapeutic intervention provide a basis for cautious
optimism that a number of useful agents may be available relatively
soon. Realistically, there may never be an absolute cure for AIDS. At
least for the next few years, it is likely that the best hopes for
treatment will come from drugs or combinations of drugs that will
permit sufficient control of the infection so that HIV-infected indi-
viduals can live healthier lives with a reasonable life span and no
longer infect others.
Need for Continued Commitment to Scientific Basis for Clinical
Trials-Given the life-threatening nature of HIV infection and AIDS,
there is a growing tension between the understandable desire to make
potential therapies available as quickly and as widely as possible, and
the need to obtain correct and enduring answers through carefully
designed scientific research.
Concern has been expressed that scientists are rigidly adhering to
experimental traditions that are not relevant to the AIDS crisis and
that impede progress to solutions. In view of the lethal threat posed
by the underlying disease, the very rationale for conducting method-
ical, controlled clinical trials of experimental AIDS therapies has been
called into question; many believe that experimental clinical drug
protocols are too complex, take too long to develop, and once
developed are too restrictive in their criteria for admission and
execution. Correspondingly, there is strong pressure on the scientific
community to loosen the standard practices used for evaluating drugs
and to abandon the need to scientifically prove both safety and
efficacy. Yet, for reasons of both safety and science, carefully con-
trolled clinical trials are necessary.
Clinical trials may put conditions or restrictions on participation
that may be perceived as unnecessary but that are critical to obtaining
clear, unambiguous results. For example, it is essential that the
population participating in the clinical trial be carefully defined and
32
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
relatively homogeneous in certain manifestations and stages of the
disease because a given drug may be effective only at a certain stage
in the disease process or for a particular subpopulation of patients.
Furthermore, there may be circumstances in which the endpoints of
drug efficacy are not as dramatic as life and death but may, rather,
involve subtle changes in parameters that require careful monitoring.
Potentially important results may not be recognized without careful
attention to study design and conduct.
Because of the risks inherent in any experiment involving human
subjects-and a clinical trial is indeed an experiment-there is a valid
and generally agreed-on principle to expose the minimal number of
individuals to the risks of the experiment. Nonetheless, many persons
with AIDS, desperate for access to any potentially useful drug, argue
that they are more than willing to assume such risks.
While greater availability of experimental drugs does offer some
initial hope and the immediate gratification of taking some action
against this relentless disease, it would be incorrect to equate the
showing of compassion with the widespread distribution of untested
agents to HIV-infected individuals. Open distribution of unproven
therapies is unlikely to help their recipients in the short term and will
certainly undermine long-term prospects to conclusively determine
effective therapies.
From a purely analytic perspective, there is little disagreement that
well-designed clinical trials provide the most efficient mechanism to
determine definitively what treatments work. Such clinical trials will
ultimately benefit more patients, and sooner, than any other ap-
proach. Past experience warns that compromising the precepts of
scientific evaluation may lead to deleterious results. Truly effective
drugs may be overlooked or discarded, either because of failure to
appreciate subtle beneficial effects that might be missed in a poorly
designed and implemented trial or because of exaggerated concern
about the relative risks of side effects. Conversely, harmful or useless
drugs may be accepted for use; such drugs may even be prescribed in
lieu of other treatments of more proven benefit. It is only through
carefully designed clinical research efforts that definitive answers will
be found for this devastating disease-both for those presently
suffering from AIDS as well as for the hundreds of thousands of
persons who are infected with HIV but not yet sick.
AIDS: The Challenge to Biomedical Research
33
Without compromising sound scientific principles, there is an
ongoing effort to expedite clinical trials. For example, the possibility
of shortening the trial process and providing earlier access to exper-
imental drugs that have shown promise of efficacy without serious
toxic side effects is under consideration by the FDA. The challenge for
policymakers will be to achieve the difficult balance between the
rigorous demands of the scientific method necessary to improve
therapy and the rights of patients suffering from life-threatening
diseases to gain access to new therapies at the earliest possible time.
Improved Access to Clinical Trials-In a distinct but related
matter, there is a pressing need to provide a broader spectrum of the
infected population with greater access to clinical trials of investiga-
tional drugs. Clinical research activities are usually conducted at
academic medical centers, whereas most patients with HIV infection
are cared for in a community setting by nonacademically affiliated
providers. Not surprisingly, this situation has been reflected in an
underrepresentation of minorities, women, children, hemophiliacs,
and those with problems of IV drug use in clinical trials. Future AIDS
clinical research efforts must expand the population profile enrolled
in clinical trials and foster a greater involvement on the part of
community-based primary health-care providers.
Worthwhile opportunities exist to broaden the base of clinical
research efforts by increasing the participation of community physi-
cians and patients in both the design and the implementation of
AIDS-related research projects. At this time, concerted efforts are
being directed toward developing research activities that are innova-
tive and responsive to community needs as well as consistent with
sound criteria for scientific research.
Valuable treatment research could be conducted at the community
level, including clinical trials of new therapies, but might also involve
surveillance of ongoing clinical experience with some of the many
therapies being used on an ad hoc, "on the streets" basis. In addition,
systematic collection of data from actual practice settings-if done
prospectively and in a careful, rigorous fashion-could provide very
34
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
useful, albeit exploratory, information about the value of popular but
unstudied treatments.
The Search for a Vaccine
The development of a vaccine against HIV infection has assumed a
prominent position in the strategies for prevention and control of
AIDS. However, despite intensive research in this area and consider-
able scientific advance, there is little hope of having a safe and
effective vaccine available in the near future.
Developing a successful vaccine against HIV infection will be
difficult for several reasons. The first is due to properties of the virus
itself. Many different strains of HIV exist, and even within one
person's body the virus can undergo mutations rapidly and easily. 36
In addition, scientists still do not fully understand the nature of an
effective immune response that can protect against initial infection or
disease progression following infection. The process of vaccine
development for other diseases, such as polio and influenza, has been
facilitated by the ability to study the nature of the immune response
in individuals who have recovered without treatment and then to use
their natural immune response as a model for vaccines. AIDS
researchers have had no such opportunity, since no one has yet
recovered from the disease. The task of researchers in this area is
further complicated by the lack of adequate animal models for AIDS.
Despite these handicaps, scientists using knowledge about the
structure of the HIV and sound immunologic principles have been
attempting to develop a vaccine. The aim is to induce neutralizing
antibodies as well as cell-mediated responses against HIV and
thereby to protect uninfected individuals against subsequent infection
if they are exposed to the virus.
Vaccine development and testing must be carefully designed to
ensure that the vaccines will be safe and will elicit an immune
response. The approaches to vaccine development that are being
explored include the use of whole killed virus, purified natural
products of the virus, synthetic preparations of virus components,
recombinant DNA products, recombinant vaccinia virus containing
parts of the HIV genome, and what is termed anti-idiotype, meaning
antibodies generated against antibodies to the virus. 37 To eliminate
the possibility that the vaccine itself might be infectious, most AIDS
vaccine researchers are using some form of subunit vaccine product
AIDS: The Challenge to Biomedical Research
35
(consisting of protein components of the virus rather than the whole
virus) in their attempts to stimulate immune responses.
The whole killed virus approach raises some concern because of
the ability of HIV to integrate into the cell's genetic machinery.
Theoretically, a whole killed virus vaccine could introduce viral
genetic material into host cells and trigger tumor development or
other undesirable side effects. However, given the multiple and
variable strains of HIV found, the whole killed virus approach may
prove preferable because of its ability to elicit a protective immune
response that is effective against many strains of HIV. This hypothesis
is based on the observation that the individuals naturally infected
with live HIV develop antibodies that are broadly reactive with a
range of HIV isolates or strains. In contrast, the immune response to
the subunit vaccine appears at this point to be limited to the original
strain of virus used to make the vaccine.³⁸
To date, some studies using subunit vaccines-in particular those
based on segments of the viral envelope-have been shown to
stimulate antibody synthesis in rodent and primate models. Certain
of the antibodies produced have been shown to be so-called neutral-
izing antibodies, capable of blocking HIV infection in tissue culture
systems. However, the neutralizing antibody responses were unable
to protect against subsequent HIV infection in the animals. 39 These
findings are in keeping with clinical observations in which no
correlation is found between levels of neutralizing antibody and the
progression of infection in patients. 40
In general, candidate vaccines are clinically evaluated in humans
only after safety and immunogenicity are demonstrated in laboratory
and animal studies. However, given the urgency of the AIDS epi-
demic, the FDA has approved human trials of a limited number of
potential AIDS vaccines, despite the lack of animal data or a clear
delineation of the requirements for a protective immune response in
humans. Several candidate vaccines are now in the early phases of
testing in human volunteers, in both the United States and
elsewhere.
41
A significant dilemma in the evaluation of an AIDS vaccine is how
to test candidate vaccines for efficacy. Because AIDS is a fatal disease,
it would be ethically unthinkable to deliberately expose a study
volunteer to HIV. Therefore, the only available way to show efficacy
is to administer the vaccine to a large number of individuals identified
36
Margaret A. Hamburg, M.D., and Anthony S. Fauci. M.D.
as being at risk for developing HIV infection and then follow them
over a long period of time. If the incidence of new infection in a
population at risk is low-as is currently the case for male homosex-
uals in the United States-literally thousands of people would have to
be enrolled in a vaccine trial to achieve meaningful results. Further-
more, ethical considerations would dictate that participants in the
vaccine trial receive appropriate instruction about how to avoid HIV
infection, making the demonstration of the efficacy of a vaccine still
more difficult.
It has been suggested that a candidate vaccine would be most
effectively evaluated for efficacy if tested in areas of the world where
incidence and prevalence rates for HIV infection are highest. Studies
conducted in such localés-including certain developing nations
particularly hard hit by the HIV epidemic, such as those of central
Africa-would yield more rapid and discernable results, and the
potential benefits would be considerable.⁴ Nonetheless, vaccine
testing in such settings has numerous complications. These include
problems of different strains of the virus, difficulties in long-term
followup, lack of infrastructure for appropriate clinical evaluation,
and multiple social, cultural, and political considerations.
*
*
*-
The magnitude of the AIDS epidemic and the urgency of develop-
ing treatments or a cure represent an enormous challenge for
biomedical research. Building upon a strong foundation of knowl-
edge accumulated over several decades of research in such fields as
immunology, microbiology, infectious diseases, molecular biology,
and epidemiology, AIDS research efforts have moved forward swiftly
and productively since this new disease was first recognized. Seldom
has biomedical science progressed so rapidly, yet real solutions to the
control and prevention of HIV infection remain elusive. Perhaps
more than any other disease, AIDS has raised a host of complex
questions, from the most fundamental nature of biological systems to
the role of scientific research in society at large. And beyond the
challenge to biomedical research, there are profound and broader
implications of the AIDS crisis for many aspects of health care, law,
ethics, and society. The needs are tremendous and the answers
difficult, but we are moving forward and new solutions are within
AIDS: The Challenge to Biomedical Research
37
our grasp. The benefits will be far-reaching-not just for AIDS, but
for many other areas of health and disease as well.
ENDNOTES
'Centers for Disease Control, Acquired Immunodeficiency Syndrome Weekly
Surveillance Report, (Atlanta, Ga.: Centers for Disease Control, 26 December
1988).
²Public Health Service, Department of Health and Human Services, Quarterly
Report to the Domestic Policy Council on the Prevalence and Rate of Spread of
HIV in the United States (Atlanta, Ga.: Centers for Disease Control, July 1988).
³P. Piot, F. A. Plummer, F.S. Mhalu, et al., "AIDS: An International Perspective,"
Science 239 (4840) (1988):573-79.
⁴Public Health Service.
⁵M. S. Gottlieb, R. Schroff, H. M. Schanker, et al., "Pneumocystis Carinii
Pneumonia and Mucosal Candidiasis in Previously Healthy Homosexual Men:
Evidence of a New Acquired Cellular Immunodeficiency," New England Journal
of Medicine 305 (1981): 1425-31; and H. Masur, M. A. Michelis. J. B. Greene,
et al., "An Outbreak of Community-Acquired Pneumocystis Carinii Pneumonia:
Initial Manifestation of Cellular Immune Dysfunction," New England Journal of
Medicine 305 (1981): 1431-38.
"Masur et al.; and Centers for Disease Control, "Kaposi's Sarcoma and Pneumo-
cvstis Pneumonia among Homosexual Men-New York City and California."
Morbidity and Mortality Weekly Report 30 (3 July 1981):305-8.
Public Health Service: and Centers for Disease Control, "Update on Acquired
Immune Deficiency Syndrome (AIDS) United States," Morbidity and Mortality
Weekly Report 31 (24 September 1982):507-14.
R. C. Gallo, S.Z. Salahuddin, M. Popovic, et al., "Frequent Detection and Isolation
of Cytopathic Retroviruses (HTLV-III) from Patients with AIDS and at Risk tor
AIDS," Science 224 (1984):500-502; F. Barre-Sinoussi, J. C. Chermann, F. Rev,
et al., "Isolation of a T-Lymphotropic Retrovirus from a Patient at Risk for
Acquired Immune Deficiency Syndrome (AIDS)," Science 220 (1984):868-71:
and J. A. Levy, A. D. Hoffman, S. M. Kramer. et al., "Isolation of Lymphocyto-
pathic Retroviruses from San Francisco Patients with AIDS," Science 225 (1984):
840-42.
R. C. Gallo and L. Montagnier, "AIDS in 1988," Scientific American 259 (1988):
40-48.
¹⁰J. W. Curran, H. W. Jaffe. A. M. Hardy, et al., "Epidemiology of HIV Infection
and AIDS in the United States," Science 239 (4840) (1988):610-16.
11 Centers for Disease Control, Acquired Immunodeficiency Syndrome.
¹²S. Logan, M. Newell. T. Ades, et al., "Breast Feeding and HIV Infection," Lancet
(11 June 1988):1346.
38
Margaret A. Hamburg, M.D., and Anthony S. Fauci, M.D.
¹³M. A. Sande, "Transmission of AIDS: The Case against Casual Contagion," New
England Journal of Medicine 314 (6) (1986):380-82.
14U. S. Congress, Office of Technology Assessment, "Do Insects Transmit AIDS?" a
staff paper in OTA's series on AIDS-related issues (Washington, D.C.: Govern-
ment Printing Office, 1987).
¹⁵R. R. Redfield and D. S. Burke, "HIV Infection:- The Clinical Picture," Scientific
American 259 (October 1988):90-98.
¹⁶Curran et al.
¹⁷Redfield and Burke.
¹⁸A. B. Rabson and M. A. Martin, "Molecular Organization of the AIDS Retrovi-
rus," Cell 40 (1985):477-80.
19W. A. Haseltine and F. Wong-Staal, "The Molecular Biology of the AIDS Virus,"
Scientific American 259 (October 1988):52-62.
20Ibid.
²¹S. Koenig and A.S. Fauci, "AIDS: Immunopathogenesis and Immune Response to
Human Immunodeficiency Virus," in V. T. DeVita, Jr., S. Hellman and S. A.
Rosenberg, eds., AIDS: Etiology. Diagnosis, Treatment, and Prevention, 2nd ed.
(Philadelphia, J. B. Lippincort Company, 1988). 61-77.
22S. Broder and A. S. Fauci, "Progress in Drug Therapies for HIV Infection," Public
Health Reports 103 (May-June 1988):224-28.
231bid.
²⁴Koenig and Fauci.
²⁵Ibid.; and T. M. Folks, S. W. Kessler, J. M. Orenstein, et al.. "Infection and
Replication of Human Immunodeficiency Virus-1 (HIV-1) in Highly Purified
Progenitor Cells from Normal Human Bone Marrow," Science 242 (1988):
919-22.
26R. W. Price, B. Brew, J. Sidtis, et al., "The Brain in AIDS: Central Nervous System
HIV-1 Infection and AIDS Dementia Complex," Science 239 (4840) (1988):586-
92.
27S. Kwok, D. H. Mack, K. B. Mullis, et al., "Identification of Human Immunode-
ficiency Virus Sequences by Using in Vitro Enzymatic Amplification and Oligo-
mer Cleavage Detection," Journal of Virology 61 (1987): 1690-94.
2⁸A. S. Fauci, "The Human Immunodeficiency Virus: Infectivity and Mechanisms of
Pathogenesis," Science 239 (4840) (1988):617-22.
29Gallo and Montagnier.
³⁰Kwok, Mack, Mullis, et al.
31 Fauci.
³²Price, Brew, Sidtis, et al.
³³Folks, Kessler, Orenstein, et al.
AIDS: The Challenge to Biomedical Research
39
34 Broder and Fauci.
35 Ibid.
³⁶A. G. Fisher, B. Ensoli, D. Looney, et al., "Biologically Diverse Molecular Variants
within a Single HIV-1 Isolate," Nature 334 (1988):444-47.
³⁷W. C. Koff and D. F. Hoth, "Development and Testing of AIDS Vaccines," Science
241 (1988):426-32.
³⁸lbid.
39 A. M. Prince, B. Horowitz, B. L. Baker, et al., "Failure of an HIV Immune
Globulin to Protect Chimpanzees Against Experimental Challenge with HIV,"
Proceedings of the National Academy of Sciences (forthcoming).
⁴Broder and Fauci; and M. Robert-Guroff, M. Brown, and R. C. Gallo, "HTLV-
III-neutralizing Antibodies in Patients with AIDS and AIDS-related Complex,"
Nature 316 (1985):72-74.
41 Koff and Hoth.
⁴²Institute of Medicine, Prospects for Vaccines against HIV Infection, report of the
Conference on Promoting Development of Vaccines Against Human Immunode-
ficiency Virus Infection and Acquired Immune Deficiency Syndrome (Wash-
ington, D.C.: National Academy Press, 14-15 December 1987).
Justice/State
waiver of AIDS
S.F. (June30th) couf.
amotisabilities Oct.
jo along w/ W.H.O.
Document Originally
Attached to
Previous Page
STEVE
CA PRESS GUIDANCE
Wednesday, January 17, 1990
VISAS: POLICY RE AIDS VICTIMS
Q: Is it true that the U.S. Government is easing, but not
eliminating, restrictions on the freedom of people infected
with AIDS to enter the U.S.?
A :
-- UNDER THE IMMIGRATION & NATIONALITY ACT, VISA APPLICANTS
WHO ARE HIV-POSITIVE ARE INELIGIBLE FOR VISAS BECAUSE THEY
ARE AFFLICTED BY A "DANGEROUS CONTAGIOUS DISEASE." AS IN
ALL SUCH CASES, WAIVERS MAY BE OBTAINED FROM THE
IMMIGRATION & NATURALIZATION SERVICE.
-- A SIXTH INTERNATIONAL CONFERENCE ON AIDS IS BEING
PLANNED FOR JUNE 1990 IN SAN FRANCISCO. THE WORLD
HEMOPHILIA CONFERENCE IS SCHEDULED FOR AUGUST 1990 IN
WASHINGTON, D.C.
-- THE STATE DEPARTMENT, THE IMMIGRATION & NATURALIZATION
SERVICE, AND THE U.S. PUBLIC HEALTH SERVICE HAVE AGREED ON
CERTAIN SPECIAL PROCEDURES SO AS TO FACILITATE TRAVEL TO
THE U.S. BY HIV-POSITIVE PERSONS WISHING TO ATTEND EITHER
OF THESE CONFERENCES.
-2-
-- THE PROCEDURES ARE AS FOLLOWS:
(1) IN THOSE CASES WHERE AN HIV-INELIGIBLE APPLICANT
INDICATES AN INTENTION TO REMAIN IN THE U.S. FOR THIRTY
DAYS OR LESS TO PARTICIPATE IN THE SIXTH INTERNATIONAL
CONFERENCE ON AIDS OR THE WORLD HEMOPHILIA CONGRESS, AND
REQUESTS A WAIVER OF INELIGIBILITY, THE CONSULAR OFFICER
SHALL ASSUME IMMIGRATION & NATURALIZATION SERVICE APPROVAL
OF A WAIVER REQUEST AND ISSUE THE VISA.
(2) IF THE HIV-POSITIVE APPLICANT OBJECTS TO HAVING THE
WAIVER ANNOTATION PLACED IN HIS OR HER PASSPORT, THE
CONSULAR OFFICER SHALL STAMP THE VISA AND PLACE THE
NOTATION ON A SPECIAL FORM.
(3) ALL APPLICATIONS, WAIVER REQUESTS, OR OTHER RECORDS OR
COMMUNICATIONS ON HIV-POSITIVE PERSONS TRAVELING TO THE
U.S. TO ATTEND THESE TWO CONFERENCES WILL BE TREATED AS
CONFIDENTIAL (LIMITED OFFICIAL USE) ONLY AMERICANS AND
FOREIGN SERVICE NATIONAL EMPLOYEES WITH APPROPRIATE
CLEARANCES WILL BE ALLOWED ACCESS TO SUCH INFORMATION.
-3- -
Q: Do you expect these procedures to satisfy those groups now
threatening to boycott the conferences because of U.S. policy?
A:
WE DO NOT EXPECT THESE CHANGES TO SATISFY EVERYONE WHO
OBJECTS TO U.S. LAW ON THE ADMISSION OF HIV-POSITIVE
APPLICANTS. HOWEVER, WE BELIEVE THAT THIS IS AS MUCH AS WE
CAN DO WITHIN THE LIMITS OF THE LAW AS IT NOW STANDS.
Q: Will this apply to future AIDS conferences?
A:
WE WILL CONSIDER FUTURE CONTINGENCIES AS THEY ARISE.
Drafted: CA/PA:FTJones
01/17/89 ext. 71488 Doc#:0103y
Clearance:
Info:
CA/PA:PCovington
H:PDoherty
CA/VO/F/P:CHoward
ARA/P:ASigmund
EUR/P: NWhite
AF/P:GMorris
EAP/P:MCYates
NEA/P:DGoode
ROUTINE
RUSH
MESSAGE NO
Peggy Polk
TO
DATE
3/7/90
Lee C. Smith, Levi Strauss International
FROM
2
NUMBER OF PAGES
SUBJECT
ADDITIONAL DOCUMENTS ATTACHED
IF THERE IS A TRANSMISSION PROBLEM, CALL 415/544-6091
TEXT:
LEVI STRAUSS & CO. P.O. Box 7215, San Francisco, CA 94120 Phone: 415/544-6000
FAX: 415/544-3939
Following are the suggested themes for the March 29th "Presidential
Address".
OBJECTIVE
To provide national leadership and legitimize the HIV disease
thereby providing hope to those directly and indirectly affected by
AIDS. Setting the fiscal pressures aside, there is a vital need
for leadership, vision, education and collaboration from the
executive branch.
TONE
Positive, direct, encouraging and supportive.
ISSUES
1. The AIDS epidemic is NOT over. We have made huge gains and
enormous advances. But hundreds of thousands of Americans are
infected and will become ill, and thousands are at risk for
new infection. We must be vigilant in our commitment to AIDS
prevention as we move forward to address the ever changing
health care needs of those with HIV disease. We must support
the healthy, positive behavior change that has occurred in
communities at great risk for HIV disease.
2. The federal government intends to take a leadership role in
wiping out discrimination against people who are HIV positive
- including immigration restrictions. Those with the disease
must not be abandoned, must not be written off. They are part
of the American fabric and are deserving of our support, our
compassion and our respect.
3.
At a time when federal budget resources are tight, I want to
work cooperatively with Congress to ensure that the 1991
budget includes adequate funds for research, prevention,
public eduation and patient care.
POI 3363 111 SIS IS IA37* WV 11:39 06 '20 '80
4.
AIDS is everyone's responsibility. Every American, every
public official and every business organization needs to
enlist in the fight against the HIV virus.
Business leadership is vital at the local level. We need our
business leaders to lend their expertise, volunteers and
resources to our local community-based AIDS service
organizations that have shouldered the burden in the struggle
to date.
5. The business community can improve health benefits and access
to decent, affordable health care for its employees.
AIDS is exacerbating an already over burdened and costly
health care system. The business community should lead the
way in addressing systematic changes necessary to lower health
care costs, provide access to treatment for those in need and
prevent or delay disease progression.
The private sector must carry its fair share of the health
care burden without instituting or condoning unfair
discriminatory practices in private insurance coverage.
This is critical to implementing sane early intervention
programs making life extending drugs available, through
insurance coverage, to all who require them.
SUMMARY
My goal is to eliminate further HIV infection and I want to be sure
that those already infected receive appropriate care and
compassion. The only way to accomplish this is through an
effective, efficient public/private partnership where we can step
up public education programs, support early intervention and
provide a continuum of care for our fellow citizens that have the
HIV disease.
PO2 3353 111 115 IS IA37* WA 11139 06 .20 OF
Nov. 30 / Administration of George Bush, 1989
of millions of dollars of illegal income in the
at present, we will continue the most vigor-
Statement by Press
form of bribes and kickbacks.
ous research efforts. At the same time, we
on the 1990 Houst
This ban is consistent with international
must also educate and prevent. The disease
Summit
efforts to further isolate the Noriega
is spread through known ways, and it is
December 1, 1989
regime, which is currently shunned by the
clear that education on the facts is our best
democratic nations of Latin America and
means of combating AIDS at this time.
President Bush will
around the world. The resolution of the re-
Finally, we must remember those Ameri-
of the seven major
cently concluded General Assembly of the
cans who have become infected with the
July 9-11, 1990, in ]
Organization of American States was sharp-
nomic summit is th
virus, including some who may be unaware
ly critical of the Noriega regime and is only
leaders of the world
one example of the international condem-
of their infection. These people need our
mocracies to discuss
nation of Noriega. The President has made
help and our compassion. Our hearts go out
review other key in
it very clear that there will be no accommo-
to those afflicted, as our heads work to-
ticipating in the Hot
dation with the illegal Panamanian regime.
wards finding solutions. In the meantime,
will be Canada, the
The United States will continue various
we must continue to educate those around
Germany, France, I
efforts designed to assist the Panamanian
us regarding the prevention of this terrible
Kingdom, the Unite
people in their endeavor to bring about
disease.
mission of the Europ
Noriega's departure and the establishment
The President has
of democratic institutions responsive to the
Malek to serve as I
will of the people.
with the personal r
The United States regrets the hardships
that capacity he wi
which Noriega has brought to the people of
Statement by Press Secretary Fitzwater
for and staging of th
Panama, who deserve to be led by a gov-
on the Attempted Overthrow of the
currently president
ernment of their choice. The United States
Philippine Government
and cochairman of
will continue to exercise its rights and
November 30, 1989
mercial Group.
comply with its obligations under the
The President ha
Panama Canal Treaties and looks forward to
We reiterate the unequivocal support of
ard T. McCormacl
a time when it can work closely with a
the U.S. Government for Philippine democ-
State for Economic
democratically elected, constitutional gov-
racy and the government of President Cor-
as his Personal Re
ernment in Panama, dedicated to serving
azon Aquino. We strongly condemn the
for preparation of p
the interests and welfare of the Panamanian
effort to destabilize the elected Philippine
nomic summit. Mr.
people.
Government. According to U.S. law, all U.S.
similar capacity dur:
foreign assistance to the Philippines would
Paris.
be suspended if the elected Government of
the Philippines were removed by a military
Statement on the Observance of World
coup.
Points of Light Re
AIDS Day
November 30, 1989
The President name
uals and institutio
On December 1, World AIDS Day, there
commitment to ma
will be a commemoration in Washington to
Statement by Press Secretary Fitzwater
central to the life a
remember all those with HIV infection and
on United States Military Assistance for
can. The daily rec
all who have died from it. The end result of
the Government of the Philippines
tended as a nation
this infection, AIDS, has been diagnosed in
December 1, 1989
order to every singl
over 112,000 people in this country as of
difference in the 1
October 1989, and 65,000 people have died
At the request of President Aquino, the
since the beginning of the epidemic.
President has authorized U.S. military assist-
The President ex
Though the problem is great and taxing our
ance to the Government of the Philippines
the following:
health care system now, far greater difficul-
in defending itself against a coup attempt.
November 27
ties await us in terms of human suffering
This assistance is intended to allow the
Dr. William and Mr
and provision of health care.
democratically elected government of the
City, OK. The rec
We have committed resources at an un-
Philippines to restore order. The President
operate a free med
precedented rate to HIV-related research of
also is determined to protect the lives of
serious medical pr
all kinds. Though there is no cure for AIDS
Americans in the Philippines.
sclerosis. The clini
1856
Feb. 9 / Administration of George Bush, 1989
Speech Coness
Administration of George Bush, 1989 / Feb. 9
will back up those who put their lives on
oil. And when those with the most promise
We have a moral contract with our senior
We face a massive task in cleaning up the
the line every single day-our local police
can be tapped safely, as with much of the
citizens. And in this budget, Social Security
waste left from decades of environmental
officers.
Alaska National Wildlife Refuge, we should
is fully funded, including a full cost-of-living
neglect at America's nuclear weapons
My budget asks for beefed-up prosecu-
proceed. But we must use caution. We must
adjustment. We must honor our contract.
plants. Clearly, we must modernize these
tion, for a new attack on organized crime,
respect the environment. And so, tonight
We must care about those in the shadow
plants and operate them safely. That's not
and for enforcement of tough sentences—
I'm calling for the indefinite postponement
of life, and I, like many Americans, am
at issue; our national security depends on it.
and for the worst kingpins, that means the
of three lease sales which have raised trou-
deeply troubled by the plight of the home-
But beyond that, we must clean up the old
death penalty. I also want to make sure that
bling questions, two off the coast of Califor-
less. The causes of homelessness are many;
when a drug dealer is convicted there's a
mess that's been left behind. And I propose
nia and one which could threaten the Ever-
the history is long. But the moral impera-
cell waiting for him. And he should not go
in this budget to more than double our cur-
glades in Florida. Action on these three
tive to act is clear. Thanks to the deep well
rent effort to do so. This will allow us to
free because prisons are too full. And so, let
lease sales will await the conclusion of a
of generosity in this great land, many orga-
the word go out: If you're caught and con-
identify the exact nature of the various
victed, you will do time.
special task force set up to measure the
nizations already contribute. But we in gov-
problems so we can clean them up, and
But for all we do in law enforcement, in
potential for environmental damage.
ernment cannot stand on the sidelines. In
clean them up we will.
I'm directing the Attorney General and
my budget, I ask for greater support for
interdiction and treatment, we will never
We've been fortunate during these past 8
the Administrator of the Environmental
emergency food and shelter, for health
win this war on drugs unless we stop the
years. America is a stronger nation than it
demand for drugs. So, some of this increase
Protection Agency to use every tool at their
services and measures to prevent substance
was in 1980. Morale in our Armed Forces
disposal to speed and toughen the enforce-
abuse, and for clinics for the mentally ill.
will be used to educate the young about the
has been restored. Our resolve has been
ment of our laws against toxic waste dump-
And I propose a new initiative involving
dangers of drugs. We must involve the par-
the full range of government agencies. We
shown. Our readiness has been improved.
ents. We must involve the teachers. We
ers. I want faster cleanups and tougher en-
must confront this national shame.
And we are at peace. There can no longer
must involve the communities. And, my
forcement of penalties against polluters.
There's another issue that I've decided to
be any doubt that peace has been made
friends, we must involve ourselves, each
In addition to caring for our future, we
mention here tonight. I've long believed
more secure through strength. And when
and every one of us in this concern.
must care for those around us. A decent
that the people of Puerto Rico should have
America is stronger, the world is safer.
One problem related to drug use de-
society shows compassion for the young, the
the right to determine their own political
Most people don't realize that after the
mands our urgent attention and our con-
elderly, the vulnerable, and the poor. Our
future. Personally, I strongly favor state-
successful restoration of our strength, the
tinuing compassion, and that is the terrible
first obligation is to the most vulnerable-
hood. But I urge the Congress to take the
Pentagon budget has actually been reduced
tragedy of AIDS. I'm asking for $1.6 billion
infants, poor mothers, children living in
necessary steps to allow the people to
in real terms for each of the last 4 years.
for education to prevent the disease and for
poverty-and my proposed budget recog-
decide in a referendum.
We cannot tolerate continued real reduc-
research to find a cure.
nizes this. I ask for full funding of Medicaid,
Certain problems, the result of decades of
tion in defense. In light of the compelling
If we're to protect our future, we need a
an increase of over $3 billion, and an expan-
unwise practices, threaten the health and
need to reduce the deficit, however, I sup-
new attitude about the environment. We
sion of the program to include coverage of
security of our people. Left unattended,
port a 1-year freeze in the military budget,
must protect the air we breathe. I will send
pregnant women who are near the poverty
they will only get worse. But we can act
something I proposed last fall in my flexible
to you shortly legislation for a new, more
line. I believe we should help working fami-
now to put them behind us.
freeze plan. And this freeze will apply for
effective Clean Air Act. It will include a
lies cope with the burden of child care. Our
Earlier this week, I announced my sup-
only 1 year, and after that, increases above
plan to reduce by date certain the emissions
help should be aimed at those who need it
port for a plan to restore the financial and
inflation will be required. I will not sacrifice
which cause acid rain, because the time for
most: low-income families with young chil-
moral integrity of our savings system. I ask
American preparedness, and I will not com-
study alone has passed, and the time for
dren. I support a new child care tax credit
Congress to enact our reform proposals
promise American strength.
action is now. We must make use of clean
that will aim our efforts at exactly those
within 45 days. We must not let this situa-
I should be clear on the conditions at-
coal. My budget contains full funding, on
families, without discriminating against
tion fester. We owe it to the savers in this
tached to my recommendation for the
schedule, for the clean coal technology
agreement that we've made with Canada.
mothers who choose to stay at home.
country to solve this problem. Certainly,
coming year: The savings must be allocated
We've made that agreement with Canada,
Now, I know there are competing propos-
the savings of Americans must remain
to those priorities for investing in our future
secure. Let me be clear. Insured depositors
that I've spoken about tonight. This defense
and we intend to honor that agreement.
als. But remember this: The overwhelming
We must not neglect our parks. So, I'm
majority of all preschool child care is now
will continue to be fully protected. But any
freeze must be a part of a comprehensive
provided by relatives and neighbors and
plan to refinance the system must be ac-
budget agreement which meets the targets
asking to fund new acquisitions under the
Land and Water Conservation Fund. We
churches and community groups. Families
companied by major reform. Our proposals
spelled out in Gramm-Rudman-Hollings law
who choose these options should remain eli-
will prevent such a crisis from recurring.
without raising taxes and which incorpo-
must protect our oceans. And I support new
The best answer is to make sure that a mess
rates reforms in the budget process.
penalties against those who would dump
gible for help. Parents should have choice.
like this will never happen again. The ma-
And for those children who are unwanted
I've directed the National Security Coun-
medical waste and other trash into our
jority of thrifts in communities across the
cil to review our national security and de-
oceans. The age of the needle on the beach-
or abused or whose parents are deceased,
Nation have been honest. They've played a
fense policies and report back to me within
es must end.
we should encourage adoption. I propose to
major role in helping families achieve the
90 days to ensure that our capabilities and
And in some cases, the gulfs and oceans
reenact the tax deduction for adoption ex-
dream of home ownership. But make no
resources meet our commitments and strat-
off our shores hold the promise of oil and
penses and to double it to $3,000. Let's
mistake, those who are corrupt, those who
egies. I'm also charging the Department of
gas reserves which can make our nation
make it easier for these kids to have parents
break the law, must be kicked out of the
Defense with the task of developing a plan
more secure and less dependent on foreign
who love them.
business; and they should go to jail.
to improve the defense procurement proc-
180
181
June 8 / Administration of George Bush, 1989
Administration of George Bush, 1989 / June 8
proper avenue there, but I cannot-and you
want to have-you said mandatory for
ask a good question-I simply cannot tell
everybody?
Visa Extensions for Chinese Students
posal. And we've done exactly that. The
you with authority who is calling the shots
Q. Yes. Or at least an end to the anonym-
Q. I have one followup. There are 20,000
proposal we made at NATO has unified the
there today.
ity of it?
Chinese students in the United States.
alliance, and some of the leaders told me
Q. Let me follow by asking you this then.
The President. No, I don't favor that. I
The President. Yes.
that it's more unified than it's been in histo-
When you were in China earlier in the
think there is a certain right to privacy that
Q. Many of them have spoken out. Are
year, you met with Li Peng, and I believe
ry. We've made a good proposal now, and I
we should respect. And so, in terms of ano-
you told him that China was exempted
you prepared to grant them political asylum
hope the Soviets will take it on good faith,
nymity, I would like to suggest that records
in this country, should these
from your policy review because you knew
and I am encouraged by the response so
China, you understood China. Have you
of that nature should be kept private.
The President. They're not seeking
far.
There's a lot of suffering for AIDS victims
asylum. I'll tell you why I answer the ques-
been let down personally? Have you been
Having said that, in dealing with the
misled in any way?
There's a lot of human tragedy that we
tion that way. They're not seeking asylum.
Soviet Union, I am going to continue to
The President. I feel a certain sense of
haven't really focused on too much. And I
We had four of them in the other day. And
keep my eyes wide open. I will also say I
personal disappointment. But they weren't
think something less than very discreet han-
the first thing that one of them-Jia Hao-
want to see perestroika succeed. I want to
said, "I love my country." And he wants to
exempt from the norms of behavior that are
dling of that information would not be help-
see it succeed, not fail. And I told Mr. Gor-
accepted internationally in terms of armed
ful. But do I encourage people to come for-
go back to his country. But what I have
bachev that one-on-one last fall at Gover-
ward and talk to their doctors and all about
done is extend the visas so that people are
people don't shoot down unarmed students.
nors Island. So, I don't think he believes
Nobody suggested that.
partners that may affect others? Yes, I do
not compelled to go back to our country.
that I view this as some kind of a Cold War
He's not seeking asylum. This man is not
There was an interesting point in there-
think you need that kind of frankness, and I
relationship, or that I want to see peres-
going to turn his back on his own country.
and I don't want to delve into the detail of
do favor certain kinds of testing.
He wants to change things. But he also
troika fail. He did say that he felt there
private conversations-but one of the Chi-
Lesley [Lesley Stahl, CBS News]?
wants to know that he is going to be safe,
were some elements in this country that
nese leaders, a very prominent name, told
and I don't blame him for that. So, it's not a
did. But I hope that now he knows that I
me, "We want change, but people have to
China-U.S. Relations
question of all these people-asylum is a
don't look at it that way.
understand it's very complicated here, how
Q. Mr. President, back to China. There
legal status, and that's not what they're
Q. Well, let me just follow up. Do you
fast we move on these reforms. We've come
are reports tonight that the Government
looking for.
accept that he is sincere in terms of-are
a long way." And indeed, they did move
there has begun rounding up the student
Q. light of the student roundups. I
you operating on the assumption that he is
dramatically faster on economic reforms
mean, if they face—
sincere when he says he's interested in new
than I think any of us in this room would
leaders, who face at the very least, persecu-
The President. I think it's appalling, and
thinking in international affairs?
have thought possible.
tion, at the most, possibly charges of treason
so I would simply say that what we've al-
The President. He's already demonstrated
But what hasn't caught up is the political
and whatever punishment that will bring.
ready done would say to these people, You
that he's interested in new thinking. Who
reforms and reforms in terms of freedom of
You have talked tonight about your strong
desire to keep this relationship going and to
don't have to go back. But I'm not going to
would have thought that we would sit here
expression. The freedom of press caught up
ask them to turn down the flag that they
and, on television, see a relatively lively
a little bit; but it hadn't gone, obviously,
keep the dialog and all our business as usual
love and turn their back on China. These
debate? It's nothing like our Congress, but
near far enough. And now there's martial
moving forward. If the-
are patriotic young people who fear be-
it had some similar aspects to it. And so, I
law and censorship. But we were cautioned
The President. Not all of them. Excuse
cause of seeing their own brothers and sis-
think he has already demonstrated his com-
on that visit about how fast China could
the interruption-
ters gunned down. But they're not seeking
mitment to change and to reform.
move. Some of it was economic, and clearly,
Q. Well, except for the military-
asylum. They don't want to flee China; they
But there's ways now to solidify these
some of the message had to do with how
The President. Yes.
want to help change China.
changes. They have 600,000 troops, and we
fast they could move politically.
Q. Except for the military, sir. If we find
Soviet Union
have 305,000. And I made an offer to him. I
AIDS Testing
out that the people who perpetrated the
said the best way to guarantee stability and
Q. Mr. President, turning your attention
killings in Tiananmen Square and who were
Q. Mr. President, we can discuss another
less warlike attitude is to go to equal num-
to a matter that's devastating here at home
rounding up these students are running the
Communist country for a while. Your atti-
bers. And they are being asked to take out
tude towards the Soviet Union seems to
many, many more troops than we are. But
and all over the world, the question of
Government, can the United States main-
AIDS. Respected experts are now starting
tain fairly normal relationships with them,
have shifted a bit since you became Presi-
I've said, What's wrong with being equal?
given our aim to foster human rights and
dent, from deep skepticism to seeming ac-
The United States will have 275,000 troops
to suggest that instead of the anonymous
testing that has existed in the past, there
promote democracy?
ceptance of their intentions. Do you now
deployed, and you, sir, will have 275,000.
accept Mr. Gorbachev's sincerity in regard
should be mandatory reporting of new cases
The President. It would make it extraor-
So, here's a test now. Nobody can argue the
to his pledge of new thinking? And can you
by name and numerous followups on sexual
dinarily difficult. But the question is so hy-
inequity of that, particularly since we've
tell us a little bit about why you've
put aircraft and helicopters and these other
partners and needle-sharing partners. Do
pothetical that I'm going to avoid answer-
changed.
categories on the table.
you favor such an approach, sir?
ing it directly. But anything that codifies
The President. I don't think it's shifted as
The President. I've spoken at an interna-
the acceptance of brutality or lack of re-
And I am inclined to think that if I do my
much as you think, Michael [Michael Gelb,
tional AIDS conference, at which I was
work properly and we keep NATO moving
spect for human rights will make things
Reuters]. I don't think it's shifted as much.
forward on this quick timetable, that we
roundly booed, 2 years ago or so, advocat-
much more difficult. There's no question
What I did was to say, We need a time to
can succeed. And if we do, he will once
ing certain kinds of testing. And I don't
about that.
make some prudent investigation and dis-
again have demonstrated his desire for
covery and then to go forward with a pro-
change.
868
869
Bushia
George Bush for President
CONTACT: ALIXE GLEN
FOR IMMEDIATE RELEASE
(202) 842-1988
Tuesday, June 28, 1988
STATEMENT BY THE VICE PRESIDENT
ON THE AIDS COMMISSION REPORT
The Commission Report is a landmark analysis of the problems
facing our country due to the AIDS epidemic. There is little
doubt that it will be the benchmark for future discussions.
Admiral Watkins, the Commission members and staff have done an
excellent job.
They have proved their critics wrong. Many pundits believed
that the Commission would fail, yet Admiral Watkins and his
colleagues have set the right tone for how we should approach
AIDS in the months and years to come.
I am particularly pleased that the Commission recognizes the
need for patient notification and wide-spread testing as a means
to limit the spread of AIDS. Such programs will be ineffective
without being coupled with strict confidentiality and
anti-discrimination provisions.
I am also encouraged by their understanding that the AIDS
crisis and the drug crisis are intertwined. We will be unable to
stop the spread of AIDS if we do not stop the spread of drug
abuse.
The Commission identified the problems confronting our
scientific and medical communities in the search for a cure,
vaccine and treatment of those with the disease. The
Commission's recommendations to make these efforts more effective
should be given the highest priority.
It is our duty to do all we can, not only to find a cure and a
vaccine, but also to make sure we never create a climate in
America where friend turns against friend, where countrymen turn
against countrymen.
# # #
733 15TH STREET, N.W., SUITE 800, WASHINGTON, D.C. 20005
TELEPHONE: (202) 842-1988
Paid for by George Bush for President
the peak came in the third week of
Polio Prognosis
September. In 1949, which set the record
of 42,366 cases, polio reached its height
No one could convince Mr. and Mrs.
in the third week of August.
Donald F. DeMars that 1951 wasn't a
bad year for polio. Within a few days the
Live Cortisone
Van Nuys, Calif., couple (see cut) had
seen six of their eight children stricken
As a manufacturing process it wasn't
with the disease. But at the week end
worth an inflated nickel. But as a scien-
officials of the National Foundation for
tific achievement. fellow chemists agreed,
Infantile Paralysis were far from certain
two teams of Harvard researchers
whether this year's occurrence of polio
headed by Profs. Robert B. Woodward
would approach the record-breaking epi-
and Louis F. Fieser had scored one of
demics of 1949 and 1950.
the triumphs of the century.
Some very sore spots had already ap-
The accomplishment, announced last
peared. Polio was raging in Colorado,
week in the Journal of the American
particularly around Denver and Pueblo,
Chemical Society, was the complete syn-
and in the Caddo and Red River parishes
thesis of cortisone. Now for the first time
of Louisiana. Mississippi was having the
chemists could. if they so desired, make
worst outbreak in years, centered in Sun-
the drug from its basic elements-carbon,
flower County in the delta country. Mil-
hydrogen, and oxygen.
waukee, with the worst epidemic in its
Meanwhile, in the same journal. chem-
history, reported twice ás many cases as
ists of Merck & Co. reported that they
at this time last year. The number of
could synthesize cortisone from four nat-
cases was rising in the Salt Lake City
ural substances much more abundant
National
of
area. And Texas and California. endemic
than the OX bile currently most used as
Sweat: A biochemical lever
areas, were suffering from their usual
the starting point for commercial produc-
summer upswing.
tion. The four were: ergosterol, from
glands of cattle. After two years of
But as of Aug. 4. 1951, polio was
yeast; diosgenin, from the Mexican yam*;
work Dr. Max K. Sweat (rhymes
running behind 1950-6.845 cases re-
stigmasterol, from soybeans: and choles-
let), biochemist of the National Insti
ported as compared with 7.298 at the
terol, which can be extracted from wool
of Health, last week reported suc
same time last year. The foundation
fat or the spinal cords of cattle.
Dr. Sweat first grinds the ad
judged that the present situation is "not
Meantime, scientists of the United
glands (which look like frozen shrit
abnormally serious, nor is the rate abnor-
States Public Health Service had been off
He then centrifuges the pinkish "gl
mally low." Until the epidemic reaches
on another tack: making cortisone or its
getting a clear pink-tinged fluid.
its peak, no one can tell how serious it
natural counterpart from the adrenal
finally small crystals of an renzy
will become Last year when 33,351 cases
prótein which spurs biological act
*The raw material used by Syntex, Inc., of
were reported throughout the country,
Mixed with stigmasterol from
Mexico City (NEWSWEEK, July 16
beans (see above), the enzyme
to work and produces small amoun
hydro-cortisone, a near cousin of
sone and just as good if not be
Sweat says frankly: "It is quite CC
that synthetic methods will be the
mary source of the [cortisone-like]
mones. The main contribution of
work is that it helps us understand
of the intricate mechanisms OCCU
inside the adrenal glands.
He is fascinated particularly by
key enzyme-"a wonderful and un
substance that acts like a lever in
ducing the hormone. It is probably
first enzyme to be identified in the
ing of a hormone."
Sweat has reason to be proud.
enzyme accomplishes in one fifteen
ute step what takes 27 steps in
current commercial process. More
esting is the conjecture that the en
itself might some day be given to
people to help them speed up
natural hormone production and
fight disease.
Healthmanship
Stephen Potter, author of "Games
ship" and "Lifemanship," the defi
Associated Press
works on psychological warfare ap
Richard DeMars, aged 3, with parents: How many will follow him?
to polite society, last week came out
52
News
NEWSWEEK 8-20-51
Services of Mead Data Central
PAGE
2
3RD STORY of Level 1 printed in FULL format.
Copyright (c) 1989 The Washington Post
October 8, 1989, Sunday, Final Edition
SECTION: METRO; PAGE D3; COURTLAND MILLOY
LENGTH: 737 words
HEADLINE: A Fabric of Love, Pain, Anger
BYLINE: COURTLAND MILLOY
BODY:
I did not expect to find anybody I knew memorialized in an AIDS quilt on
the Ellipse yesterday. I did not expect to cry. I'd been to the Vietnam
Veterans Memorial wall, seen cemeteries filled with rows of cold gravestones,
and pretty much figured that there was nothing to do for the dead except pay my
respects.
But somehow these 10,848 panels of cloth rocked my soul in a way that granite
never did. So delicate and vulnerable to nature's elements, each fiber became
the very embodiment of the AIDS victim that it represented.
There were squares with poems for the babies who had died, squares with
photographs of innocent children woven into them. A black baby, dressed in a new
pink dress and matching bonnet --- dead of AIDS before she could grow out of
her bell shoes.
There was a square with a row of mournful teddy bears, stitched onto a window
sill, crying into the night for a man called "Boo Boo," whose photograph was
sewn in near them.
"We whispered
'We miss you!' = said the little bears. "But there was
no reply. We sat by the window, and heard the moon sigh."
Thoughtful words and pictures sewn onto a piece of cloth, breaking the hearts
of all who saw them. Those weren't just little bears speaking -- but children,
mothers, fathers, sisters, brothers, friends and lovers who have been deeply
hurt by death.
A sister of a man who had AIDS sat at the edge of a square she had sewn, 50
sorry that she had not spoken to him in the years before the disease took his
life. Now he was gone. Would he please forgive her, she prayed, leaving a
handful of roses as she tearfully staggered away.
People who thought they were just taking a curious stroll, such as I,
suddenly found themselves wiping away tears. I had forgotten about my fellow
journalist, ABC newsman Max Robinson. But a panel honoring him was there. I had
forgotten about Melvin Boozer, the first black president of the Gay Activist
Alliance. But there was cloth for him too. There were even squares for people
whom I hadn't even known were ill. Suddenly, I discovered they were dead.
Among the living were heartwarming people such as Ray Kinlock, whose job is
to repair damaged squares. Surely it would be easier for him to handle his
feelings, having seen the squares hundreds of times. It was.
LEXIS® NEXIS® LEXIS® ® NEXIS ®
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every
jun
PAGE
(c) 1989 The Washington Post, October 8, 1989
fablic its
"I don't fight it. I just cry --- all the time," Kinlock said. "It is so sad.
I have made quilts for 30 friends who have died. I can see a certain color, a
certain fabric or read a certain poem, and something breaks inside me. Every
colors,
time I see the panel of Baby Jessica, the first infant to die of AIDS, I am
moved to tears."
its sourl.
He added, "I think of the quilts as educational art, and notice how it has
brought so many people together, how it has helped reduce the fear."
two
Evelyn Martinez, organizer of the quilt repair crew, also worked feverishly
no
to keep the panels looking like new. For her, there was no point trying to keep
her emotions in check either.
alites
are
"Sometimes I feel 50 guilty, like I am not doing enough," she said. "I work
full time on the panels, but I always feel like they are not going to hold up.
It's as if they were human beings. As they get older, they begin to fall apart.
But if you can fix it, restore it to beauty, that is such a satisfying feeling."
Joseph van Es-Ballesteros, the logistics coordinator for the AIDS quilt,
a bridge
was not totally satisfied. Pointing angrily beyond the quilt toward the White
House, he criticized the federal government's response to the AIDS crisis.
fetween
"The inaction and insincerity that comes from the president, as well as
Congress, is abhorrent," he said. "The compassion and caring on the part of the
number
friends and family is wonderful, but without serious action on the part of our
leaders, it won't amount to anything."
It
and
the
Philip Pannel, who worked at an AIDS awareness table for the United Black
Fund, was angry too. Very few black people, he noted, had bothered to make
squares or visit the display, even though blacks have a higher rate of AIDS
infection than whites.
"I guess if they don't care about AIDS victims when they are alive, no
reason to expect they'll care once they are dead," he said.
The displayed squares represented only 18 percent of those who have died of
AIDS in the United States.
Yet, on and on they went, for 14 acres, SO that after 49 miles of walking
around the cloth, the effect of a major catastrophe was more than apparent. It
was overwhelming.
TYPE: COLUMN
SUBJECT: ACQUIRED IMMUNE DEFICIENCY SYNDROME; DISTRICT OF COLUMBIA; DEATH AND
DEATH CEREMONIES
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PAGE
4
4TH STORY of Level 1 printed in FULL format.
Copyright (c) 1989 The Washington Post
October 8, 1989, Sunday, Final Edition
SECTION: METRO; PAGE D3
LENGTH: 544 words
HEADLINE: AIDS Quilt Captures the Fear Behind the Loss;
Panels That Don't Identify Loved Ones Serve as Reminder of Public Stigma
BYLINE: Brooke A. Masters, Washington Post Staff Writer
BODY:
The Names Project AIDS Memorial Quilt is above all about preserving
people's identities.
From the gold lame' rectangle dedicated to Broadway choreographer and
director Michael Bennett to a calico quilt pieced together by the friends and
relatives of Helen Beckey, each of the 10,848 panels on display at the Ellipse
this weekend serve as handsewn reminders that AIDS has killed individuals.
Throughout the weekend, the names of the people memorialized on the 14-acre
quilt and of those who have died too recently to have their own squares boomed
overhead, read over a loudspeaker by activists and family members.
But amid all the emphasis on names and identity, many people have sought
anonymity.
Organizers estimated that up to 10 percent of the panels are not embroidered
with full names. Fifty-three of the squares are dedicated only to Jims or
Jimmys, and 57 memorialize anonymous Johns and Johnnys.
Then there was the panel for Robert W.
Pinned across Robert's last name was a blue felt strip embroidered with the
words "Family fear removed this name. Love can remove this patch."
Quilt visitors who have lost family members to AIDS said they understand
such fear.
When Michael Hackney contracted AIDS, "There was no question we were going
to take care of him," said his mother, Edith Hackney, who had come from
Philadelphia to see Michael's panel in the quilt. "If people didn't want to
come to our house
=
Her voice trailed off and then strengthened. "The
hardest part was when ambulance drivers would come with hoods on like the Ku
Klux Klan."
Betty Berge said the death of her son, John Karl Berge, from AIDS has made
her sensitive to fear and ignorance about the disease.
"I live in Front Royal, and AIDS is not a very popular disease there,"
Berge said. "There are a lot of people who need comfort who don't get it because
they are afraid."
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PAGE
5
(c) 1989 The Washington Post, October 8, 1989
Since her son's death two years ago, Berge has joined a group for people
infected with the AIDS virus and their families. The group keeps its
membership confidential, for fear of reprisals, she said.
After writing her son's name and the words "Your death was a teaching of
love" on one of the panels set aside for visitors' signatures, Berge said, "I'm
going to stay in Front Royal and [try to] reach enough people."
The death of their son, Robert Shuman, galvanized Alma and Jim Shuman to
fight for AIDS awareness in their home state of Oklahoma. "We've been making
strides. Now when one of our young men passes away, they say in the paper he has
AIDS, = said Alma Shuman, who wore a "Tell Tulsa" button.
Many quilt visitors said Project Names helps counter the stigma they have
encountered because of AIDS. "Where else could you see people walking around
with reverence and despair all wrapped into one?" said Bob Krieger of New York,
who sat by his dead lover's panel, listening to a tape of the man singing. "At
one time, you want to shake your fist to the heavens and thank God."
Act Up, a New York-based group, tried to capitalize on that impulse and
yesterday's Housing Now! march by organizing a protest in front of the White
House. About 250 people demanded housing for AIDS patients and chanted slogans
such as "Bush, Bush, you can't hide. We charge you with genocide."
GRAPHIC: PHOTO, THE AIDS QUILT'S SHOWING AT THE ELLIPSE, WHICH ENDS AT 5
P.M. TODAY, MARKS THE LAST TIME THE QUILT WILL BE SHOWN IN ITS ENTIRETY
BECAUSE OF ITS SIZE. BILL SNEAD
TYPE: DC NEWS
SUBJECT: DISTRICT OF COLUMBIA; ACQUIRED IMMUNE DEFICIENCY SYNDROME; DEATH AND
DEATH CEREMONIES
flanket of lone
spreading out accross
embracing ameria the hurt
LEXIS® NEXIS® ® LEXIS® NEXIS® R
Services of Mead Data Central
PAGE
6
5TH STORY of Level 1 printed in FULL format.
Copyright (c) 1989 The Washington Post
October 7, 1989, Saturday, Final Edition
SECTION: METRO; PAGE B3
LENGTH: 573 words
HEADLINE: Stories of Love, Sorrow Blanket Ellipse;
Quilt Commemorating Those Who Have Died of AIDS Covers 14 Acres in Final
Full Display
BYLINE: Kathy Ann Waterman, Washington Post Staff Writer
BODY:
Chuck Egger sat cross-legged on the grass of the Ellipse yesterday,
embroidering a love letter on a piece of canvas the size of a grave.
"Dear Dick," the red thread spelled out, "I love you. I will always love you.
I never got tired of saying that even after 8 1/2 years. I'll remember the life
we built
the good times and the bad."
Egger's lover, Dick O'Doniel, died of AIDS a few months ago.
Egger is one of thousands of people across the country who made panels for
the Names Project AIDS Memorial Quilt, which is on display this weekend in
Washington for the last time in its entirety.
The quilt now covers all 14 acres of the Ellipse, and with more panels
still arriving from as far away as Europe, Africa and Australia, there will be
no space large enough to show it in the future, organizers said.
The 10,848 panels represent 18 percent of all U.S. AIDS deaths, according
to the Names Project.
Like scrapbooks of memories, but containing more than photographs and
letters, the panels are laden with the unusual and the commonplace: locks of
hair, wedding rings, a beaded hat, cremation ashes, a sequinned parrot, medals,
sheets of music, ballet shoes. Egger attached O'Doniel's leather jacket, teddy
bear and picture of their Shar-pei dog onto the canvas.
Some panels bear only the name of the person who died, the dates of birth and
death and perhaps a brief "I miss you" or "I love you." Others show painstaking
detail, days of painting, cutting, gluing, stitching.
One memorial is a collection of neckties plus two Campbell's soup labels.
Another is made of a pink baby blanket with a child's frilly dress attached to
the center. It belonged to a girl named Maria Prophet, who died of AIDS in
1982 at age 4.
Happy scenes of satin rainbows and velvet trees, silk flowers and balloons
contrast with grim satire. One panel depicts a pair of hands gripping a ladder.
A dagger, dripping red, pierces the right hand. On the dagger is written R.
Reagan.
LEXIS® ® NEXIS® LEXIS® NEXIS
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Services of Mead Data Central
PAGE
7
(c) 1989 The Washington Post, October 7, 1989
A reading of names of the dead went on all day yesterday. Singer Dionne
Warwick was a volunteer reader, as was actress Betsy Palmer. People clapped when
they took the stage, but it was the dead and not the living who claimed center
stage.
About 10,000 people moved slowly along the 49 miles of black canvas walkways
that separate sections of the quilt. Some stooped to leave roses or carnations
on the quilt. Two men embraced and wept on each other's shoulder.
Tears came freely yesterday. Names Project volunteers kept packets of tissue
paper in their pockets. "Many people have not had the chance to grieve for their
loved one," said Michael Persico, a volunteer. "For them, this is like attending
a funeral or going to the cemetery."
Through the tears, people were telling their favorite stories about the dead.
Mary Jane Edwards, of California, laughed and cried as she told how her son,
Gregory Connell, playfully tipped a plate of pie into his lover's face as he
tried to get him to eat. Edwards, who helped form Mothers of AIDS Patients,
said, "Gregory was so weak and thin
but he never stopped laughing
until the end when he could barely talk."
Laughter was also sewn into the quilt. One panel told the story of a man
named Brad whose ashes were scattered on the Mississippi River. The river was
depicted on the cloth and the inscription read, "You always did want a free ride
to New Orleans and now your ashes are doing this for you."
GRAPHIC: PHOTO, THE 10,848 PANELS REPRESENT 18 PERCENT OF ALL U.S. AIDS DEATHS.
SMITHSONIAN INSTITUTION; PHOTO, MARGARET THOMAS
TYPE: DC NEWS, NATIONAL NEWS
SUBJECT: ACQUIRED IMMUNE DEFICIENCY SYNDROME; DEATH AND DEATH CEREMONIES;
DISTRICT OF COLUMBIA
ENHANCEMENT: QUILT
LEXIS® ® NEXIS® LEXIS® NEXIS®
A formater of Natina Coulition 7
on LAIDS
Dr. Lee - on original AIDS commission
450-500 CEOS pro - admistration
taken deadership position on treating their amployees
1/2 million HIV - positive identified
Persons (living). with AIDS NOT AIDS patients
PWA
hot homosexual
gay
HIV-inberted NOT AIDS
employers only shield against AIDS people
ending up on welfare
must be thanked for haping people employee
1. congratulate businessman - they are panying the
bill
2. discrimination - americans with Disabilities act
3. thank pts. of light - religious +
community leaders, volunteers
y. Education - for how - is are only weapon
- -prevention
AZT cost recently lowered from $12,000
to $ 8,000 per year
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
01. Notes
Handwritten notes
n.d.
(b)(6)
Re: President's AIDS speech; personal information redacted.
(2 pp.)
Collection:
[Original OA/ID 06854]
Record Group:
Bush Presidential Records
Office:
Speechwriting, White House Office of
Series:
Speech File, Backup
Subseries:
Chronological Files
WHORM Cat.:
File Location:
National Coalition on AIDS 3/29/90 [2]
Date Closed:
10/15/2004
OA/ID Number:
13710-010
FOIA/SYS Case #:
S
Appeal Case #:
Re-review Case #:
2004-2265-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal. privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
alice anderson
NAM
AIDS
BJ Stiles (bout contact)
P-6,(b)(6)
Bill Schambra
Dr. antonio Novello
James allen
Dr. anthony Fanci
NOVELLO
" alo is Blusiase of finalies
not a discuse of wen only
Honosexualo done a good just of taking care - preventia
Computersive one- stop came
children - -orphans possible
stignatized if parents die, but they dont
are Rosenthal
3/18/90
have AIDS
*
NYT ines your ages AIDS orphans
fed. Pedicitic tush force
FAUCI:
emphasize personal caring
extraording amount into research
trujing to reach minorities Nt/AIDS that
have trouble getting any dind of care
speaking there on 29kg as well
AZT appoved by FDA for early use
importert -> delays more severe symptoms, saves $
HIV infected not allowed into US without as
waiver / Problem for S.F. world conf.
P-6, (6)(6)
BJ Stiles:
Business & Union people
Human Resource / Public affairs execs
450 people from around the country
some working on AIDS, some have not/
indecided
mosts hurge, mat'l. companies
are
8:30 - 3-p.m.
all state Insurance - host + intro
business response to AIDS sime 1980
Lou Sallivan - over-view of epidemic
overall admin. policy
Fanci - update on research +
treatment
Jim Cumin - CDC - demographics of AIDS
lowering official projections
Q + A
Bob Hass - Levi Strams - filler for POTUS
POTUS
Lunch Dick Munroe - Time Inc. CE
any
HIV+ appointees
?
1 Belinda Mason - HIV writing + Bush appointer
to AIDS Commission
Health Insurance issues
Labor response to AIDS
Renee Poussaint "Liring & Working with ADS
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
02. Notes
Handwritten notes, Re: President's AIDS speech; personal
n.d.
(b)(6)
information redacted. (3 pp.)
Collection:
[Original OA/ID 06854]
Record Group:
Bush Presidential Records
Office:
Speechwriting, White House Office of
Series:
Speech File, Backup
Subseries:
Chronological Files
WHORM Cat.:
File Location:
National Coalition on AIDS 3/29/90 [2]
Date Closed:
10/15/2004
OA/ID Number:
13710-010
FOIA/SYS Case #:
S
Appeal Case #:
Re-review Case #:
2004-2265-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed_as apersonal record misfile
P-6, (b)(6)
Dr. David Rogers - Vice Chairma - AIDS
Commission
In this nation there is only are way
to deal will individuals who are sick!
with dignity / compassion, care
lack of descrimination
Young surgeons not Caring for AIDS
patients adequately - almost mailpractico
Rogers ordered then to stop it.
Changed behavior - not necesurily
attitudes 1 they change
more slowly
Joan abrahmoon - Dr. Salk
Polio - spread by oral ingestions human contact only
fecal transmission in poor constries
not insect aborn
camphor -used
long been described in Japan, the first
epidemics of appreciable size reported
there came in the Nineteen Thirties,
and similarly this happened in a num-
ber of tropical countries in the Thirties
and Forties. Quite recently the new
state of Israel experienced its first
native epidemic.
In other and populations, among
which one could include the Philip-
pines and certain North African coun-
tries, poliomyelitis epidemics of any
size among the natives do not yet seem
to have been observed. Nevertheless
the virus of poliomyelitis is present in
such countries, for the rates at which
United States and British troops con-
tracted poliomyelitis in some of these
"primitive, nonepidemic" areas during
World War II bears witness not only
to the presence of the virus but its
frequency. The local native adult pop-
ulation, on the other hand, did not suf-
fer. They were apparently more im-
mune than were the visiting soldiers.
IF
one attempts to explain all these
situations in the light of our rather
limited knowledge, one is treading on
dangerous ground. Furthermore, one
must inevitably deal with controversial
points here, and perhaps deal with
NYT
them somewhat arbitrarily. Such an
approach is usually adopted in the in-
terest of simplicity, but it involves the
Mag
danger of over-simplification and
therefore of a sacrifice of accuracy.
which is one of the reasons why scien-
tists as a group are at a disadvantage
at the hands of journalists.
There are. however, some generali-
zations that one can make about
poliomyelitis withia fair degree of con-
fidence.
We can regard it, as a contagious
disease, of which the cause is known to
be a virus discovered in 1908.
The poliomyelitis virus is a repre-
sentative of a whole race of ultra-
microscopic agents known as filterable
viruses, many of which are harmless
To solve the riddle of poliomyelitis-A researcher uses a mass spectrometer, an electronic device for analyzing fluids.
to man, while some others are deadly
parasites. The main way in which the
properties of viruses, or, indeed, the
Mysterious, Paralyzing Disease
very existence of certain of them can
be demonstrated is by the cumbersome
process of inoculating material pre-
sumably containing the virus into an
Doctors have learned much about the causes and treatment
experimental animal and subsequently
watching for the development of fever
of poliomyelitis but prevention has proved a baffling quest.
or other signs of illness in the animal.
The pollomyelitis family of viruses is
one of the most elusive members of
H
AS any real progress been made
By JOHN R. PAUL
Eighteen Eighties and Nineties did the
this whole group, because with most
recently in man's struggle to
contagious character of poliomyelitis
strains of this virus (and four distinct
control or prevent infantile pa-
so effective. such as the sulfonamides
really became known.
types are known), the only animals
ralysis-or, as it IS more commonly
and the antibiotics-penicillin. strepto-
called today. poliomyelitis? The best
The first observations of this type
susceptible to infection are monkeys
mycin. aureomycin, or chloromycetin,
were made in Scandinavia. The disease
and anthropoid apes, which are expen-
one can do in reply to this question is
to mention some of an already long
thereafter was identified in periodic
sive and often difficult to come by. It
to point to certain gains which have
and growing list. We can merely say
epidemics in some regions, of which
was discovered only in 1938 that one
been achieved in other aspects of treat-
that research is being conducted in an
Scandinavia, northern Europe, the
member of the family of poliomyelitis
ing poliomyelitis. For instance, there
effort to discover such agents for use
United States and Canada, Australia
viruses could also infect mice.
have been improvements in what is
in poliomyelitis. This. of course, grossly
known as the after-care of patients
and New Zealand are notable examples.
understates the magnitude of these
No longer was infantile paralysis a
R
who have been paralyzed. New meas-
efforts.
ESEARCH on the virus itself in-
medical problem alone: by the turn of
ures have been introduced for the re-
dicates It to be one of the smallest of
lief of pain during the acute disease,
B
the century it had become a public
UT. if one cannot report medical
health problem as well.
the race, 80 small that it has not yet
and for saving lives in the most serious
been clearly defined under the electron
achievements along these lines, it be-
Did the behavior of the disease actu-
cases. One might assemble quite a
microscope. Some of its properties, on
comes all the more important to ask:
long list of such achievements. But in
ally alter in this time, or does the
What is known about poliomyelitis?
the other hand, are definite. Poliomye-
the field of prevention-no.
paucity of records merely indicate that
Why have doctors been so baffled by
epidemics of poliomyelitis had escaped
litis viruses are killed by heat, at tem-
There is no vaccine available for
it? is it & new disease-a twentieth-
notice in the early nineteenth century
peratures which also destroy bacteria.
purposes of immunization. Nor is there
century disease, as some people have
and before? I would hesitate to make
but unlike many bacteria they resist
any specific drug known to be effec-
said?
pronouncements about this, but I
certain chemicals or disinfectants such
tive in acute poliomyelitis comparable
The story is incomplete. but it is
rather favor the view that its behavior
as carbolic acid or chloride of lime.
to those which in bacterial diseases are
likely that infantile paralysis goes
underwent PL change in certain geo-
What is not known about these
back as far as recorded human his-
graphical areas.
viruses is how to deal with them; how
tory. Unfortunately, prior to 1800 the
JOHN R. PAUL IS Professor of Preventive
Indeed. we have witnessed something
their spread can best be controlled, and
records about "acute paralysis of in-
Medicine at Yale's School of Medicine.
like this in our own times, for, although
how the disease can be checked in its
fants" are scanty, and not until the
scattered cases of poliomyelitis had
earliest stages, Continued on Page 26,
18
Children stricken in an outbreak of poliomyelitis lie in respirators at Roanoke, Va.
The Mysterious, Paralyzing Disease
(Continued from Page 18)
with poliomyelitis it appears
not the case in some of the
and a host of other practical
that people may become in-
remote parts of the world
questions whose numbers only
fected without ever having
where the causative virus
serve to emphasize our ignor
been in contact with other
penetrates only very occasion-
ance.
recognized cases of poliomyeli-
ally and exposure comes less
It is known that a certain
tis. For its spread does not
often.
degree of immunity develops
necessarily take place from
In connection with the
in the experimentally infected
one severe and recognized case
spread of poliomyelitis, there
animal after its recovery
to another. as occurs with
are a number of other peculiar
(with or without paralysis).
measles. but often through
features which might be re-
an immunity which renders
cases so mild as to escape
garded as further evidence
the animal resistant to acquir-
recognition entirely.
that the disease 18 undergoing
ing a second infection due to
some sort of evolution. In our
the same type of poliomyelitis
NE does not, in other
grandparents' time in this
virus, although this same ani-
words. have to have the para-
country and elsewhere polio-
mal may acquire a second in-
lytic form of the disease in
myelitis was a disease of in-
fection due to a different type
fants - the true "infantile"
of poliomyelitis virus. And it
order to spread it to others.
The evidence is quite convinc-
paralysis." Indeed. according
is more or less presumed that
ing that during an average
to physicians in New York
this same situation holds true
for man, although this pre-
epidemic of poliomyelitis.
City at the turn of the cen-
those individuals who are ill
tury. the malady was rarely
sumption is not clearly estab-
enough to become diagnosed
seen in children over 6 years
lished. as two attacks of polio-
represent only a fraction-
of age. Today we find, not
myelitis in the same individ-
perhaps 1 to 10 per cent-of
only in the northern half of
ual are rare.
the total number of people in-
this continent but more par-
IT
fected. This means that dur-
ticularly in Scandinavia and
is commonly agreed that
ing an epidemic a child. or
in other parts of Europe and
poliomyelitis is generally
even an adult: may unknow-
Australia, that poliomyelitis is
spread by contact between
ingly harbor and transmit the
not limited to infants but is
persons, in somewhat the same
virus to others.
commonly seen in children of
manner as diseases like mea-
It also involves the corol-
school age and teen age. Per-
sles and mumps are spread.
haps 25 per cent of the vic-
lary, often unsuspected. that a
But we cannot explain why
tims in New England today
very high percentage of adults
climate and season exert such
are 15 years or over.
--roughly around 85 per cent
8. profound influence and why
or more--have not only been
epidemics of poliomyelitis
exposed unknowingly to polio-
T
HIS change in the age level
nearly always occur in the
myelitis virus but have been
of incidence has not taken
summer rather than in the
infected unknowingly with it,
place everywhere. for the dis-
winter in temperate climates.
and have emerged from the
ease is still concentrated
Either something may happen
experience not only unscathed
among infants in certain prim-
in the warm weather which
but, indeed, the better for it
itive countries-in contrast to
enormously facilitates the
because they have attained
the other remote areas where
spread and dissemination of
some degree of immunity.
the disease strikes adults—
the virus throughout a com-
and these include the areas
munity or something may
Thus adults usually do not
happen in warm weather
get poliomyelitis for the same
where epidemics of poliomyeli-
which makes some people
reason that adults usually do
tis have not appeared. Hence.
not get measles; most of them
one might suppose that this
more vulnerable and far more
have not only been exposed to
alteration in the character of
apt to acquire poliomyelitis
than at other times of the
it already but have actually
the disease could somehow be
had it. Evidence that most
associated with some feature
year.
adult individuals living in the
of our twentieth-century way
And at this point we en-
United States have been natu-
of life-such as the changing
counter another confusing fac-
character and composition of
tor. One can readily under-
rally immunized by exposure
populations, or the curtail-
stand that so-called communi-
to poliomyelitis finds support
ment in the size of families.
cable diseases are transmitted
in the fact that although this
or even our sanitation.
by persons who are themselves
disease is still more or less a
If the latter is responsible.
victims of that disease, but
children's disease here, such is
/Continued on Following Page)
(Continued from Preceding Page)
tially infectious, the health of-
one could propose the hy-
ficer is at a serious disadvan-
pothesis that modern hygienic
tage. The fact that 80 many
methods might have reached
people who have no recogniz-
that point at which infants
able symptoms may have very
and very young children are
mild infections means that
being pretty well protected
many potentially infectious in-
from exposure to this virus,
dividuals are at. large in a
but has not yet reached a
community during an epi-
point which protects them
demic, and there is no means
later-that is, during childhood
of labeling them as such or
or adolescence; and so their
controlling their activities.
"attack of poliomyelitis" has
The hope for measures then
been postponed, not elimi-
to eliminate the virus from a
nated. These hypotheses are
community and thus rid our-
mentioned merely to show
selves of this disease by such
that much remains to be
means is not good.
learned about the principles
involved in, as well as the
A
PPARENTLY what is
techniques for, preventing this
disease
needed most in the struggle to
/A more practical question is
prevent poliomyelitis is some
means of bolstering the immu-
whither this disease is spread
nity of children (and adults)
by agents other than infected
to enable them to resist in-
persons-food, water, insects,
fection induced by periodic ex-
for example-as is the case,
posure to the virus. That is,
for instance, with streptococ-
we would combat poliomyelitis
cal diseases and typhoid fever.
as we now combat smallpox,
If such were the case with
poliomyelitis these "inter-
diphtheria and whooping
cough-by vaccination.
mediate" agents might be con-
trolled by "sanitary" meas-
Since no vaccine for polio-
ures. They do not loom large
myelitis is available, our pre-
dictions can go no further, but
in the picture at present.
it has long been obvious to
T
students of this disease that
HAT poliomyelitis virus
it is desirable to discover
has been found on food (pos-
strains of virus which, when
sibly contaminated by flies)
inoculated into man, would
and in flies during an epi-
cause a mild "disease" only,
demic there is no doubt. But
and at the same time serve to
there is no evidence that flies
immunize against poliomyeli-
are an essential link in the
tis. This would be similar to
chain, as are mosquitos in the
the way that "cowpox" virus,
transmission of malaria, in
now known as vaccine virus,
which they carry a parasite;
confers immunity on the in-
or in yellow fever, in which
dividual vaccinated against
they carry a virus. Further-
smallpox.
more, in certain situations
The development of such a
where poliomyelitis has oc-
vaccine is the great quest on
curred it is difficult to imag-
which the energy of many re-
ine how flies could possibly
search laboratories is now
have played much or any part
being expended and to which
in the spread.
the resources of great institu-
For the present the control
tions and foundations in a
measures devised to protect
number of different countries,
communities against polio-
such as our own National
myelitis are therefore based
Foundation for Infantile Pa-
essentially on our knowledge
ralysis, are being turned. The
that people (usually children)
path is difficult and danger-
in the early stages of recog-
ous, and it would seem highly
nizable or suspected poliomye.
unlikely that an effective vac-
litis are infectious, and that
cine will be reached by inves-
the situation in the family.
tigators working on mice and
the home and the community
monkeys alone. For the real
should be handled accordingly.
experiment will come when
When it comes to quarantin-
the new vaccines are tried on
ing individuals who are poten-
man.
A process in the efforts to isolate the poliomyelitis virus.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
03. Notes
Handwritten notes, Re: President's AIDS speech; personal
n.d.
(b)(6)
information redacted. (1 pp.)
Collection:
[Original OA/ID 06854]
Record Group:
Bush Presidential Records
Office:
Speechwriting, White House Office of
Series:
Speech File, Backup
Subseries:
Chronological Files
WHORM Cat.:
File Location:
National Coalition on AIDS 3/29/90 [2]
Date Closed:
10/15/2004
OA/ID Number:
13710-010
FOIA/SYS Case #:
S
Appeal Case #:
Re-review Case #:
2004-2265-S
Appeal Disposition:
P-2/P-5 Review Case #:
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AR Disposition:
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RESTRICTION CODES
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personal privacy [(a)(6) of the PRA]
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C. Closed in accordance with restrictions contained in donor's deed of
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PRM. Removed as a personal record misfile.
P-6, (b)(6)
Belinda Mason -
talk about am. w/Disabilitis act
AIDS is a not'l. disaster
Epidemic is not over enough will net worse
We are rich & compassionate to care
for all people with diseases.
Compassion doesn't cost anything.
need nat'l leadership
doesn't know the President
AIDS community wants the issue treated
Call before using her as an example
got aIDS about 3 years ago
with a blood transfusion during the
birth of her baby
ge Bush, 1989
Administration of G
loration
Two decades ago, the men of Apollo 11
United States Senate and 5 are appointed
Letter to the Cl
began our journey into the universe, taking
by the House of Representatives.
and House Com
with them our heartfelt prayers and our
Belinda Ann Mason, of Indiana. This is a new
Appropriations
highest hopes. They opened a door that can
position. Since 1988 Ms. Mason has been presi-
Communication
tes
never be closed and, in so doing, changed
dent and a member of the board of directors
Interdiction
forever the course of human history. As we
for the National Association of People with
July 20, 1989
continue to follow the steps of those brave
AIDS (NAPWA) in Washington, DC. Since 1988
she has served as an AIDS educator and con-
Dear
pioneers, wherever we travel, we will, like
sultant, traveling throughout the country
them, have come in peace for all mankind.
The enclosed rt
!0, 1969,
speaking to educational institutions, interest
ne Moon,
Now, Therefore, I, George Bush, Presi-
porting requirem
groups, health care professionals, and legisla-
f the uni-
the FY 1989 Nat
dent of the United States of America, by
tors.
tion Act.
at "giant
virtue of the authority vested in me by the
David E. Rogers, of New Jersey. This is a new
a million
The report foc
Constitution and laws of the United States,
position. Since 1986 Dr. Rogers has served as
triumph
tions support for
do hereby proclaim July 20, 1989, as Space
the Walsh McDermott university professor of
responsibilities foi
urage-it
Exploration Day. I call upon the people of
medicine at Cornell University Medical Col-
American
cations network;
the United States to observe this day with
lege. Prior to this, he was president of the
appropriate programs, ceremonies, and ac-
Robert Wood Johnson Foundation in Princeton,
the funding appro
teroperable intera
ive been
tivities.
NJ.
frastructure to sup
nination,
In Witness Whereof, I have hereunto set
Richard Cheney, Secretary of the Department of
forts; highlights th
nericans,
my hand this 20th day of July, in the year of
Defense.
cations network
onstrated
our Lord nineteen hundred and eighty-
Edward Dericinski, Secretary of Veterans Af-
comprised of sev
Like the
nine, and of the Independence of the
fairs.
systems and that
e space
United States of America the two hundred
Louis Sullivan, Secretary of Health and Human
subsystems serve
ve since
and fourteenth.
Services.
and are not nece!
mpelling
interdiction suppo
y of the
George Bush
A similar letter
the ex-
man, House Comr
of men
[Filed with the Office of the Federal Regis-
and the Chairmen
al Aero-
ter, 11:20 a.m., July 21, 1989]
Statement on the Crash of a United
Committees on Ap
on, the
merican
Airlines Jetliner in Sioux City, Iowa
Sincerely,
institu-
July 20, 1989
qualities
Appointment of Five Members of the
ay.
Barbara and I extend our deepest sympa-
Note: Identical le
venture
National Commission on Acquired
thy to the families and friends of the vic-
Nunn, chairman 0
out our
Immune Deficiency Syndrome
tims of Flight 232. Our hearts-indeed, the
ices Committee; R
miverse
July 20, 1989
hearts of all Americans-go out to them in
the Senate Appro
ave en-
their time of sorrow.
Aspin, chairman c
fic pur-
The President today announced his inten-
ices Committee;
demon-
tion to appoint the following individuals to
I am sure I speak for many when I com-
chairman of the
hen we
be members of the National Commission on
mend the extraordinary efforts of the air-
Committee.
work in
Acquired Immune Deficiency Syndrome.
port personnel, rescue teams, National
The National Commission on Acquired
Guardsmen, and local citizens who rushed
indreds
Immune Deficiency Syndrome was estab-
to the crash scene to offer aid. The compas-
e have
lished by Public Law No. 100-607 on No-
sion and generosity demonstrated by the
ng dec-
vember 4, 1988. The Commission has 15
entire Sioux City community in the wake of
Remarks at a Cei
I, trans-
members, 5 of which are appointed by the
this catastrophe has been overwhelming.
Commemorating
end of
President. Of these 5 appointed members, 3
July 21, 1989
Today we pray for the passengers killed
-which
are the Secretary of Health and Human
on Flight 232. Let us also ask God to bless
Thank you all f
ith our
Services, the Secretary of Veterans Affairs,
their loved ones and those survivors who
White House. And
pportu-
and the Secretary of Defense; and the other
remain hospitalized. May they find strength
to the White Hou
nd pro-
2 are chosen from the general public. The
and comfort in their faith and in the love of
Captive Nations W
of the
members serve for the life of the Commis-
family and friends.
but blessed by hop
sion. Five members are appointed by the
Administration of George Bush, 1989 / Dec. 22
1928, in New York City. Mr. Lambert
society that they voted for and that they so
served in the U.S. Army, 1953-1955. He is
rightfully deserve.
married, has three children, and resides in
In these last days before Christmas, I did
New York.
want to stop by here and salute what you
are doing in biomedical research-the best,
the very finest, all of you. For here, too, in
your way you are standing for decency.
Remarks to the AIDS Research Staff at
You're helping to improve the health of
the National Institutes of Health in
millions of Americans. And even more, like
Bethesda, Maryland
those soldiers in Panama, those heroes,
you're giving the greatest gift imaginable:
December 22, 1989
the gift of life. And nowhere is this gift
more evident than in your work to combat
Thank you all very much. I'm so very
AIDS. And it's that which I'd briefly like to
proud to be accompanied here and intro-
talk about today. For only together can we
duced here by Lou Sullivan. Barbara is, too.
wage all-out war against this terrible killer.
A little historical Trivial Pursuit: Bar used to
be on the Morehouse School of Medicine
Two years ago in this very building, I met
a person with AIDS who spoke of his pro-
Board, working for a slave driver named
longed suffering. And I've just come from
Lou Sullivan. [Laughter] And so, it's fitting
two more meetings-one with a patients'
that they be sitting side by side.
support group and the other, a family sup-
To Under Secretary Horner, if she is
port group-and both reminded me of the
here, and Dr. Mason and Dr. Raub, Dr.
need for compassion and understanding.
Fauci, Dr. Broder and Dr. Decker and Dr.
And by that, I mean the compassion that
Rall and Dr. Bick and Dr. Goodwin-
moves us to care for all those infected with
[laughter]-Dr. Lenfant, Dr. Alexander, and
the HIV, men and women, adults and chil-
whoever is left out, all the rest of you: I am
dren. And we must help them. And you,
delighted, I mean it, really pleased, and so is
you above all, are doing just exactly that.
Barbara, to be here.
And I want you to know, I am with you and
This morning, let me just say a word
extraordinarily grateful for what you are
about another area before I just make a few
doing. And by understanding, I mean edu-
comments on your work, your wonderful
cating, educating Americans who don't
work. I am sure that your hearts and minds
want to help, don't want to become in-
are with our kids, our brave soldiers in
volved because of a misplaced fear. They're
Panama, so let me just say a quick word
afraid of holding an AIDS patient because
about that. As I said yesterday, all human
they're frightened of getting AIDS. Barbara
life is precious. We're all children of a
and I want to say, and we hope we can
loving God, and we sorrow at the casualties
continue to demonstrate this, they are
in Panama. But we know that nothing is
wrong. They're simply uninformed. They
n-
more crucial to peace on Earth than free-
are wrong about that.
e
dom and democracy. And that's what our
A few minutes ago, we were in a room
n-
American soldiers are achieving: freedom
full of kids with AIDS, and you could just
e
and human liberty for those who have en-
feel the courage and character of the doc-
ed
dured brutal tyranny and brutal oppression.
tors and the nurses and the parents and the
And this weekend, Americans will begin
counselors. And being with them, I thought
a
our traditional holiday celebration. And it is
of how there is no reason to fear for your
tt
a time of rest and reflection and, most of
health, just their health. And I want to
he
all, of family. And while America stops to
thank those who are not afraid, especially
of
catch its breath from the dramatic events of
foster parents who have opened their
in
1989, I assure you that through these holi-
homes and their hearts, and those of you
days we will not forget our brave soldiers
here today who do so much for so many.
ni-
down there and their families. We will con-
And my good friend, Dr. Lou Sullivan,
aw
tinue to do what is necessary to help the
our Secretary-it's appropriate that he be
14,
people of Panama achieve the democratic
here with us today. He knows about com-
1987
Dec. 22 / Administration of George Bush, 1989
passion and understanding. And so do other
And God bless the United States of Amer-
December 16
great men and women of science and medi-
ica. And Merry Christmas to all. Thank you
Jack L. Powell, of Sal
cine. I think of our Assistant Secretary, Dr.
very, very much.
ganizes the annual
James Mason, or Dr. William Raub, the
his home town. B
Acting Director of NIH, who greeted us
Note: The President spoke at 12:34 p.m. in
House drive has rais
here; Doctor Fauci, who is still embar-
the Clinical Center. In his remarks, he re-
clothing for impove
rassed, I think, that I singled him out in the
Contributors have
ferred to Secretary Louis W. Sullivan,
last year as a hero, but he is; and Dr. Sam
school students to t
Under Secretary Constance Horner, Assist-
Broder and Robert Gallo, Dr. Antonia No-
pioneered the shop
ant Secretary James O. Mason, and Dr.
vello, the Surgeon-General-designate. Each
This technique has
of these dedicated scientists preaches com-
Frederick K. Goodwin, Administrator of the
organizations, inch
passion and understanding, as do others in-
Alcohol, Drug Abuse, and Mental Health
America, who colle
volved in treatment and research activities
Administration, of the Department of
in their 1989 food C
on AIDS at the NIH Clinical Center, from
Health and Human Services. The President
December 18
doctors and nurses to chaplains and social
also referred to the following National In-
stitutes of Health staff members: Dr. Wil-
Aja Dyani Henderso
workers, from teachers to dietitians. For ex-
Henderson, 15, saw
ample, the clinical pathology staff, the diag-
liam F. Raub, Acting Director; Dr. Anthony
hood. Children wh
nostic radiology staff, the nuclear medicine
Fauci, Associate Director for AIDS Re-
get to the public ]
staff-you are attacking the scourge of
search; Dr. Samuel Broder, Director, Na-
means of transpor
AIDS; and so are the laboratory scientists
tional Cancer Institute; Dr. John Decker,
brary in her own
engaged primarily in AIDS-related basic re-
Director of the Warren Grant Magnuson
in her community
search, all of the dedicated employees
Clinical Center; Dr. Joseph E. Rall, Deputy
own collection, sh
throughout all the institutions here.
Director for Intramural Research; Dr. Ka-
books. Unlike the
You know, there is a lot of talk about
therine L. Bick, Deputy Director for Extra-
open through the
AIDS today. And I hear those who say we
also volunteers in
mural Research and Training; Dr. Claude
have far to go. And, yes, they're right. But I
gram targeted at il
Lenfant, Director, National Heart, Lung
would also add: Look how far we've come.
and Blood Institute; Robert C. Gallo, Chief,
December 19
And look at the advances in vaccine devel-
Laboratory of Tumor Cell Biology, National
GlenCastle Project,
opment and early therapeutic intervention.
Cancer Institute; and Dr. Duane Alexander,
is transforming a
Look at the recently reported success of a
Director, National Institute of Child Health
cost housing for h
vaccine in animals or clinical studies which
and Human Development. Secretary Sullivan
to 1929, the Atla
show how AZT can retard the disease in
is a former president of the Morehouse
most infamous pr
infected individuals. Look at the treatment
School of Medicine. Prior to his remarks, the
ing it has been a
to prevent the onset of PCP, the pneumo-
President attended an AIDS family support
addicts. But next
nia that infects large numbers of AIDS pa-
group meeting. Following his remarks, the
reopen as a com
tients and often, regrettably, leads to death.
will include 67 a
President and Mrs. Bush flew to Camp
Where did these advances stem from?
lies, nonprofit fo
David, MD, for the Christmas holiday.
care center, a j
They're rooted in the biomedical research
chapel.
conducted and supported by NIH. And they
show the value of your commitment, and I
December 20
commend that commitment. They stem
Eugene Lang, of N
from your work which makes America
Points of Light Recognition Program
the founder of th
proud.
tion, which enco
Too often, we speak of compassion and
The President named the following individ-
school by offerin
understanding only in this time of year, the
port, and guara
Christmas season. You embody it, and you
uals and institutions as exemplars of his
education. In 198
live it all year round. And too often we
commitment to making community service
by offering to pe
forget the true message of this time of year.
central to the life and work of every Ameri-
group of Harler
It's that justice and kindness can indeed
can. The daily recognition program is in-
stay in school.
foster good will toward all.
tended as a national tribute of the highest
Dream" Found
order to every single American who makes a
chapters in 32 ci
You know that message. You live that
difference in the life of someone in need.
Lang giving bot
message. And for that, I thank you. And I
over 9,000 kids
want to wish you and your families a warm
volunteers in e:
and happy holiday season. God bless you
The President extends his appreciation to
develop relation
and those you are working so hard to save.
the following:
gram.
1988
A Private Sector
Leadership Response
to the Challenges
of AIDS
NATIONAL
LEADERSHIP
COALITION
ON AIDS
National Leadership Coalition on AIDS
Suite 202
1150 17th Street, N.W.
Washington, D.C. 20036
202/429-0930
GCIU C439
T.M. (Terry) Mulready
Pacific Bell
THE NATIONAL
Emilio R. Nicolas, Jr.
LEADERSHIP
KMEX-TV, Los Angeles
COALITION
Beny J. Primm, Jr., M.D.
Addiction Research Treatment Corporation
ON AIDS
Mervyn F. Silverman, M.D.
American Foundation for AIDS Research
A National Private Sector Response
The Rt. Rev. William E. Swing
Episcopal Diocese of California
to the HIV Epidemic
Larry H. Williford
Allstate Insurance Company
A
IDS, Acquired Immune Deficiency
Syndrome, is the most complex health
problem our nation faces today. An
insidious killer, the disease is spreading
SO rapidly that few will be spared its devastating
impact, either personally or indirectly. The
only hope of limiting its fatal spread and
dealing humanely with its tragic consequences
is for each of us to become actively involved.
It is none too early.
The rapidly-mounting numbers tell the
chilling story all too well. According to the
Centers for Disease Control, 68,220 cases of
AIDS had been reported in the U.S. by the
middle of 1988. Of those individuals, 38,541
have died.
The outlook is also bleak. The U.S. Public
Health Service estimates that by the year 1991,
285,000 will have AIDS, of whom 195,000 will
have died.
The global figures are shocking. As of June
30, 1988, 100,410 people are known to have
contracted AIDS worldwide, and
approximately half have already succumbed.
The World Health Organization documents
over 130 countries with cases of AIDS.
12
1
THE NATIONAL
BOARD OF DIRECTORS
LEADERSHIP
COALITION:
Officers
John R. Taylor
Chairman & CEO (Ret.), The Principal Financial Group, Chair
A Catalyst for Action
J. Richard Munro
As the challenges of the HIV epidemic
Chairman & CEO, Time Warner Inc., Vice Chair
steadily mount, there is also a growing
David N. Sundwall, M.D.
recognition that no single segment of our
Vice President, AmHS Institute, Vice Chair
society can marshal the resources required to
Karen Ignagni
respond to the fears and help individuals and
Assoc. Dir., Occupational Safety and Environmental Affairs,
AFL-CIO, Secretary
society cope with the burdens of AIDS.
Michael Pollard
That is why the National Leadership
Partner, Michaels & Wishner, P.C., Treasurer
Coalition on AIDS was established in May
B.J. Stiles
1987. Its goal is to bring together the
President
collective resources of the private sector-
Gwynn C. Akin, Ph.D.
corporate, non-profit and charitable-to
Syntex Corporation
respond to the AIDS crisis.
Lewellys F. Barker, M.D.
Composed of major corporations, labor,
American Red Cross
trade and professional associations, and key
Nora Kizer Bell, Ph.D.
civic, voluntary, religious, gay and ethnic
University of South Carolina
groups, the National Leadership Coalition
Erline Belton
reflects the diversity of American society.
Digital Equipment Corporation
Although they may differ ideologically, the
Edward N. Brandt, Jr., M.D., Ph.D.
College of Medicine, Oklahoma University, Health Sciences
Leadership Coalition's diverse members share
Center
a common commitment to helping people
Sharon Canner
with AIDS and their loved ones, and to
National Association of Manufacturers
preventing its further spread.
Glenn E. Haughie, M.D.
International Business Machines Corp.
William R. Hendee, Ph.D.
American Medical Association
Stephen E. Herbits
Joseph E. Seagram & Sons, Inc.
Stanley G. Karson
Center for Corporate Public Involvement
Larry Kessler
AIDS Action Committee of Massachusetts
Bryan Lawton, Ph.D.
Wells Fargo Bank
Sam S. McKeel
The Sun-Times Company
Stephen T. Moskey
Aetna Life & Casualty
11
2
The National Assembly of National Voluntary Health & Social
THE NATIONAL
Welfare Organizations, Inc.
National Association of People with AIDS
LEADERSHIP
National Coalition of Hispanic Health and Human Services
Organizations
COALITION:
National Council of La Raza
National Education Association
The National Foundation for Infectious Diseases
What We're Doing To Help America
National Gay & Lesbian Task Force
National Health Council
Face the AIDS Challenge
The National Hemophilia Foundation
While no cure or vaccine for AIDS is in
National Hospice Organization
1
The National Kidney Foundation
sight, the Leadership Coalition's members are
National Minority AIDS Council
working with other key executives and
New York University (School of Education, Health, Nursing
decision-makers to combat the epidemic. We
and Arts Professions)
The Salvation Army
are supporting improved education and
The Stop AIDS Resource Center
services and promoting the policies and
United Church Board for Homeland Ministries
United Way of America
strategies required to cope with the awesome
Volunteers of America
challenges of AIDS.
The Coalition represents business and labor
Local and Regional Associations, Voluntary, Religious,
in responding to AIDS, and encourages
and Educational Organizations
national private sector organizations to
AID Atlanta
collaborate in responding to the epidemic.
AIDS Foundation of Chicago
AIDS Resource Center
The Coalition bridges the gap between groups
Boston AIDS Consortium
recently emerging on the AIDS policy scene
California Medical Association
and those already established as experts.
The Carl Vogel Foundation
Citizens Commission on AIDS for the New York City-Northern
The National Leadership Coalition on AIDS
New Jersey Region
is not a lobbying organization. Rather, it has
Concern for Dying
Greater Detroit Area Health Council
these overall objectives.
Howard Brown Memorial Clinic
Instituto Familiar de la Raza-Latino AIDS Project
1. Improving understanding
Mothers of AIDS Patients
Philadelphia AIDS Task Force
This involves supporting informational
Phoenix Shanti Group, Inc.
campaigns about AIDS, highlighting emerging
Planned Parenthood of New York City, Inc.
needs stemming from the disease and its
San Francisco AIDS Foundation
Washington Metropolitan Area Business Leadership Taskforce
impact, and promoting balanced and informed
on AIDS
consideration of public policies involving
Whitman-Walker Clinic
AIDS.
Grantmaking Organizations
2. Encouraging cooperative efforts
American Foundation for AIDS Research
Design Industries Foundation for AIDS
This includes stimulating private sector
Funders Concerned About AIDS
involvement, improving business and labor
The Hunt Alternatives Fund
Pettus-Crowe Foundation
response to AIDS, enhancing public/private
sector collaboration, promoting American
10
3
traditions of justice, fairness and compassion,
Pfizer, Inc.
and sharing resources with and offering other
Pharmaceutical Manufacturers Association
Philip Morris Inc.
assistance to national and international
Playboy Enterprises, Inc.
organizations focusing on AIDS.
Polaroid Corporation
The Principal Financial Group
The Procter & Gamble Company
A Record of Accomplishment to Date
The Prudential Insurance Company of America
Public Relations Society of America
In the short time since its founding, the
Security Life of Denver
National Leadership Coalition has moved
Security Pacific Corporation
1
Service Employees International Union
swiftly to accomplish these objectives. These
Southern California Edison Company
activities include:
Southern New England Telephone
Spelling Entertainment, Inc.
Co-sponsored a conference with Allstate
Syntex (U.S.A.) Inc.
Time Warner Inc.
Insurance Company entitled "AIDS:
Transamerica Occidental Life Insurance Co.
Corporate America Responds." The
US WEST, Inc.
Union Carbide
landmark conference was attended by more
United Auto Workers - General Motors
than 350 senior executives and produced an
Wells Fargo Bank
influential report that is helping executives
address the implications of AIDS on their
National Voluntary, Religious, and Educational
organizations and businesses.
Organizations and Associations
Academy for Educational Development
Produced a brochure addressing AIDS in
AIDS Action Council
AIDSFilms, Inc.
the workplace. It has been distributed to
AmHS Institute
230,000 workers by 800 corporations and
American Academy of Family Physicians
businesses, including Joseph E. Seagram &
American College of Cardiology
American College Health Association
Sons, The Equitable Life Insurance Society,
American Hospital Association
and Pacific Northwest Bell.
American Institutes for Research
American Lung Association
Collaborated with Fortune magazine in
American Medical Association
launching a groundbreaking survey that
American Nurses Association
American Pharmaceutical Association
analyzed CEO attitudes and actions in
American Psychological Association
response to AIDS, and developed several
American Public Health Association
AIDS presentations for the annual Fortune
American Red Cross
Corporate Communications Seminar.
American Society of Hospital Pharmacists
Association of American Medical Colleges
Helped to form regional and industry task
The Association of Junior Leagues
Catholic Health Association
forces on AIDS.
Center for Community Change
Center for Population Options
Co-sponsored with PBS a videoconference
Children's Defense Fund
in May, 1988 on "AIDS: A Matter of
The Episcopal Church Center
Corporate Policy." This closed-circuit, four-
Gay Men's Health Crisis
Health and Welfare Ministries, General Board of Global
hour training conference involved over
Ministries, United Methodist Church
3,000 managers from 140 American cities
Healthcare Financial Management Association
and focused on the development of
Hospice Foundation
Human Interaction Research Institute
corporate policies towards AIDS by business
Human Rights Campaign Fund
executives.
National AIDS Network
4
9
ROSTER OF MEMBERS
Assisted the Presidential Commission on the
HIV Epidemic in selecting topics, obtaining
Business and Labor
and preparing witnesses, developing
Abbott Laboratories
materials for its report, and seeking support
Abt Associates
for the Commission's work.
Aetna Life & Casualty
Allstate Insurance Company
American Brands, Inc.
Presented briefings and training seminars at
American Council of Life Insurance
more than 25 local/regional/industry
American Federation of Labor and Congress of Industrial
gatherings that focused on corporate and
Organizations
American Federation of State, County & Municipal Employees
business concerns about AIDS policies.
American Federation of Teachers
Coordinated briefings and seminars for
American Telephone & Telegraph
Apple Computer, Inc.
grantmakers and grantseekers interested in
Associated Madison Companies, Inc.
filling gaps.
Bellcore
Blue Cross Blue Shield Association
Boeing Commercial Airplane Company
Education as Our Primary Weapon
Bristol-Myers Squibb Company
Burroughs Wellcome Company
Why We Need Your Help
CBS, Inc.
CIGNA Corporation
Our primary weapon against further
Chevron, U.S.A., Inc.
transmission of the HIV virus is eduation.
Ciba-Geigy
Every American should understand that AIDS
Digital Equipment Corporation
Employee Assistance Professionals Association, Inc.
is preventable and how each person can
The Equitable Life Assurance Society
protect him or herself.
Foote, Cone & Belding
Yet this education needs to be undertaken
General Electric
General Mills, Inc.
on a scale that no single entity or sector can
Group Health Association of America
hope to accomplish on its own. The same is
Health Industry Manufacturers Association
Health Insurance Association of America
true for other actions urgently needed today.
Hoffmann-La Roche Inc.
Only a unified effort has any chance of success
Institute for Disease Prevention in the Workplace
to counter this true epidemic.
International Business Machines Corp.
Johnson & Johnson
The National Leadership Coalition on AIDS
Joseph E. Seagram & Sons, Inc.
is leading a collaborative effort, and we urge
Levi Strauss & Co.
you to join our ranks. The larger our
Levine, Huntley, Schmidt & Beaver
Lincoln National Corporation
membership, the more effective we will be.
Loews Hotels Corporation
Your active participation can make a valuable
Marshall Field & Company
contribution.
Maytag Corporation
Mead Corporation
We are counting on your support-on
Mercantile and General Reinsurance Company
behalf of the hundreds of thousands who will
Merck & Co.
be afflicted-and on behalf of all of us who
Meredith Corporation
Metropolitan Life Insurance Co.
will be affected in one way or another.
Mobil Oil Corporation
Motorola, Inc.
NCR Corporation
National Association of Chain Drug Stores
National Association of Home Builders
National Association of Manufacturers
Northwestern Mutual Life Insurance Company
Ogilvy & Mather
Pacific Bell
8
5
Membership Benefits
NATIONAL
The National Leadership Coalition on AIDS
LEADERSHIP
offers members a key role in joining forces
COALITION
to limit the impact of a disease that would
otherwise go unchecked.
ON AIDS
Specific membership benefits include:
Membership Enrollment Form
Immediate access to the only national
Yes, I want to become a member of the
network of corporate and non-profit
National Leadership Coalition on AIDS. Please
organizations actively concerned with AIDS
enroll me as a:
issues.
Membership Categories
Annual Dues
A bi-monthly resource packet of timely
Business/Labor
$1,000
materials that describes what the Coalition,
its members, and other groups are doing to
National Voluntary
combat AIDS. Included are samples of the
Organization Member
500
latest resources available to fight this battle.
Local Voluntary Organization
The opportunity to play a leadership role in
Member
100
the war against AIDS.
Grantmaking Organization
Please complete the membership form and
Member
1,000
join the National Leadership Coalition on AIDS
Associate Member
100
today!
(Individuals who wish to support the purposes of the
National Leadership Coalition on AIDS)
Name
Title (if Corporate/Organization Member)
Company/Organization (if appropriate)
Address
City
State
Zip
Phone No.
Please return this form to:
B.J. Stiles
President
National Leadership Coalition on AIDS
1150 17th Street, N.W. Suite 202
Washington, D.C. 20036
(202) 429-0930
6
7
Business
and Labor
speak out onAIDS
NATIONAL
LEADERSHIP
COALITION
ON AIDS
202/429-0930
Washington, D.C. 20036
1150 17th Street, N.W.
Suite 202
National Leadership Coalition on AIDS
"The AIDS epidemic
is a rip in the
fabric of our society.
Left unmended, it will unravel
"
Contents
FOREWORD
4 Edward N. Brandt, Jr., M.D., Ph.D., Chair,
National Leadership Coalition on AIDS
A CORPORATE OVERVIEW
7 Robert D. Haas, Chairman & CEO, Levi Strauss &
Company
AIDS: A CHALLENGE TO BUSINESS
17 Albert Bowers, Ph.D., Chairman & CEO, Syntex
Corporation
18 Anthony A. Herrmann, M.D., Vice President,
Johnson & Johnson
18 Richard J. Haayen, Chairman & CEO, Allstate
Insurance Company
19
Ann McLaughlin, former Secretary, Department of
Labor
19 Andrew V. Smith, President, Pacific Northwest Bell
20 Bryan Lawton, Ph.D., Vice President & Director,
Employee Assistance Services, Wells Fargo Bank
20
Stanley G. Karson, Director, Center for Corporate
Public Involvement
21
Admiral James D. Watkins (Ret.), Secretary,
Department of Energy and former Chairman,
Presidential Commission on the Human
Immunodeficiency Virus Epidemic
21
Ronald B. Eisenhauer, Vice President, Sales, U.S.
Central Area, Digital Equipment Corporation
22 Peter W. Bertschmann, Vice President, Human
Resources, New England Telephone
22
Robert V. Van Fossan, Chairman & CEO, Mutual
Benefit Life Insurance Company
23 Robert A. Beck, Chairman Emeritus, Prudential
Insurance Company of America
23
Sandra S. Person, Executive Director, Houston
Area Health Care Coalition
AIDS: A NEED FOR CIVIC RESPONSIBILITY
24 John J. Sweeney, International President, Service
Employees International Union
25 Lawrence H. Williford, Senior Vice President,
Allstate Insurance Company
25
David R. Carpenter, Chairman & CEO,
Transamerica Occidental Life Companies
26 Herbert E. Lister, Chairman, Allstate Insurance
Company
26 Charles E. McKittrick, Jr., Vice President,
Governmental Programs, International
Business Machines
27
P. Roy Vagelos, M.D., Chairman & CEO, Merck
& Company
2
27 Richard S. Schweiker, President, American Council
of Life Insurance
28 John B. Carter, President & CEO, Equitable Life
Assurance Company
28 Jordan A. Barab, Occupational Safety & Health
Coordinator, American Federation of State,
County and Municipal Employees
29 Carl J. Schramm, President, Health Insurance
Association of America
30 Margaret M. Seminario, Associate Director,
Department of Occupational Health, Safety
and Social Security, AFL-CIO
31 William F. Sinclair, President, Greater Washington
Board of Trade
31 Al Shanker, President, American Federation of
Teachers
32 Gwynn C. Akin, Ph.D., Director of Health Policy,
Syntex Corporation
AIDS: A CALL FOR LEADERSHIP
33 Admiral James D. Watkins (Ret.), Secretary,
Department of Energy and former Chairman,
Presidential Commission on the Human
Immunodeficiency Virus Epidemic
34 John J. Creedon, President & CEO, Metropolitan
Life Insurance Company
34 Benneville N. Strohecker, President, Harbor Sweets
35 Sam S. McKeel, Publisher & Chairman,
Philadelphia Newspapers, Inc.
35 Theodore Cooper, M.D., Ph.D., Chairman &
CEO, The Upjohn Company and Chair,
Committee for the Oversight of AIDS
Activities, Institute of Medicine
36 Mary Hatwood Futrell, President, National
Education Association
36 Terry M. Mulready, Vice President-External
Affairs/Corporate Communications, Pacific Bell
37 Paul A. Ross, Ed.D., Manager, AIDS Program
Office, Digital Equipment Corporation
37 William K. Borwegen, Director, Occupational
Health & Safety, Service Employees
International Union
38 Arthur H. White, President & CEO, WSY
Consulting Group, Inc.
39 James W. Curran, M.D., M.P.H., Director, AIDS
Program, Centers for Disease Control
40 Sanford Cloud, Jr., Vice President, Corporate
Public Involvement, AEtna Life & Casualty
Foundation
40 Otis R. Bowen, M.D., former Secretary,
Department of Health and Human Services
3
Edward N. Brandt, Jr., M.D., Ph.D
Chair, National Leadership Coalition
on AIDS
Foreword
AIDS is one of
the most serious health problems facing America
today. Measured in terms of actual and potential
costs, and in human suffering, AIDS challenges
every sector of society. It calls for bold, innova-
tive responses. It demands leadership as the na-
tion mobilizes its resources.
AIDS presents
opportunities as well as challenges, especially for
business and labor. It may challenge our ability
to do business. But we can meet this challenge by
actively dealing with AIDS as a workplace issue.
AIDS also offers US an opportunity to fulfill an im-
portant civic responsibility. We can serve the pub-
lic interest by sponsoring education, mobilizing
communities, supporting AIDS services and pro-
grams, and actively contributing to the nation's
response. Finally, AIDS is a call for leadership in
a time of crisis.
AIDS is not a
problem of government. It is a problem of society.
Everyone, including business and labor, must be-
come involved in finding solutions. Local commu-
nities need help as they mobilize their resources
to fight AIDS. Above all, they need leadership.
Business and labor can provide this leadership,
just as we have at other critical times in our na-
tion's history.
Many com-
panies and labor unions have courageously spo-
ken out on AIDS. The speech by Robert D. Haas,
Chairman & CEO of Levi Strauss & Company, de-
livered in Boston on March 16 in conjunction with
the presentation of the George S. Dively Award
for Corporate Public Initiative, exemplifies the
highly visible leadership role of one outstanding
corporate executive. Other executives and labor
leaders cited in this booklet also have taken
forceful positions.
Some companies
remain on the sidelines. They are convinced that
because they and their communities are not yet
directly experiencing the impact of the epidemic,
there is no need to become involved. The AIDS
epidemic has just begun, however. The full impact
is still in front of us. The costs to business and la-
bor, as well as to society, could be high. But in
fact, tomorrow's costs will depend in large part
upon what business and labor do today.
Edward N.
5
AIDS:
Meeting Tomorrow's
Challenge
ROBERT D. HAAS, CHAIRMAN & CEO, LEVI STRAUSS &
COMPANY
Delivered at the presentation
of The George S. Dively Award
For Corporate Public Initiative
Harvard University
March 16, 1989
6
A Corporate Overview
It is a great honor
for me to address this audience of influential business,
academic and community leaders. We are joined
together today by our concern about AIDS, a subject
of critical importance.
ften when we
talk about the HIV epidemic, we get caught up in the
technical language of medicine or the impersonal realm
of statistics. I think it's important to focus on the human
dimension of the epidemic.
very day in this
country, and around the world, an increasing number of
people find themselves locked in the battle with this
grave and relatively new illness. They wage this fight
with courage. Sometimes they are alone. Sometimes
they have the love and support of family, friends
and community.
When I think
about AIDS, I see people's faces-a dear friend, employ-
ees with whom I worked closely. You may recall faces
of people you know who have been stricken by this re-
lentless disease. Please remember these faces as I speak.
By recalling them, what I am going to say will become
more personal for each of us.
AIDS reaches well
beyond those we know. Its deadly embrace ensnares men,
women and children of all ages, colors and nationalities;
in San Francisco, in Boston and around the globe. For
every individual who is diagnosed, there's an immediate
circle of family and friends who are affected. Many of you
know and deal directly with the consequences of AIDS.
While scientists
struggle to find a cure, the grim toll keeps rising. If we
were to pause now and devote a second to each person
with AIDS, our silent tribute would last nearly 24 hours.
Two years ago, it would have been 10 hours. Five years
from now, we would sit silently for five days. Even
then we would be a little short. That's how fast the
number of cases is rising.
As of 1986, there
were 37,000 cases. As of last year, 85,000 cases. The
Public Health Service estimates that five years from
now, there will be over 450,000 cases.
7
ublic health ex-
perts say it won't be long-a mere three years-before
American deaths from AIDS will reach roughly three
times the number of deaths of all American service per-
sonnel in the Vietnam War. To use another yardstick, in
its first decade, AIDS deaths will exceed all lives lost
during the polio epidemic that raged for 40 years. This
rising tide of suffering and sorrow means a flood of new
faces for us to remember in the future.
Yet despite these
horrifying statistics, our response to AIDS has been be-
lated and tentative. Why? I believe our hesitancy is due
to the fact that in this country, AIDS has had its greatest
impact on people without a voice-people in groups that
our society shuns or ignores: gay men, IV drug users
and the poor.
ur task, as a
"kinder and gentler" nation, as compassionate people, is
to make sure that those with AIDS are not isolated. Our
task is to break the silence about AIDS, to give help to
those in need, and to limit the further spread of this
heartless epidemic.
Today, I stand be-
fore you representing a corporation headquartered in San
Francisco. Our company has operations in large cities
such as Knoxville, El Paso and Little Rock. We also
have plants in smaller communities such as Valdosta,
Georgia; Florence, Kentucky; and San Benito, Texas.
We also have facilities in Canada, Europe, South Amer-
ica and in the Pacific Rim countries.
From our experi-
ence in each of these communities, I can tell you that
business cannot hide from this disease, no matter where
it operates, whether in the U.S. or abroad, in small cities
or large. Yet in this country, fewer than one company in
10 has an AIDS program or policy.
The front lines of
the AIDS war are advancing beyond cities like San Fran-
cisco and New York. The Public Health Service says
that within a few years, 80 percent of new HIV infec-
tions will occur outside those areas where the infection
currently is concentrated.
8
learly, one way
or another, the HIV epidemic will have an impact on
every business, large and small. Business leaders have a
simple choice. We can wash our hands of the problem
and be content with the decisions made by others, or we
can roll up our sleeves and influence how this horrible
epidemic is managed and mitigated.
If you have not al-
ready confronted the direct impact of HIV on your oper-
ations, you soon will. What will happen in your com-
pany when a person diagnosed with AIDS returns to
work? Will other employees walk off the job? What will
happen in your company when co-workers become hys-
terical because they think the memos the department
secretary has been handling might transmit AIDS? What
will happen when a key member of your staff is work-
ing on a critical assignment and becomes too ill to
handle the task?
None of us should
underestimate the practical impact this epidemic will have
on us, our customers, our suppliers and the way we
conduct our everyday business. Additionally, business
has a stake in this epidemic that goes well beyond its
short-term effects on our operations and financial results.
usiness cannot
shoulder the burdens of government or family or indi-
vidual responsibility. But neither can it shirk its own ob-
ligation to address a social problem of this magnitude. It
would be immoral and unconscionable for us to do so.
Each of us must act to ensure that this does not occur.
Six major areas
need our attention and involvement. Each is crucial.
Taken together, these issues represent an agenda for ac-
tion that addresses the legitimate needs of business and
our communities.
Discrimination
At the top of the
list is discrimination. The Presidential Commission on
the Human Immunodeficiency Virus Epidemic identified
discrimination as the most significant obstacle to prog-
ress against the epidemic. A few months ago, researchers
9
at the Harvard School of Public Health published a
study. It showed just how great that obstacle is. Here
are some of the findings:
One in four Americans would refuse to work beside
a person with the disease.
Forty percent are opposed to having people with
AIDS live in their neighborhoods.
About half that group-17 percent-said people with
AIDS should be banished to an island as lepers
once were.
Nearly a third of the people favored requiring any-
one with a positive HIV blood test to be tattooed.
These are views
grounded in fear and ignorance. But they affect every re-
gion of our country and every person fighting the virus.
This kind of dis-
crimination destroys housing and jobs for those afflicted.
It blocks access to education, insurance and health care.
It tears families apart. Ultimately, it undermines efforts
to control the disease. So long as those infected or those
at high risk fear losing their jobs or housing or insur-
ance, they will be reluctant to come forward for testing,
counseling and care.
The sad thing is
that from a health standpoint, there's no need to treat
people with AIDS differently. As the Presidential Com-
mission pointed out, in the vast majority of settings-the
workplace, housing, schools-there's virtually no risk of
contracting the disease from someone who has it.
The Harvard re-
port also suggested that if past epidemics are any guide,
hostility and discrimination will increase as more people
are personally threatened with the disease. This may in-
deed be the case as the epidemic spreads rapidly-as it
is-among IV drug users and urban low-income and mi-
nority communities.
What can business
do to fight discrimination? It must start by weeding out
discriminatory practices in its own operations. Dismissal
of workers with AIDS must stop. Using pre-employ-
ment testing to screen out HIV-infected persons must
stop. From a purely practical standpoint, litigation costs
arising from such policies can be ruinous.
10
ut more impor-
tantly, business men and woman have a responsibility to
their fellow human beings not to abandon or discard
them when they most need our care and concern. Em-
ployees with AIDS have the right to assume that their
employers will fulfill their contract to provide medical
care and disability benefits.
usiness must also
support federal legislation to shield HIV-infected people
from discrimination in the private sector. Currently,
they are protected by law only in the public sector.
Education
The second issue
on my agenda is education. Fear and ignorance fuel dis-
crimination. They also foster the spread of the epidemic.
To press the attack on both fronts calls for greater use
of a powerful and indispensable weapon-education
about HIV.
ducation pro-
grams must be clear and direct so there's no confusion
about how HIV is transmitted. Last month, the National
Research Council reinforced the importance of clear, ex-
plicit communication, customized for each specific
group. Education programs must be pushed aggressively
into every corner of society, from schools to the work-
place. We especially must reach young people. The
number of AIDS cases is doubling each year among
those 13 to 21 years of age. A small study conducted at
a shelter for run-away youths in New York City found
that approximately 40 percent of the adolescents were
infected with HIV.
What can business
do to fight fear and ignorance? Every company must es-
tablish an education program for its workers and their
families. Employers have one of the clearest and most
direct channels of communication to enormous numbers
of people. Experience bears out that workers' attitudes
and reactions reflect those of management. Straight talk
about AIDS can dispel myths that cause fear.
ducating employ-
ees also has a beneficial ripple effect-informed employ-
ees share important concerns with family members,
11
friends and neighbors. Workers at Levi Strauss & Com-
pany have responded well to AIDS information pre-
sented in the workplace. We also know that having an
education program in place before the problem arises can
minimize disruption, maintain employee morale,
and reduce incidence of discrimination against HIV-
infected employees.
In short, AIDS ed-
uation works well in business. And it works for com-
munities, too. San Francisco's experience has shown that
education, when part of a broad-based community pre-
vention strategy, can help stop the epidemic. In San
Francisco, the annual rate of new infections among gay
men is less than 1 percent. That compares to a rate of 10
to 25 percent just several years ago.
This experience
must be replicated across the country. But this cannot be
done without leadership from the business and public
health communities. As a community citizen, business
can act as a catalyst to bring together the appropriate
community organizations and leaders to start a commu-
nity on the road to halting the epidemic. Once a forum
is created, business can use its influence to ensure calm
and considerate deliberation of the issues.
I am pleased that
business task forces on AIDS, such as the New England
Corporate Consortium in Boston and the Metropolitan
Business Task Force in Washington, D.C., are becoming
active in a growing number of cities. I also want to rec-
ognize the pioneering and excellent work being done by
the National Leadership Coalition on AIDS to marshal
the resources of both business and labor.
Prevention
third issue we
must face is prevention. Here, our efforts are thwarted by
uncertainties about the scope of the epidemic and our in-
ability to identify people who require treatment and
care. Widespread, confidential testing is essential if we
are to stop the spread of AIDS. But it will happen only
if it's voluntary, and only if the results are kept abso-
lutely confidential. And it will never happen if we don't
take the anti-discrimination measures I talked about first.
12
What can business
do to limit the spread of AIDS? We should support
voluntary, confidential testing and oppose efforts that
threaten people's basic rights. This is important so
people with HIV are identified and can get treatment
and care.
Recently, business
in California did just this. Scores of major employers,
including Levi Strauss & Company, stood up with doc-
tors, nurses and others and said that violating confiden-
tiality was bad medicine and bad public health policy.
Our intervention helped defeat, by a two-to-one margin,
a very damaging initiative to require mandatory report-
ing of the names of those testing positive for HIV. Past
epidemics have often pitted the civil liberties of indi-
viduals against the rights of the public. This time, for-
tunately, supporters of civil liberties and public health
authorities are on the same side.
dditionally, busi-
ness should encourage new approaches for changing be-
haviors which lead to HIV infection. We can educate our
employees who can then educate their young people.
Paying for Health Care
Next on my
agenda is the need to review the way we pay for health
care in this country. The HIV epidemic has exposed and
intensified the shortcomings of our current system. One
in five AIDS patients has no insurance. Forty percent of
all AIDS patients must rely on Medicaid-more than
four times the proportion in the population at large. At
one public hospital in Texas, fully 75 percent of its
AIDS patients have no health insurance.
This trend may be-
come even more pronounced in the future. Increasingly,
private health insurance carriers appear to be screening
out HIV-infected persons, thus shifting the cost of their
care to the public sector. Infected workers who are em-
ployed by self-insured companies or companies with
small group plans are being denied coverage.
What can business
do to address the payment issue? It must forcefully artic-
ulate three messages. First, Medicaid's purse strings must
13
be loosened and its waiting period reduced. Second, the
public sector must respond to this issue. Third, private
health insurance must be bolstered.
Health care must
be accessible to everyone, including those with HIV.
Business must work cooperatively with insurance com-
panies to devise new cost-effective and humane solu-
tions, such as volunteer home care. Then business
must lead the way in testing these solutions and adopt-
ing the best.
Managing Health Care Services
The next issue on
my agenda is the need to deliver health care services in
more efficient ways. HIV is becoming a chronic disease.
People are living longer and need ongoing health care.
What can business
do to change the way health care services are managed?
One promising innovation is case management. This
technique involves assigning one person to manage all
aspects of a patient's care-from dealing with social
workers and arranging housing, food, home and hospice
care to helping decide when a patient must be hospital-
ized. Business can make a difference by taking the lead
in bringing together the appropriate community re-
sources to implement new models of care. We must
challenge our benefits people. We must tell them to pull
together and draw upon these resources so we can help
our employees with AIDS rather than restrict them, and
ourselves, to traditional formulas.
San Francisco has
developed a case-management model that provides a
comprehensive, integrated system of community-based
services for people with HIV. This model resulted from
a creative collaboration between the private and public
sectors. Other communities can cut the costs of health
care by following this approach or by developing their
own models.
14
Government HIV Policy
The final issue on
my agenda is the need to develop a government policy
toward the HIV epidemic. Confused and cautious
thinking and a lack of leadership in government only
makes it more difficult to address AIDS-related issues in
the workplace.
What can business
do to infuence government policy? Employers have a re-
sponsibility to themselves and their employees to pro-
mote enlightened approaches to the epidemic and to op-
pose political measures based principally on fear. We
should exert our influence at the local, state and national
levels to assure rational government policies regarding
the disease. These policies must be free from hysteria
and political agendas. They must reflect scientific facts
rather than extremist views.
Whenever business
leaders talk to government leaders, at whatever level, on
whatever topics, we must raise the question of what's
being done about AIDS.
adical solutions
may be needed in some instances. Consider the magni-
tude of the nation's drug problem and the ineffectiveness
of what we have done so far to solve it. Yet health ex-
perts tell us our ability to control the course of the HIV
epidemic depends greatly on our ability to control drug
abuse. With lives being lost at an alarming rate, now is
not the time for caution. AIDS isn't a conventional
problem. So when we think about how to deal with it,
we have to open ourselves to unconventional solutions.
And that involves risk.
Call for Leadership
I call upon the
business leaders of our nation-including those at the top
of our biggest, most prestigious, most powerful corpo-
rations-to join me in the fight to defeat this devastating
disease. It's not someone else's fight. It's ours. We have
the resources to do it. We have the ability to make a dif-
ference. The question is, do we have the will?
Can we break the
inertia of "business as usual?" Can we put aside political
differences? Are we willing to fight homophobia and in-
difference toward the poor?
15
If we can't, several
things will happen. There will be more AIDS cases than
need be. Expenses of dealing with AIDS will be higher
than they should be, draining resources from other na-
tional priorities. And it will cost business more-in inef-
ficiency and disruption in the workplace, in employees'
lives, in health insurance premiums, and in tax dollars.
This need not, and should not be, the case.
The business com-
munity cannot do this alone. We need partners. It will
take a concerted and cooperative effort-federal, state
and local governments, business, labor, our educational
institutions, the religious community, health care profes-
sionals, and private citizens.
As a nation, we
are good at facing local, limited emergencies-quenching
forest fires, rescuing a tiny child from an abandoned
Texas well, or freeing whales from the ice in Alaska.
But can we pull together as a nation to face this emer-
gency of national proportions?
I
believe we can, if
prominent leaders from every segment of society are en-
gaged in the battle against AIDS, starting with the Presi-
dent of the United States. President Reagan glossed over
the findings of his own Presidential Commission. As
Vice President, George Bush endorsed the Commission's
work, particularly the anti-discrimination recommenda-
tions. I am eager for President Bush to tell the nation
what his administration will do to address AIDS.
The AIDS epi-
demic is a rip in the fabric of our society. Left un-
mended, it will unravel. If we don't act, the issues of the
future won't be the six I've outlined here. There will be
only nagging questions: Why didn't we move sooner?
Why did we hang back, fearful and timid?
And if this comes
to pass, the faces we remembered earlier today will
haunt us forever.
16
AIDS:
A Challenge to
Business
All of us in business should be
asking ourselves the following
questions: What will you do
when an employee develops
AIDS? When an employee is
believed to be infected with the
AIDS virus? When co-workers
refuse to work with a person
thought to have AIDS? When an
infected employee asks for your
help? I urge you to take action.
Because this is a crisis situation.
ALBERT BOWERS, Ph.D, CHAIRMAN & CEO,
SYNTEX CORPORATION
San Francisco Chronicle
March 14, 1988
17
AIDS cuts across all segments of society. It can
disrupt families, schools, communities and work-
places. Johnson & Johnson is no exception. Like
other corporations, we are committed to the health
and safety of our employees and their families.
This commitment cannot be met unless we are will-
ing to join the effort against AIDS.
ANTHONY A. HERRMANN, M.D., VICE PRESIDENT,
JOHNSON & JOHNSON
Testimony before the Presidential
Commission on the Immunodeficiency
Virus Epidemic, May 10, 1988
AIDS is on the verge of becoming a
multi-billion dollar a year problem
for American business-just in terms
of lost productivity. These costs will
be passed on to corporations and
individuals. So it makes sense from a
purely practical point of view to
invest time and money in the effort to
deal with this social issue. And these
economic considerations add to-
not detract from-our very human
response to the suffering associated
with AIDS.
RICHARD J. HAAYEN, CHAIRMAN & CEO, ALLSTATE
INSURANCE COMPANY
Allstate Forum on Public Issues,
AIDS: Corporate America Responds,
October 13, 1987
18
A recent survey of U.S.
executives ranked AIDS as the
third most pressing problem
facing the United States,
behind the federal deficit and
drug abuse. Yet only seven
percent of all corporations
have an AIDS policy. It's time
now for businesses to act.
ANN McLAUGHLIN, FORMER SECRETARY, DEPARTMENT
OF LABOR
AIDS Frontline Healthcare
Conference,
Washington, D.C., January 9, 1989
Corporate America is long overdue in
stepping up to the problem of AIDS as it
affects the workplace-and our lives in
general. AIDS leaves a trail of sorrow,
bitterness, and fear. It can immobilize a
workforce. It can damage productivity. No
business wants or can afford that. So we
must address AIDS directly. AIDS
challenges business-as a community and
a family-to renew our commitment to
love one another today. Because for those
with AIDS, there is no tomorrow.
ANDREW V. SMITH, PRESIDENT, PACIFIC NORTHWEST
BELL
Speech before the Seattle Rotary,
August 10, 1988
19
Large companies have a duty and
responsibility not only to help their
employees deal with AIDS, but also
to share information, expertise and
resources with smaller companies
and with the community. AIDS is a
community problem. Because of
this, it is a problem for business. If
we don't unite around our common
best interests, AIDS will cause
devastating problems for business.
BRYAN LAWTON, Ph.D., VICE PRESIDENT & DIRECTOR,
EMPLOYEE ASSISTANCE SERVICES, WELLS FARGO BANK
Second Annual National Disability
Management Conference,
Washington, D.C., October 17, 1988
One measure of good corporate
management is its ability to assess
and adjust to new conditions and
needs. Corporate leadership and
support in the battle against AIDS
are surely logical results of good
corporate management. It would
also be in the finest tradition of
corporate public involvement.
STANLEY G. KARSON, DIRECTOR, CENTER FOR
CORPORATE PUBLIC INVOLVEMENT
Editorial, Response,
August 1986
20
The easy work-building a
national strategy to deal with
AIDS-is over. Now the tough
part-implementing that
strategy-has begun. Business
has a mandate not just to
participate, but also to help lead
the nation as it undertakes its
response to AIDS. It has a
mandate because AIDS is a
problem of human resources and
human capital, and of our ability
to compete. And these are
fundamentally business problems.
ADMIRAL JAMES D. WATKINS (RET.), SECRETARY,
DEPARTMENT OF ENERGY AND FORMER CHAIRMAN,
PRESIDENTIAL COMMISSION ON THE HUMAN
IMMUNODEFICIENCY VIRUS EPIDEMIC
Private Sector Leadership Conference
on AIDS, Chicago, 1988
Businesses cannot afford to ignore or walk
away from the AIDS problem. AIDS will
affect the workforce for years to come. If
we do not address AIDS now from a
business perspective, we might not be
able to recoup our losses in the future.
RONALD B. EISENHAUER, VICE PRESIDENT, SALES, U.S.
CENTRAL AREA, DIGITAL EQUIPMENT CORPORATION
Private Sector Leadership Conference
on AIDS, Chicago, 1988
21
When nine major corporations
band together on any issue, as we
have done in the New England
Corporate Consortium for AIDS
Education, it makes a powerful
statement. And we wanted to
make a powerful statement to our
employees, to other businesses,
and to the community at large,
that we are concerned for our
employees, and for the
community as a whole.
PETER W. BERTSCHMANN, VICE PRESIDENT, HUMAN
RESOURCES, NEW ENGLAND TELEPHONE
Testimony before the Presidential
Commission on the Human
Immunodeficiency Virus Epidemic,
May 10, 1988
We must not lose sight of the
fact that social problems,
including AIDS, affect every
sector in society. Corporate
America can help to build
stronger communities.
Stronger communities make
for a stronger economy, and
that is good for business.
ROBERT V. VAN FOSSAN, CHAIRMAN & CEO, MUTUAL
BENEFIT LIFE INSURANCE COMPANY
Annual Forum, National Assembly of
National Voluntary Health and
Social Welfare Organizations, Inc., June 1988
22
No one in the private sector can
feel that AIDS is someone else's
problem. By 1991, in addition to
human tragedies, AIDS-related
illnesses and premature deaths
are expected to cost business
and industry more than $50
billion in lost productivity. So we
have a clear reason to become
involved-not just for altruistic
reasons but also because it is in
our own self-interest.
ROBERT A. BECK, CHAIRMAN EMERITUS, PRUDENTIAL
INSURANCE COMPANY OF AMERICA
National AIDS Network Skills-
Building Conference, New Orleans,
October 21, 1988
AIDS offers a window of
opportunity for business, as well
as the nation. If we can jump the
barriers for AIDS, we can also
jump them for mental health, low
birthweight babies, cancer, heart
disease and the litany of plagues
in American health. The real cost
of AIDS will be in lost life.
Families will lose loved ones.
Industries will lose workers. No
one can yet predict the full costs of
AIDS to business or to our nation.
SANDRA S. PERSON, EXECUTIVE DIRECTOR, HOUSTON
AREA HEALTH CARE COALITION
Health Agenda 1988, the Washington
Business Group on Health and
National Association of Manufacturers
23
AIDS:
A Need for Civic
Responsibility
If AIDS is truly "Public
Enemy Number One," then
all unions have a
responsibility to become
involved, to push for
increased support for research,
education, and services to
people with AIDS.
JOHN J. SWEENEY, INTERNATIONAL PRESIDENT,
SERVICE EMPLOYEES INTERNATIONAL UNION
AIDS Frontline Healthcare
Conference, Washington, D.C.
January 10, 1989
24
In a pluralistic society, business,
like every other institution, must
serve the public interest. AIDS
qualifies as one of society's major
problems. It's going to become
even more serious in the near
future. By helping fight AIDS, we
can dispel the myth that big
business can't act quickly or
decisively when confronted with a
significant challenge.
LAWRENCE H. WILLIFORD, SENIOR VICE PRESIDENT,
ALLSTATE INSURANCE COMPANY
Fortune Corporate Communications
Seminar, LaQuinta, California,
March 23, 1988
The question isn't whether business
should become involved. It's what can
business do. The answer is
straightforward. Make sure employees get
the real facts about AIDS. Support the
activities of worthwhile AIDS groups in the
community. Provide financial help to
medical and research organizations. AIDS
is too big for any one of US to battle
alone. Other businesses must join US in
this fight. By working together, we can
make a real difference.
DAVID R. CARPENTER, CHAIRMAN & CEO, TRANSAMERICA
OCCIDENTAL LIFE COMPANIES
Press Conference for the American
Foundation for AIDS Research,
Los Angeles, January 14, 1986
25
Companies large and small must
move AIDS to the top-or near the
top-of their public service agendas.
We want people to join with each
other-inside and outside the busi-
ness community-to emphasize
everyone's stake in dealing with this
deadly disease.
For once and, I hope, for all, busi-
ness can make a difference. In the
process, we can demonstrate that
business believes in values beyond
the bottom line. We can show that
when the call to care was sounded,
corporate America answered.
HERBERT E. LISTER, CHAIRMAN, ALLSTATE INSURANCE
COMPANY
Allstate Forum on Public Issues,
AIDS: Corporate America Responds,
January 20, 1988
AIDS raises serious questions
for business, not the least of
which is how we can prepare
not just our employees but
also our communities. If we
start working together now,
we can come up with answers
that will help us deal with this
problem fairly and responsibly.
CHARLES E. McKITTRICK, JR., VICE PRESIDENT,
GOVERNMENTAL PROGRAMS, INTERNATIONAL BUSINESS
MACHINES
Press conference announcing the
formation of the Washington
Metropolitan Area Business
Leadership Task Force on AIDS,
January 11, 1989
26
The scientific, medical, and educational
progress needed to control AIDS will
depend largely on support from all
influential elements of society, including
business leaders like yourselves. / urge
the leaders of American business to do
their part. Because business leaders can
exert a very constructive influence on the
outcome of this epidemic.
P. ROY VAGELOS, M.D., CHAIRMAN & CEO,
MERCK & COMPANY
Address to The Business Council,
October 10, 1987
Business must be involved in the
fight againt AIDS. First and
foremost, it must educate its
employees. But it can do far
more. Business can support
community-based AIDS
organizations and activities. It
can reach out to minorities, drug
abusers and young people. The
possibilities for making a major
impact are limitless.
RICHARD S. SCHWEIKER, PRESIDENT, AMERICAN COUNCIL
OF LIFE INSURANCE
PROJECT HOPE Conference on
the Socio-Economic Impact of AIDS
on Health Care Systems,
Washington, D.C., March 25, 1987
27
AIDS must be a national priority. There's
lots to do in combatting AIDS. The work
starts with communication. Each of US in
business has a responsibility to
communicate as authoritatively as
possible the AIDS story, and to
do it often.
JOHN B. CARTER, PRESIDENT & CEO, EQUITABLE LIFE
ASSURANCE COMPANY
Interview, Insurance Compensation,
October 1987
Labor has an important role
to play in the AIDS crisis.
My union has made a
commitment. We are
working to make sure that
all the recommendations
made by the Presidential
Commission and the
Institute of Medicine are
adopted, from the federal
government all the way
down to the workplace.
Other unions must make
the same commitment.
JORDAN A. BARAB, OCCUPATIONAL SAFETY AND
HEALTH COORDINATOR, AMERICAN FEDERATION OF
STATE, COUNTY AND MUNICIPAL EMPLOYEES
Private Sector Leadership Conference
on AIDS, Chicago, 1988
28
We have a strong pluralistic
tradition in this country, a
history of mixing public and
private sector roles. This
should be the foundation for
our fight against AIDS. State
risk pools can address the
problem of the medically
uninsured. Medicaid could be
expanded to pay the full costs
of appropriate care for all the
poor. Incentives and subsidies
should be used to maintain
private insurance for those
who become disabled and lose
their employee benefits. Case
management should be
encouraged. Laws against
discrimination in employment
must be enforced. And
we must prohibit the use of
sexual orientation in
underwriting.
CARL J. SCHRAMM, PRESIDENT, HEALTH INSURANCE
ASSOCIATION OF AMERICA
Testimony before the Presidential
Commission on the Human
Immunodeficiency Virus Epidemic,
April 27, 1988
29
Unions historically have
responded to broad social
problems, including
hunger, illiteracy, and
disenfranchisement. Now, we
must expand these efforts to
include AIDS.
As representatives of
working men and women,
unions are uniquely situated
to confront and dispel
people's fears about AIDS.
We have an historic obligation
to fight discrimination. As the
number of those with AIDS
increases, we have a
responsibility to ensure that
those with AIDS, as well as
all Americans, have access to
the best, highest quality health
care services.
MARGARET M. SEMINARIO, ASSOCIATE DIRECTOR,
DEPARTMENT OF OCCUPATIONAL HEALTH, SAFETY AND
SOCIAL SECURITY, AFL-CIO
Private Sector Leadership Conference
on AIDS, Chicago, 1988
30
AIDS challenges business
and our community. It is a
challenge that cannot be
ignored. In Washington,
D.C., businesses have joined
with academia, medicine,
religious institutions, local
government and community
groups to pool their
expertise and resources to
address this problem. The
Board of Trade encourages
this active business response.
WILLIAM F. SINCLAIR, PRESIDENT, GREATER
WASHINGTON BOARD OF TRADE
Press Conference announcing the
formation of the Washington
Metropolitan Area Business
Leadership Task Force on AIDS,
January 11, 1989
By working together,
organized labor, the schools,
business, government, the
health care industry, parents
and community
organizations can create an
effective partnership to help
prevent the transmission of
HIV and meet the needs of all
in the community who suffer
from this terrible disease.
AL SHANKER, PRESIDENT, AMERICAN FEDERATION OF
TEACHERS
AIDS Education Project Report,
March 1989
31
AIDS stands for Acquired Immune
Deficiency Syndrome. It also means
"American Industry Do Something!"
Syntex did something in the battle
against AIDS. We believe all
businesses should. Why? Because this
is an unprecedented epidemic.
Because it will be a long time before
there will be a vaccine or a cure.
Because education about the
epidemic is essential. And most
importantly, because we believe
strongly that business can, and
should, make a difference.
GWYNN C. AKIN, Ph.D., DIRECTOR OF HEALTH POLICY,
SYNTEX CORPORATION
Private Sector Leadership Conference
on AIDS, Chicago, 1988
32
AIDS:
A Call for Leadership
AIDS challenges every segment of
society. Why are we waiting to do
something until we are in a crisis
situation? I can't tell you the passion
that's out there in this country waiting for
the leadership to say "OK, we're beyond
the rejection and the denial and the
vilification of others and we're ready to
wage war on the virus rather than on
groups of people." It won't be an easy
war. For me, the military was a lot
easier. Being Chief of Naval Operations
at the Joint Chiefs of Staff was a piece of
cake compared with AIDS.
ADMIRAL JAMES D. WATKINS (RET.), SECRETARY,
DEPARTMENT OF ENERGY AND FORMER CHAIRMAN,
PRESIDENTIAL COMMISSION ON THE HUMAN
IMMUNODEFICIENCY VIRUS EPIDEMIC
PBS AIDS Quarterly, February 28, 1989,
produced by WGBH Boston
33
What the nation needs is leadership, a
commitment by heads of corporations,
public officials, leaders of community
groups and charitable organizations, to
direct our energies to defeating AIDS. If
we are strong enough to accept the
challenges of leadership, the defeat of
AIDS could be our finest hour as a
caring people.
JOHN J. CREEDON, PRESIDENT & CEO, METROPOLITAN
LIFE INSURANCE COMPANY
National AIDS Awareness Test,
September 15, 1987
AIDS, although already in
epidemic proportions, seems easy
to ignore since it does not yet
touch most of us personally. But
it will. And it will touch us with
disastrous potential. For precisely
this reason, chief executive
officers, presidents, and chairmen
must assert themselves now, and
take an aggressive leadership
position on AIDS.
BENNEVILLE N. STROHECKER, PRESIDENT, HARBOR SWEETS
You Can Do Something About
AIDS, Second Edition (in press)
34
It is sometimes said that the most
important quality a newspaperman can
have is a sense of outrage-outrage
at human injustice and at the
ineffectiveness of government and
institutions in times of crisis. Well,
AIDS is a crisis-of human, economic,
medical, social, ethical and political
proportions. It's time for the leaders of
America-those in government,
medicine and business-to hone their
own senses of outrage and begin leading.
SAM S. McKEEL, PUBLISHER AND CHAIRMAN,
PHILADELPHIA NEWSPAPERS, INC.
Private Sector Leadership Conference
on AIDS, Chicago, 1988
Business must accept AIDS
as a special problem, in the
workplace, and in the
community. Business can
assume a leadership role,
and point the way. The
absence of our leadership
will convince others that
AIDS is really not an
important problem.
THEODORE COOPER, M.D., Ph.D., CHAIRMAN & CEO, THE
UPJOHN COMPANY AND CHAIRMAN, COMMITTEE FOR
THE OVERSIGHT OF AIDS ACTIVITIES, INSTITUTE OF
MEDICINE
Private Sector Leadership Conference
on AIDS, Chicago, 1988
35
Management and labor must
join forces on AIDS. Now is the
time to fulfill the definition of
the term "leadership" by
working together-to increase
knowledge, reduce fear, and
fight prejudice. Most
importantly, management and
labor must foster public
concern and compassion for
those living with HIV.
MARY HATWOOD FUTRELL, PRESIDENT, NATIONAL
EDUCATION ASSOCIATION
Conference on AIDS Education in
the Schools, Atlanta, May 1988
There's a widespread
misconception among
corporate executives that
getting involved with AIDS
spells disaster. That the
safest route is to do
nothing. But our employees,
our companies, our
communities, our country
face a crisis. There is no
excuse for inaction. People
are looking for leadership.
If you give it, you'll be the
leader.
TERRY M. MULREADY, VICE PRESIDENT-EXTERNAL
AFFAIRS/CORPORATE COMMUNICATIONS, PACIFIC BELL
Speech to The Arthur Page Society,
September 28, 1987
36
I'm very proud of Digital
Corporation for putting a
stake into the ground and
showing corporate leadership
both in the community and
within our company. I firmly
believe that as business
leaders, we must bring our
skills to bear on AIDS. We
must go forth into the
communities where we are
known and work. There, we
can make the difference we
surely were meant to make.
PAUL A. ROSS, Ed.D., MANAGER, AIDS PROGRAM
OFFICE, DIGITAL EQUIPMENT CORPORATION
AIDS in the Workplace Symposium,
Harvard University, March 16, 1989
AIDS is not going to go away any time in the
near future. And as with any other issue of concern
to workers and their communities, the need for
leadership from labor has never been more clear.
WILLIAM K. BORWEGEN, DIRECTOR, OCCUPATIONAL
HEALTH AND SAFETY, SERVICE EMPLOYEES
INTERNATIONAL UNION
AFL-CIO Community Services
Annual Convention, June 13, 1988
37
Employees, communities
and stockholders may not
hold American business
accountable today for
helping to fight AIDS. But
they will tomorrow. Business
leaders often ask what they
can do. I tell them to watch
what companies in San
Francisco, New York,
Boston, places where the
problem is more acute, are
doing. They are providing
models of corporate
leadership and
responsibility. Their example
should be an example for
American business.
ARTHUR H. WHITE, PRESIDENT & CEO, WSY
CONSULTING GROUP, INC.
Private Sector Leadership Conference
on AIDS, Chicago, 1988
38
Coming from Detroit, I learned
as a child that what's good
for General Motors is good for
the country. Well, I turn that
around and say, "What's good
for the country is good for
American business."
AIDS is the societal challenge
of the Eighties, the Nineties, and
the next hundred years. It also
presents an opportunity for real
pioneering in corporate
leadership. You have a chance to
do something you've never done
before. But to lead, you must
know the facts. And if you're
going to get involved, jump
in with both feet. Or don't
jump in at all.
JAMES W. CURRAN, M.D., M.P.H., DIRECTOR, AIDS
PROGRAM, CENTERS FOR DISEASE CONTROL
Private Sector Leadership Conference
on AIDS, Chicago, 1988
39
Business is a vital force in the
community. As such, the
primary role for business is to
set the tone for leadership as
communities mobilize to fight
AIDS. Each of US is being
given the opportunity to
demonstrate the highest
standards of compassion and
humanitarian support for
those affected by this terrible
disease.
SANFORD CLOUD, JR., VICE PRESIDENT, CORPORATE
PUBLIC INVOLVEMENT, AETNA LIFE AND CASUALTY
FOUNDATION
Start now, because the clock is ticking.
Government and the private sector must work
together on AIDS. But nothing will happen
unless you make it happen. The key is
your leadership.
OTIS R. BOWEN, M.D., FORMER SECRETARY,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Address to The Business Council,
October 10, 1987
40
Board of Directors
Edward N. Brandt, Jr., M.D., Ph.D.
College of Medicine, Oklahoma University, Chair
J. Richard Munro
Time Inc., Vice Chair
Karen Ignagni
AFL-CIO, Secretary
Michael Pollard
Michaels & Wishner, P.C., Treasurer
B.J. Stiles
President
Gwynn C. Akin, Ph.D.
Syntex Corporation
Lewellys F. Barker, M.D.
American Red Cross
Erline Belton
Digital Equipment Corporation
Sharon Canner
National Association of Manufacturers
Jane Delgado, Ph.D.
National Coalition of Hispanic Health and Human
Services Organizations
Richard Dunne
Gay Men's Health Crisis
William R. Hendee, Ph.D.
American Medical Association
Stephen E. Herbits
Joseph E. Seagram & Sons, Inc.
Stanley G. Karson
Center for Corporate Public Involvement
G. Douglas Lawrence, Jr.
International Business Machines Corp.
Bryan Lawton, Ph.D.
Wells Fargo Bank
Stephen T. Moskey
AEtna Life & Casualty
T.M. (Terry) Mulready
Pacific Bell
Woodrow A. Myers, Jr., M.D.
Indiana State Board of Health
Ed Pitt
National Urban League
Beny J. Primm, Jr., M.D.
Addiction Research Treatment Corporation
Mervyn F. Silverman, M.D.
American Foundation for AIDS Research
The Rt. Rev. William E. Swing
Episcopal Diocese of California
Larry H. Williford
Allstate Insurance Company
41
Roster of Members
BUSINESS AND LABOR
Abbott Laboratories
Abt Associates
Addiction Recovery Corporation
AEtna Life & Casualty
Allstate Insurance Company
American Brands, Inc.
American Council of Life Insurance
American Federation of Labor and Congress of Industrial
Organizations
American Federation of State, County, & Municipal
Employees
American Federation of Teachers
American Telephone & Telegraph
Apple Computer, Inc.
Associated Madison Companies, Inc., a Subsidiary of
Primerica Corporation
Association of Labor Management Administrators and
Consultants on Alcoholism, Inc.
Baltimore Gas & Electric Company
Blue Cross Blue Shield Association
Bristol-Myers Company
Burroughs Wellcome Company
Caremark Homecare
Centel Corporation
Chevron, U.S.A., Inc.
Digital Equipment Corporation
The Equitable Life Assurance Society
General Electric
General Mills, Inc.
Group Health Association of America
Health Industry Manufacturers Association
Health Insurance Association of America
Hoffmann-La Roche Inc.
Institute for Disease Prevention in the Workplace
International Business Machines Corp.
Johnson & Johnson
Joseph E. Seagram & Sons, Inc.
Levi Strauss & Co.
Levine, Huntley, Schmidt & Beaver
Loews Hotels Corporation
Marshall Field & Company
Mead Corporation
Mercantile and General Reinsurance Company plc.
Metropolitan Life Insurance Co.
Mobil Oil Corporation
NCR Corporation
42
National Association of Chain Drug Stores
National Association of Home Builders
National Association of Manufacturers
National Education Association
Ogilvy & Mather
Pacific Bell
Pharmaceutical Manufacturers Association
Philip Morris Inc.
Playboy Enterprises, Inc.
The Principal Financial Group
The Prudential Insurance Company of America
Scott Paper Company
Security Life of Denver
Security Pacific Corporation
Service Employees International Union
Squibb Corporation
Syntex Corporation
Time Inc.
Transamerica Occidental Life Insurance Co.
Union Carbide
United Food and Commercial Workers
Wells Fargo Bank
NATIONAL VOLUNTARY, RELIGIOUS, AND
EDUCATIONAL ORGANIZATIONS AND
ASSOCIATIONS
Academy for Educational Development
AIDS Action Council
AIDSFILMS, Inc.
American Academy of Family Physicians
American College of Cardiology
American College Health Association
American Health Care Institute
American Hospital Association
American Institutes for Research
American Lung Association
American Medical Association
American Nurses Association
American Pharmaceutical Association
American Psychological Association
American Public Health Association
American Red Cross
American Society of Hospital Pharmacists
Association of American Medical Colleges
The Association of Junior Leagues, Inc.
Catholic Charities, USA
Catholic Health Association
Center for Community Change
Center for Population Options
Children's Defense Fund
The Episcopal Church Center
Health and Welfare Ministries, General Board of Global
Ministries, United Methodist Church
43
Healthcare Financial Management Association
Human Interaction Research Institute
Human Rights Campaign Fund
National AIDS Network
The National Assembly of National Voluntary Health &
Social Welfare Organizations, Inc.
National Association of People With AIDS
National Coalition of Hispanic Health and Human
Services Organizations
National Council of Churches AIDS Task Force
National Council of La Raza
The National Foundation for Infectious Diseases
National Gay & Lesbian Task Force
National Health Council
The National Hemophilia Foundation
National Hospice Organization
The National Kidney Foundation
National Minority AIDS Council
Public Relations Society of America
The Salvation Army
Society for the Right to Die
The Stop AIDS Resource Center
United Church Board of Homeland Ministries
United Way of America
Volunteers of America
LOCAL AND REGIONAL ASSOCIATIONS,
VOLUNTARY, RELIGIOUS, AND EDUCATIONAL
ORGANIZATIONS
AID Atlanta
AIDS Foundation of Chicago
AIDS Resource Center
Citizens Commission on AIDS for the New York City-
Northern New Jersey Region
Concern for Dying
Gay Men's Health Crisis
Howard Brown Memorial Clinic
Instituto Familiar de la Raza-Latino AIDS Project
Mothers of AIDS Patients
New York University (School of Education, Health,
Nursing and Arts Professions)
Philadelphia AIDS Task Force
Philadelphia Commission on AIDS
San Francisco AIDS Foundation
Whitman-Walker Clinic
GRANTMAKING ORGANIZATIONS
American Foundation for AIDS Research
Design Industries Foundation for AIDS
The Hunt Alternatives Fund
Pettus-Crowe Foundation
44
"The AIDS epidemic
is a rip in the
fabric of our society.
Left unmended, it will unravel "
" a solid publication which will
assist managers in building and
improving on business AIDS education
programs."
C. Everett Koop, M.D.
Surgeon General
AIDS
Publishers:
American Foundation for AIDS Research
American Council of Life Insurance
Health Insurance Association of America
Sponsors:
AIDS National Interfaith Network
EDUCATION
American Federation of TV and Radio Artists
American Hospital Association
American Medical Association
American Red Cross
California Business Roundtable
A Business Guide
Citizens Commission on AIDS
League of Women Voters of the United States
Minority AIDS Project
National AIDS Network
National Association of Manufacturers
National Conference of Christians and Jews
National Leadership Coalition on AIDS
National PTA (National Congress of
Parents and Teachers)
National Small Business United
Screen Actors Guild
The Business Roundtable
United Auto Workers/General Motors
United Way of America
United States Conference of Mayors
FOREWORD
AIDS Education: A Business Guide represents the combined
efforts of several groups to produce a comprehensive guide to AIDS education in the workplace.
This guide addresses the need for a basic manual that describes principles and programs for AIDS education in the workplace.
The U.S. Department of Labor estimates that the work force comprises 66.1% of the American population. Because so
many people can be reached there, the workplace is one of the primary targets for AIDS education. Fifty thousand copies
of this manual will be distributed to American businesses and companies; the initial mailing will be provided at no cost.
It is designed to assist managers, human resource departments, and CEOs in planning and implementing AIDS education
programs for their employees. Also, it seeks to avoid unnecessary duplication of effort in establishing AIDS education
programs by describing resources already available to businesses and companies.
This manual was originally developed as a project of and in consultation with the Orange County, California Business
Leadership Task Force on AIDS and Alcohol & Drug Abuse convened and chaired by the Chairman of the Executive
Committee of Pacific Mutual, Walter B. Gerken, and Pacific Mutual's Chairman of the Board and Chief Executive Officer,
Harry G. Bubb.
Pacific Mutual coordinated, staffed, and underwrote the development of Facilitating AIDS Education in the Work
Environment, the first edition of this manual. Some of the material was obtained from and used with the permission
of the San Francisco AIDS Foundation. The Project Director was Robert G. Haskell, Second-Vice President, Pacific Mutual.
Suzanne D. Hoehl of Pacific Mutual's Corporate and Public Affairs Department was the Project Coordinator.
This edition was revised by the American Foundation for AIDS Research (AmFAR). Steven S. Chapman, a loaned executive
from AT&T, was Project Manager. New material was contributed by Trish A. Halleron, M.P.H., AmFAR Director of Education.
The following individuals reviewed the manuscript and offered other valuable assistance: Mathilde Krim, Ph.D, founding
Co-Chair, AmFAR; Suzanne Hoehl, Pacific Mutual; Eve Katz, Director of Public Affairs Projects for the American Council
of Life Insurance (ACLI) and the Health Insurance Association of America (HIAA); Michael Samuels, Dr.P.H., Chair of
the Department of Health Administration, School of Public Health at the University of South Carolina, and former Assistant
to the Surgeon General; Jerry Wagner, United Auto Workers/General Motors Human Resource Center; Patricia Morrow,
former Corporate Liaison for AmFAR; Mary M. Anderson, California Business Roundtable; and Alan Pardini, Harder Kibbe
Research & Consulting. The publishers gratefully acknowledge the support and contribution of these individuals.
The costs incurred in the development and
distribution of this manual were under-
SERVICES
Public Health Service
HUMAN
written by the following:
DEPARTMENT OF HEALTH & HUMAN SERVICES
HEALTH
The Surgeon General of the
Drexel Burnham Lambert
Public Health Service
Rockville MD 20857
AT&T
Pacific Mutual
American Council of Life Insurance
Health Insurance Association of America
August 1, 1988
The following organizations have reviewed
this manual and are sponsors of it. They
agree in principle with its concept and con-
Scott J. Tilden
tents, and support its distribution:
Executive Director, American
Foundation for AIDS Research
Richard S. Schweiker
AIDS National Interfaith Network
President, American Council of
American Federation of TV and
Life Insurance
Radio Artists
Carl J. Schramm
President, Health Insurance
American Hospital Association
Association of America
American Medical Association
Dear Messrs. Tilden, Schweiker and Schramm:
American Red Cross
California Business Roundtable
for the opportunity to review pleased the draft that the of AIDS previous
Citizens Commission on AIDS
Thank Education: edition, you Facilitating A Business AIDS Guide. Education edition I am in is the comprehensive Work Environment, and well- spread was
League of Women Voters of the
United States
well designed received. and will This support updated is a corporate solid publication efforts to which contain education will the assist
Minority AIDS Project
of managers HIV infection. in building It and improving on their AIDS
National AIDS Network
National Association of Manufacturers
programs. American Foundation for AIDS Insurance Research, Association the American of America, Council
National Conference of Christians
and Jews
The of and Life Insurance, sponsors should the Health be congratulated outstanding for example collaborating of the private on
National Leadership Coalition on AIDS
this your venture. Your responsibility work is an for an leadership issue of and major initiative. importance
National PTA (National Congress of
sector's to American assuming society. I applaud your
Parents and Teachers)
Sincerely yours,
National Small Business United
Screen Actors Guild
The Business Roundtable
C. Everett Koop, M.D.
Surgeon General
United Auto Workers/General Motors
United Way of America
United States Conference of Mayors
TABLE OF CONTENTS
AIDS EDUCATION: A Business Guide
Editor
Impact on Business and Society
1
Lee E. Klosinski, Ph.D.
How to Run an AIDS Employee Education Program
3
First Edition, Facilitating AIDS Education in the
Work Environment Copyright © September,
1987 by Pacific Mutual Life Insurance
Understanding AIDS
17
Company
Second Printing November, 1987
Integration of Benefits
21
Revised Edition, AIDS EDUCATION: A Business
Guide Copyright © September, 1988 by the
Appendices
25
American Foundation for AIDS Research,
the American Council of Life Insurance,
Resources
25
and the Health Insurance Association of
America. All rights reserved. No part of
Common Questions and Answers About AIDS
33
this publication may be reproduced in any
form or language without written permis-
Centers for Disease Control Guidelines
43
sion from the Publishers. For such permis-
sion, please contact the American Founda-
OSHA Enforcement
44
tion for AIDS Research.
1
CHARTER
IMPACT ON BUSINESS AND SOCIETY
As of the summer of 1988, over 68,000 cases of AIDS have been diagnosed in the United
States alone. As alarming as this figure is, the worst years of the AIDS epidemic are yet to
come. The impact of AIDS on society is inevitable. It will be felt in terms of human suffering,
the loss of productivity, and increased taxes, and health care bills.
CDC Projections of
It is estimated that at this time 1.5 million persons in the U.S. alone are infected with HIV
New Cases of AIDS
In the U.S. 1988-1992
(human immunodeficiency virus), the viral agent responsible for causing AIDS. The current
projection of the Centers for Disease Control is that by 1993 there will be 365,000 cases
80,000
of full-blown AIDS. Many scientists have projected that all of those infected with
HIV will eventually develop HIV-related illnesses or AIDS. Of course, the greatest
70,000
impact and expense to businesses and society is the loss of human life.
60,000
Large and small companies alike are seeing that they are not
50,000
immune to HIV-related illnesses. American businesses will feel
40,000
these costs in terms of losses in productivity, higher insurance
30,000
expenses, and possible costly litigation. Concern about AIDS
20,000
and its transmission in the workplace can also impact businesses
by causing fear and work disruption. Companies will need to
10,000
develop cost-effective health care programs, as well as strategies
1988
1989
1990
1991
1992
to communicate information about health benefits and company
policy on HIV-infected individuals to employees.
50,265 total cases at the end of 1987
365,000 total cases estimated at the beginning of 1993
2
AIDS Education: A Business Guide
Health Care Costs
Economists have estimated that the total annual U.S. costs associated with AIDS may reach
$66.4 billion in 1991, up from $8.7 billion in 1986. Personal medical care costs alone are
projected at $8.5 billion for 1991. The large increase in costs projected for 1991 is explained
by the dramatic increase in the number of cases of full-blown AIDS estimated by the Centers
for Disease Control.
Hospitalization accounts for 80-90% of the direct medical costs of treating HIV-related illnesses.
Lifetime treatment costs for persons with AIDS range from $24,500 to $147,000 per patient.
These costs vary because the presence of local support services and out-patient care reduces
the cost of patient care.
Productivity Costs
Because HIV-related illnesses generally strike persons 25 to 44, significant productivity is lost
due to illness, disability, and premature death. Among this age group, AIDS is second only
to cancer as a cause of death. By 1991, AIDS will account for 12% of all income lost due
to illness; the annual costs of illness and death from AIDS will be over $55 billion in productivity.
Paying for the AIDS Epidemic
Methods of treating AIDS are evolving, and assumptions about current and future infection
in the population are problematic. As a result, projecting national costs for personal medical
care of AIDS is difficult. Estimates for 1986-1991 have gone as high as $112.5 billion. One
thing is certain: the cost of this epidemic will continue to spread throughout society, increasingly
affecting the private sector, which will encounter larger bills
The Cost of the Epidemic (in billions of dollars)
for benefits and productivity losses.
'85
'86
'91
Federal support of AIDS education, research, and treatment
Medical Care
$0.6
$1.1
$8.5
has expanded in recent years. In fiscal year 1988, the federal
Research, education and
0.3
0.5
2.3
outlay for AIDS-related Public Health Service programs and
screening
Medicaid benefits will be over $1.3 billion. By 1991, an
Lost wages from disability
3.9
7.0
55.6
estimated $2.3 billion will be spent by the federal government
and death
alone on research, blood screening, education, and support
Total
$4.8
$8.6
$66.4
services. State and local governments provide funds for HIV-
related illness through state obligations for Medicaid, and
Source: Anne Scitousky, Palo Alto Medical Foundation/Research Institute (1987)
education and social services programs.
Higher taxes will be required to fund state and local governments facing shortages of facilities
and staff to provide necessary care. Through government funding, business and corporate
leadership, and individual responsibility, the future course of the AIDS epidemic can be controlled.
3
C
H
PTER
HOW TO RUN AN EMPLOYEE
AIDS EDUCATION PROGRAM
As the AIDS epidemic continues to spread, its consequences will increasingly be felt in the
workplace. Employers will be forced to confront issues related to AIDS such as employee fears,
company policy decisions, and benefits programs. Education is the best prevention against spread
of this disease as well as the best guarantee that workers will respond rationally and compas-
sionately to a co-worker with AIDS.
American businesses can play a leading role in AIDS education as they already have with
other employee welfare concerns like physical fitness and smoking reduction. Employees need
to know that AIDS is a preventable disease and that there is no
risk of transmission through casual contact in the workplace. Com-
Employees need to know that AIDS is
pany-based education programs can provide factual, non-judgmental
a preventable disease and that there is
information to employees and their dependents.
no risk of transmission through casual
The following steps can assist in planning a consistent and
comprehensive employee education program:
contact in the workplace
Educate top management and solicit their support. If a collective bargaining unit exists, include
its leadership in this process. This support should then be announced to all employees. The
remainder of the staff is then educated, with each manager able to take some responsibility
for facilitating the education of his or her staff.
4
AIDS Education: A Business Guide
Establish a Resource/Education Committee com-
Responding to AIDS: Ten Principles for the Workplace
posed of managers and employees. This increases
1 People with AIDS or HIV (Human Immunodeficiency Virus) infection
the sense of ownership and acceptance for any
are entitled to the same rights and opportunities as people with other
serious or life threatening illnesses.
program developed. Composition of the committee
should include representatives from human
2 Employment policies must, at a minimum, comply with federal, state,
and local laws and regulations.
resources, legal, medical, labor, management,
communications, housekeeping, EAP, and special
3 Employment policies should be based on the scientific and
interest groups. Once selected, these representatives
epidemiological evidence that people with AIDS or HIV infection do
not pose a risk of transmission of the virus to coworkers through ordinary
need to be educated about the issues surrounding
workplace contact.
AIDS, the company's policies, and the availability
of community resources.
4 The highest levels of management and union leadership should
unequivocally endorse nondiscriminatory employment practices and
Once trained, this committee can work together
educational programs about AIDS.
to design the company's AIDS educational program,
5 Employers and unions should communicate their support of these
respond to employee questions and concerns, and
policies to workers in simple, clear, and unambiguous terms.
promote a positive attitude about AIDS.
6 Employers should provide employees with sensitive, accurate, and
up-to-date education about risk reduction in their personal lives.
It may be helpful to your business or company
to use the committee process to develop your
7 Employers have a duty to protect the confidentiality of employees'
medical information.
program. However, any individual appointed to
organize an employee education program can easily
8 To prevent work disruption and rejection of coworkers of any employee
handle the task with the assistance of this manual
with AIDS or HIV infection, employers and unions should undertake
and the utilization of local resources. The use of
education for all employees before such an incident occurs and as needed
thereafter.
a committee or an individual to direct the AIDS
9 Employers should not require HIV screening as part of general pre-
education program will be determined by the needs
employment or workplace physical examinations.
of individual companies.
10 In those special occupational settings where there may be a potential
Decide on the information needs for the company
risk of exposure to HIV (for example, in health care, where workers
and its employees. This should include:
may be exposed to blood or blood products), employers should provide
- Why AIDS is not contagious at the work site.
specific, ongoing education and training as well as the necessary equipment
to reinforce appropriate infection control procedures and ensure that
- How HIV is spread.
they are implemented.
- What behavior puts one at risk, and how those
individuals at risk can change their behavior.
The Citizens Commission on AIDS for New York City and Northern New Jersey
- Why the stigma that accompanies the diagnosis
is a private, independent group of prominent business, union, and civic leaders.
of AIDS often leads to irrational and unfair be-
It was established by a consortium of 17 private foundations to develop leadership
havior.
in meeting the challenges of AIDS. They developed principles for the workplace
as a framework for policy development to be offered to employers, unions, and
Identify the special needs of specific audiences (e.g.,
other employee and business organizations for their endorsement. A fuller report
non-English speaking/reading, parents, etc.) within
can be obtained by writing to: Carol Levine, Executive Director, Citizens Commission
the general employee population.
on AIDS, 51 Madison Avenue, Room 3008, New York, New York 10010.
How to Run An Employee AIDS Education Program
5
Plan educational strategies. Educational materials and programs about AIDS are available
from numerous sources (see the Resources section in this manual). Collect a variety of
materials for the Resource/Education Committee to review. Several pamphlets are available
in Spanish and various Asian languages. Education materials made available to employees
should be medically accurate, non-judgmental, and deliver a consistent message.
Delivery of the AIDS education program needs to be more than a one-time effort. People
learn at different rates and through different methods. Thoughtful planning can provide AIDS
information in a variety of forms: brochures, videos, posters, and
workshops. A combination of approaches ensures that the greatest
number of people will be reached. Utilize established communication
The National AIDS Information Clearing-
channels within the company: payroll stuffers, in-house newsletters,
house has specialists who can provide data on
and in-service meetings. Small companies and large corporations
AIDS resources, speakers, services, and edu-
will have different needs to consider as they plan their AIDS
cational materials to managers who are plan-
ning work site AIDS programs.
education programs.
National AIDS Information Clearinghouse
Repetition should be a key element of the program. After an inaugural
P.O. Box 6003
communications piece, information can focus on "a fact a month"
Rockville, Maryland 20850
or "update on AIDS." Fear reduction and behavior modification
301-762-5111
are not easily accomplished and are impossible without repeated
Ordering materials:
emphasis of the basic messages. A stream of relevant information
1-800-342-AIDS National AIDS Hotline
can reinforce fact-based messages about AIDS to employees and
1-800-458-5231 Bulk Orders
give them the ability to confront breaking news stories and new
developments concerning AIDS.
Some specific forms that AIDS education programs can take include the following:
Designating an "AIDS Resource Person" at each plant or office is an important step. This
Designate an "AIDS Resource Person"
person should be able to answer questions about company policy on benefits and other personnel
issues related to AIDS. By using a single individual such as an EAP person, the company
can help to ensure the confidentiality of affected employees and the competence of persons
giving advice on company policy.
Another effective method of reaching employees is through the distribution of brochures. They
Brochure and Poster Distribution
are a convenient method of providing information about basic facts and available resources
such as AIDS hotline phone numbers. The Resources section of this manual provides many
suggestions about where brochures and posters can be obtained.
Some brochures are specific to the workplace and are appropriate to send to every employee,
either through the mail, with paychecks or via your current method of distribution. Other
6
AIDS Education: A Business Guide
brochures geared to specific groups, such as gay and bisexual men or intravenous drug users,
can be made available to employees in a manner that ensures privacy.
Posters displayed on company bulletin boards are useful visual reminders that AIDS is a problem
for all of our society and that we all need to know the basic facts. Posters also serve to remind
employees that the company is concerned about AIDS and wants its employees to be concerned
as well.
Video Lending Library
Establishing an AIDS video lending library where employees can check out videos for use
at home is an effective way of communicating the information to the families and friends
of your employees. The Resources section of this manual contains information about a variety
of educational videotapes.
Employee Meetings and Workshops
One effective method of providing education to employees is through group employee meetings
or in-service training sessions. They are relatively easy to conduct and are effective in reaching
employees. Members of the Resource/Education Committee, or other knowledgeable experts,
should conduct the meeting. If you do not have resources within the company, the Health
Department, Red Cross or state AIDS Prevention Project Directors (listed in the Resources
section of this manual) can provide information about competent speakers who are available
for these types of meetings.
If you choose to conduct the program yourself, follow these basic steps in planning an effective
employee meeting or workshop:
When:
There are several alternatives as to when to conduct an AIDS workshop. It can be incorporated
into an existing employee seminar series. It can be part of a department update session, staff
meeting or a specially-planned program. The meeting or meetings can even be conducted during
the lunch hour.
Who:
All employees should be educated. There is no risk of contracting HIV through casual contact
in the workplace. Employees need to understand why this is true, and how to prevent transmission
of the virus outside the workplace if education programs are going to be effective.
Format:
Keep it simple. A good program is one that is easy to implement and takes relatively little
support.
How to Run An Employee AIDS Education Program
7
AIDS Workshop Outline
Introduction (5-10 minutes)
Welcome
Personnel policy (if applicable)
Introduce Videotape
Videotape (15-30 minutes depending on video selected)
Discussion (30 minutes)
Highlight important facts discussed in the videotape
Respond to questions from the group
Closing Remarks and Brochure Distribution (5 minutes)
Distribute AIDS information brochures and workshop
evaluation forms
Highlight company and community resources
Stress education and sharing information with family
and friends
Introduction (5-10 minutes)
Begin by welcoming employees to the program and thanking them for taking the time to learn
the facts about this deadly disease. Refer to the "Surgeon General's Report on Acquired Immune
Deficiency Syndrome" and the brochure "Understanding AIDS."
Stress that HIV is not casually transmitted; the vast majority of work sites pose no risk. This
program will explain why this is the case. Answer their questions emphasizing there are no
"dumb questions" when dealing with a complex disease such as AIDS.
If there is a personnel policy regarding AIDS or catastrophic illness, state it. A company policy
on AIDS (and other catastrophic illnesses) is useful in conveying information about medical,
benefit, and legal issues to all employees.
Introduce any videotape you might be showing. Explain that the video provides the basic facts
about AIDS and that a discussion will follow.
Videotape (15-30 minutes)
There are a variety of videotapes available for use during the workshop. (See the Resources
section of this manual for information about sources from which to obtain videotapes.) Pay
particular attention to the descriptions of these videotapes: some are designed specifically for
teenagers, others for an older audience. Preview any video before you use it to ensure that
8
AIDS Education: A Business Guide
Understanding AIDS
Understanding
AIDS
Surgeon Report ACQUIRED
it is appropriate for your particular employees.
Some businesses or companies may wish to add
A Message From The Surgeon General
DEFICIENCY
a special introduction or trailer to existing tapes
to customize the video or to provide specific
has
United
States
prepanne
Best
experimportant
you
health
problem
and
Surgeon General's Report
information to their employees.
available
fighting
alled
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Enemy
Number On
to you
now
must
President haspirg
may
easily
oderstand
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brochure
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loved
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Some
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STATE
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Discussion (30 minutes)
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Follow the videotape with a brief discussion of
the information presented in the videotape. After
Para
U.S. Public Health Service
Department
Health
doing so, ask for questions from the audience.
Services
Public Affairs Office
Human
Rockville
200 Independence Avenue, SW
(See the "Common Questions and Answers"
Official
Buxiness
POSTAL
CUSTOMER
Washington, D.C. 20201
section of this manual for the most frequently-
202-245-6867
asked questions.) A local resource person or health
8404 Reproduction
professional knowledgeable about AIDS can be
useful in answering employee's questions.
The U.S. Public Health Service has produced these two important documents
Closing Remarks and Brochure Distribution
(5 minutes)
dealing with AIDS. The Surgeon General's Report on Acquired Immune Defi-
As the program concludes, distribute general
ciency Syndrome has received wide circulation. Understanding AIDS was mailed
information brochures to the audience. Inform the
audience who in the company can provide them
to each household in the U.S. These brochures contain basic discussions on HIV,
with further information. Also, provide informa-
tion about local community resources that are
how it is transmitted, the relative risks of transmission, and how to prevent
available.
Some people may be embarrassed about asking
AIDS. They are in the public domain and may be reproduced without any prior
questions. Prepare and distribute a confidential
workshop evaluation form, and be sure to provide
approval. Both are available in Spanish. The Public Health Service encourages
space on the form for these questions. Answer
them later in a follow-up mailing or employee
their reproduction and suggests that businesses and companies add their logo
newsletter.
to them as a sign of support and increased credibility. Employees may already
Close the session by again stressing the importance
of AIDS education. Request that people take the
be familiar with these pamphlets and they are good starting points for educa-
information they have learned and share it with
family and friends.
tion programs.
How to Run An Employee AIDS Education Program
9
Sample AIDS Workshop Evaluation Form
AIDS Education Program Confidential Evaluation Form
Please do not write your name on this form, as your answers are confidential. We would
like your help in evaluating the AIDS Education Program by completing this confidential
evaluation form. Your opinion will help US determine how we can best offer this information
to other employees.
Using the sentence and scale below, please circle the number that best describes your
reaction to the AIDS Education Program:
No
Yes
Were the goals of the AIDS Education Program stated
1
2
3
4
5
in a clear and concise manner?
Were these goals met?
1
2
3
4
5
Was the Personnel Policy described in a clear and concise
1
2
3
4
5
manner?
Was the videotape:
Interesting?
1
2
3
4
5
Informative?
1
2
3
4
5
Too basic?
1
2
3
4
5
Too technical?
1
2
3
4
5
Did it address your questions?
1
2
3
4
5
Did it answer your questions?
1
2
3
4
5
Would you recommend it to a friend?
1
2
3
4
5
Did the workshop leader highlight the important facts
1
2
3
4
5
discussed in the videotape?
Did the workshop leader lead the discussion period in
1
2
3
4
5
an engaging manner?
Did the workshop leader encourage questions?
1
2
3
4
5
Was the workshop leader able to answer questions in
1
2
3
4
5
a clear and concise way?
Did the workshop leader respect the opinion of those
1
2
3
4
5
who asked questions?
Do you feel that you clearly understand the company's
1
2
3
4
5
policy on AIDS?
Do you want/need additional information on AIDS?
1
2
3
4
5
Some employees may have additional questions about AIDS that they were not able
to ask, or did not feel comfortable asking. Please write down any additional questions
that you have. Do not sign your name. All questions will remain confidential. They will
be answered in the near future in another segment of the company's AIDS Education
Program.
We value your opinion. Please make any additional comments about our company's
AIDS Education Program that you wish. All information you share with US will remain
confidential. (Please use reverse side to make comments.)
10
AIDS Education: A Business Guide
Sample Newsletter Articles and Letters
Another useful method of providing information about AIDS is through employee newsletter
from Management
articles. In addition, a letter from the CEO to every employee demonstrates leadership support
and is useful in conveying information about AIDS. It is important to distribute a listing of
services and materials available to employees through the company. This will also help to ensure
that everyone knows information is available. Here are sample letters and newsletters on AIDS:
Sample Employee Letter on AIDS
TO: All Employees
FROM: Chief Executive Officer
SUBJECT: AIDS Awareness and Education Program
AIDS, Acquired kills thousands of people annually. In 1981, to homosexual men
Immune Deficiency Syndrome, is an infectious when AIDS disease was and
which drug first high abusers. risk identified, behavior. It is it now The was clear disease thought in sight. that continues to anyone The be limited danger can to spread contract of AIDS and to AIDS there of society through the is
still no vaccine or cure feel no one can afford to be unaware transmitted
is so great want that to we help you understand how AIDS is from infection. and
how facts. it We is not, and how you can protect yourself
the company is introducing an AIDS will Awareness include
With this in mind, Program for all employees. The program the most
and Education seminars with health experts to discuss In addition, current
educational AIDS and to answer your questions. library"
we will make videotapes the educational aspects of the program the latest to your infor- families.
information about available through a "lending
basis to bring the monthly newsletter will discuss placed on
Articles in AIDS. AIDS information material will be
mation bulletin on boards throughout the company. Educational brochures will
be made available for you and your family.
of the AIDS Awareness and Education Program misconception is to dispel
One goal AIDS. For example, there is a popular with person
myths about can be contracted through casual contact The medical evidence a
that AIDS virus. This is not true. person who
carrying the AIDS sharing work space or telephones with a your risk
confirms that full-blown AIDS does not increase intends to
has the AIDS infected virus or or developing AIDS. This program anxiety about
of rid becoming individuals of misconceptions and unnecessary AIDS.
We want to and help Education you Program. Our hope is that is you only through share
become informed through the company's will AIDS
Awareness family what you learn about AIDS. It this disease.
with awareness your that we can prevent the spread of
Sincerely,
Chief Executive SuranSmitz Officer
How to Run An Employee AIDS Education Program
11
Sample Employee Newsletter
Article # 1 on AIDS
The discovery of any new disease is
tions about AIDS abound. For exam-
a natural cause for public concern. The
ple, contrary to the popular casual-
identification of Acquired Immune
contact myth, the AIDS virus is not
Deficiency Syndrome (AIDS) in 1981
spread through normal daily contact
was no exception. What makes AIDS
at work, in school, or at home. Edu-
unique is that fear is growing among
cation programs in the workplace
those considered at low risk, despite
aimed at dispelling fear and misinfor-
scientific assurance that it is not an easy
mation about AIDS encourage
disease to catch.
employees to learn the facts.
If you are one of the many who think
Here at our company, we have intro-
you are at low risk of contracting AIDS,
duced a comprehensive work site
but who are nevertheless worried
education program about AIDS. We
about it, it is important to arm yourself
hope you will make participation in this
with accurate information. AIDS is a
program a personal priority. It is
fatal disease for which there is currently
important for all of US to recognize that
neither a cure nor a vaccine. Public
we can all join the battle against AIDS
education on the subject of AIDS is of
by fighting fear with the facts.
paramount importance. Misconcep-
Sample Employee Newsletter
Article # 2 on AIDS
Acquired Immune Deficiency Syn-
ciency virus or HIV. The virus attacks
drome (AIDS) is a deadly disease which
the body's immune system, making it
was first identified in 1981. By mid-
vulnerable to opportunistic infections
1988, there had been more than
and cancers which, in turn, result in
68,000 cases of AIDS reported in the
fatalities. There is no vaccine or cure
United States alone.
yet, but research is in progress. There
is a specific blood test which can tell
Despite all the bad news about AIDS,
whether an individual has been
there is some good news. Scientists
infected with the virus.
have discovered a great deal about
viruses and the function of the immune
HIV is difficult to catch. The virus is not
system. This information has enabled
easily spread from person to person
scientists to reach certain conclusions
and has never been spread by casual
about how the AIDS virus is and is not
contact. For the virus to infect, it must
transmitted.
be in a life-sustaining, chemically-
balanced liquid environment. For
The cause of AIDS is a specific virus
known as the human immunodefi-
Continued on page 12
12
AIDS Education: A Business Guide
Sample Employee Newsletter
Article # 2 on AIDS
Continued from page 11
transmission of the virus to occur from
breast milk. Saliva, sweat, urine, and
person to person, both the virus and
tears are not life-sustaining fluids for
susceptible, uninfected cells must be in
cells. They are not examples of fluids
a liquid environment that sustains both
in which transmission of HIV infection
the virus particles and cell life. The
can occur. Nor is transmission caused
fluids that offer the virus the environ-
by sneezing or coughing. AIDS is not
ment needed for infection to occur are
transmitted through preparation or
blood, semen, vaginal fluids, and
serving of food or beverages.
Medical authorities who have studied tens of thousands of cases
agree that AIDS is contracted in these four ways:
Sexual intercourse (vaginal, anal, or oral) with a person who
is infected with HIV;
Sharing intravenous drug needles or syringes with an infected
person;
Injection of HIV-contaminated blood or blood products; this
method of transmission has become very rare because blood
is now being screened for contamination;
A woman infected with HIV who becomes pregnant can pass
it to her baby.
No cases of AIDS have resulted from
Our company has not yet had to deal
the type of casual contact found in the
with a person with AIDS, but if and
workplace. No cases have ever been
when it happens, it is our hope that
linked to sharing typewriters, tele-
our employees will be well-informed,
phones, tools, papers, water fountains,
act rationally, and give the same
chewed pencils, eating facilities, show-
support and concern they would like
ers, or even toilet seats.
to get themselves if they had a serious
disease.
How to Run An Employee AIDS Education Program
13
Sample Employee Memo on AIDS and
the Workplace
INTEROFFICE MEMO
Our company is committed to providing a work environment which
allows all of US to perform our jobs in a safe and productive manner.
Our business philosophy, which states that we respect the dignity and
worth of every person, reinforces this commitment, as does our Equal
Employment Opportunity statement, which explains our policy and
practice with respect to prohibiting discrimination in every phase of
employment.
Employees with a disability or medical condition (life threatening or
otherwise), who are able to meet, with reasonable accommodations,
adequate performance standards and whose continued employment
does not pose a current threat to the health and safety of others
are assured equal employment opportunities in their employment here.
This has been and continues to be the policy and practice of our
company.
I am reemphasizing this policy because of the media attention currently
being given to Acquired Immune Deficiency Syndrome (AIDS) and
its impact on the workplace. Any employee who contracts AIDS will
be guaranteed the same rights as any other employee who has a
handicap or illness.
The "AIDS Issue" is surrounded by myths and misunderstandings. To
deal with it openly and honestly in the workplace, we must begin
with the facts. Over the next couple of months, we will introduce special
educational programs providing factual, medical information on AIDS,
how it can be transmitted and, more importantly, how it cannot be
transmitted. This should help to dispel rumors, lessen fears, and raise
our comfort level about this dreaded disease.
If you have questions or need assistance at any time, please contact
either EEO Administration or Employee Relations.
14
AIDS Education: A Business Guide
Questions and Answers About Business
Q What special challenges will our company's managers face in dealing with employees with
Education and AIDS
AIDS and how can I assist them?
A
A manager must first address his or her own fears about AIDS. Each manager must be
assured that there is no risk of transmission in the workplace. Then a manager needs
to be prepared to deal with confidential information. Further, he or she needs to be prepared
to deal compassionately with the special needs of the person with AIDS. The manager
must also be prepared to address the concerns of other employees: he or she may need
strategies to deal with crisis intervention among employees fearful of working with a person
with AIDS.
It may be useful to hold a "For Managers Only" session on AIDS to discuss the special
issues that a manager will face when confronted with an employee or employees with
AIDS. Perhaps a panel with a personnel representative, medical and legal counsel, and
an AIDS educator could provide the necessary additional information that managers need
to deal with the issues surrounding an employee with AIDS.
Q Since AIDS is primarily a sexually-transmitted disease and information about its transmission
frequently contains sexually explicit material, not all employees may want or need it. How
can I respect the sensitivities of my employees?
A
One possible way to distribute this information to employees without offending anyone
is to do a mailing of the information to all employees. This should be done using a sealed
envelope, and on the envelope something similar to the following could be printed: "Please
note that the information contained in this packet discusses sexual material surrounding
AIDS risk reduction."
Q What is the best response to the following question: "Why is this company keeping on its
payroll perverts, drug addicts, and other immoral people, in violation of everything that religion
and America stand for?"
A
This company is not taking a stand one way or the other on these "moral" issues. We
are saying that if one of our employees, to whom we have some responsibility as employers,
comes down with a disease that is not a threat to anyone in the workplace, we will treat
that disease the same way we would treat any other disease. We do not make any moral
judgments about any other disease. If someone got lung cancer, we would not say, "Well,
it's his fault because he smoked for years." If someone got heart disease, we would not
How to Run An Employee AIDS Education Program
15
say, "It's her fault because she was overweight or drank too much or didn't exercise
enough." We would treat those employees with respect, try to accommodate their willingness
to continue working, and would expect their fellow employees to demonstrate compassion
and understanding. Like most responsible organizations, we do not see any legitimate reason
to treat this disease any differently.
It is your right to disagree with certain lifestyles. You may disapprove of the lifestyles
of many of your co-workers and they may disapprove of yours. We are each entitled
to our own point of view. However, in this organization, we think tolerance, cooperation,
understanding, and compassion are useful human qualities. A fatal disease like AIDS provides
an opportunity to demonstrate those qualities.
17
CHARTER
UNDERSTANDING AIDS
Despite all the bad news we are constantly hearing about AIDS, there is some promising news
to report. Since AIDS was identified as a new medical condition in 1981, scientists have discovered
important information about viruses and the function of the immune system. These biological
facts concerning infectious diseases, the immune system, and AIDS have helped scientists reach
certain conclusions about how the AIDS virus is and is not transmitted.
The AIDS virus is the human immunodeficiency virus, or HIV. It can enter and infect certain
HIV-the AIDS Virus
cells, for example, the white blood cells that constitute the immune system, certain brain cells,
and certain cells lining the lower bowel.
As HIV infects and kills certain white blood cells essential to the normal function of the immune
system, the immune system progressively loses its defensive capabilities. With the body's master
defense system down, all sorts of microscopic bacteria, fungi, and viruses have a much better
opportunity to cause disease. Certain cancers and infections, called opportunistic because they
take advantage of the situation created by a suppressed immune system, plague people with
AIDS and eventually lead to death.
HIV-infected individuals who are symptomatic may suffer from a variety of HIV-related diseases
and conditions which indicate that the immune system is impaired without having the specific
opportunistic diseases associated with AIDS. (In the past, this condition was known as ARC,
AIDS Related Complex.)
18
AIDS Education: A Business Guide
The Transmission of AIDS
Even under ideal laboratory conditions, HIV does not infect cells readily. It takes concentrated
virus, or whole, live, infected white blood cells releasing virus to infect susceptible cells in
the test tube.
For transmission of HIV infection between people to be possible, exacting conditions must
be realized. HIV-infected cells, carried in a chemically balanced, nutrient-rich liquid environment
that sustains cell life, must be contributed by an infected person to an uninfected one. In
addition, these infected cells must find their way into the body of the uninfected person. Saliva,
sweat, urine, and tears are not life-sustaining fluids for cells. These are not fluids through
which transmission of HIV occurs. Nor is transmission brought about by sneezing or coughing,
nor even, as far is known today, by deep kissing.
The fluids that do offer infected cells the environment needed for the transmission of this
viral infection are blood, semen, vaginal fluids, and breast milk.
The transmission of HIV can occur:
during vaginal, anal, or oral intercourse, particularly when the uninfected
partner has an open lesion in the mucosal membranes or the skin of
the genital area;
when unclean syringes or hypodermic needles contaminated with HIV-
infected blood are used for injection;
when blood from an HIV-infected mother passes to her child in the womb
or at birth;
when HIV-infected blood is inadvertently transfused into an uninfected
person;
in rare cases when the skin is accidentally punctured with a sharp object
contaminated with HIV-infected blood.
Both men and women can become infected through vaginal, anal, or oral
intercourse.
The specific circumstances under which HIV infection can be transmitted from person to person
have been amply confirmed by detailed epidemiological studies. After several years of obser-
vation, it has been shown that HIV infection has never been transmitted from one person
to another unless infected semen, blood, vaginal secretions, or infected breast milk had been
involved in its transmission.
Understanding AIDS
19
That is why it can be said today with great confidence that there is no transmission of HIV
under conditions of casual contact between people such as occurs in the workplace, in schools,
and in public transportation systems; there is no transmission of HIV infection through food
preparation, food handling, or food sharing. Barring blood transfer or sexual contact, there
is no transmission of HIV among people living in the same household or from HIV-infected
patients to doctors and nurses caring for them in hospitals, or from health care personnel
to patients.
Protecting Oneself and Others from AIDS
There are few situations under which HIV infection can occur. Its spread in the population
can be slowed by the adoption of the following:
practicing sexual abstinence or maintaining a mutually monogamous sexual
relationship with an uninfected person;
decreasing risk of exposure to HIV by decreasing the number of one's
sexual partners;
preventing, through the proper and regular use of latex condoms and
a spermicide, direct contact of semen with the vaginal or rectal mucosa
(unless sexual partners positively know neither of them is infected);
avoiding unprotected oral sex;
using clean needles (whether new or thoroughly disinfected);
preventing pregnancy in HIV-infected women;
preventing the use of HIV-infected blood for transfusion, or of HIV-infected
tissues or organs for transplantation.
See also the section in this manual entitled "Common Questions and Answers
About AIDS." Additional information on the immune system and AIDS
can be found in the AmFAR publication "The Facts About AIDS".
21
Ц
CHARTER
INTEGRATION OF BENEFITS
The key to effective care coverage is the integration of all the benefits so that, at any stage
of the disease, people with HIV-related illnesses do not fall between the cracks of an other-
wise well-designed health-care program.
Case management that is carefully integrated into a total health care program has proven to
The Case for Case Management
be an effective method of dealing with AIDS as well as other high-cost illnesses. The term
"case management" used here describes the use of a fourth party (a case manager) to analyze
the psychosocial, legal, financial, housing, and clinical needs of an individual patient at high
risk for catastrophic health care costs.
Case management programs must emphasize the provision of high quality, medically appropriate
services for all individuals using their health benefits. Employees should retain control over
health care decisions and yet not lose coverage for treatment in situations where their treating
physician, who is most familiar with their medical needs, recommends a manner of treatment
different from that of the case manager.
22
AIDS Education: A Business Guide
It is still not known how much long-term care will be needed for patients with HIV-related
illnesses. For instance, the incidence of HIV-related mental impairment (dementia), which will
likely require intensive treatment on a long-term basis, is increasing. In order to minimize
costs of caring for patients with HIV-related illnesses, long-term disability administrators need
to provide the same type of intensive case management as that provided under the medical
plan.
Informing Employees About
Informing employees about the health benefits and company policy concerning HIV-infected
Benefits and Policies
individuals presents a communications challenge. Employers should expect this news to trigger
a variety of responses. Many employees will see it as a sign that the company cares about
their well-being. For others, however, it may provoke fear that there is a large AIDS problem
in the company. Infected individuals may fear discrimination. Managers may feel unprepared
to answer questions from employees.
One common, effective strategy is to include AIDS and other HIV-related illnesses under existing
policies on catastrophic illness. When this decision is made, no new definition of health benefits
is necessary. If a company policy on catastrophic illness does not yet exist, the AIDS education
program can be an optimum time to formulate a clear statement of the benefits and policy
for employees who suffer from HIV-related illnesses and other major life threatening diseases.
A well-planned communications effort can ensure that the policy on AIDS and other catastrophic
illnesses is greeted positively and seen for what it is: practical and compassionate health care
coverage. Presenting it in conjunction with a company's AIDS education program will promote
its reception.
Integration of Benefits
23
The following suggestions can help secure a positive reception:
Garner support from the CEO, chairman of the board, or president of
the company. If the business or company has a collective bargaining unit,
solicit support from its leadership as well. A memo or letter by a recog-
nized representative from top management and, where appropriate, union
leadership, presenting the company's catastrophic illness policy
demonstrates important support;
Emphasize confidentiality and nondiscrimination;
Alert, don't alarm, employees. Let employees know that the policy is
addressing the special needs of individuals infected with HIV, as well as
the needs of those who may suffer from other serious illnesses. Assure
them that the program goes hand-in-hand with an education and prevention
program and that the workplace is safe;
Meet with managers first. If the business or company has a collective
bargaining unit, include the union stewards as well. Give them time to
prepare for questions that may arise from employees;
Take advantage of Employee Assistance Program (EAP) resources. EAPs
can play a key role in explaining health-related policies. The EAP is uniquely
suited to provide counseling services. Confidentiality, critical in this
situation, is a hallmark of an EAP. Companies can work directly with
outside organizations or in-house staff to provide the necessary training
to deal with AIDS and other diseases. The EAP staff can help diffuse
or preempt potential problems associated with the presence of HIV-infected
individuals in the workplace, as well as in management-employee relations.
"AT&T's position on AIDS is to treat it as we would any other disabling
condition and to emphasize that casual contact in the workplace is not a
risk.
An employee who has AIDS will be treated like those with any
other illness. If not disabled, they will be permitted to work."
Dorothea Johnson
AT&T Corporate Vice President for Health Affairs
25
CHARTER 5
APPENDICES
Resources
A large number of resources are available to businesses to assist in formulating AIDS Education
Programs and to make available accurate information about AIDS, HIV infection, and its
transmission to employees. The following listing of resources may be used to obtain further
information about AIDS.
Initially, the best resource in your community may be the city, county or state Health Department
Local Resources
or a local chapter of the American Red Cross. These agencies can provide accurate information
about AIDS, state, and local health policies, and HIV antibody testing sites. Most larger cities
or geographical areas have AIDS service agencies which supply expert speakers, brochures,
and posters, in addition to direct services to people with AIDS. Many of these agencies staff
AIDS information hotlines.
26
AIDS Education: A Business Guide
National Resources Service Directories
The following directories provide comprehensive listings of educational and informational
materials concerning HIV infection, HIV-related illnesses, and full-blown AIDS. They describe
service organizations, brochures, pamphlets, videotapes, curricula, posters, books, manuals,
government reports, and other resource documents on AIDS.
AIDS Information Resources Directory
Local AIDS Services National Directory
American Foundation for AIDS Research
United States Conference of Mayors
(AmFAR)
1620 "I" St., NW
1515 Broadway, 36th Floor
Washington, D.C. 20006
New York, NY 10036
202-293-7330
212-333-3118
Directory of AIDS Resources:
AIDS Service Profiles - 1987-88 Directory
A Guide to Sources of Information
National AIDS Network (NAN)
United Way of America
1012 14th St., NW, Suite 601
710 North Fairfax St.
Washington, D.C. 20005
Alexandria, VA 22314-2045
202-347-0390
703-836-7100
Organizations and Information Sources
AIDS National Interfaith Network
Centers for Disease Control (CDC)
132 W. 31st St., 17th Floor
Office of Public Inquiries
New York, NY 10001
1600 Clifton Road, NW
212-239-8700
Building 1, Room B63
Atlanta, GA 30333
American Foundation for AIDS Research (AmFAR)
404-639-3534
1515 Broadway, 36th Floor
New York, NY 10036
National Minority AIDS Council
212-333-3118
714 "G" Street, SE
Washington, D.C. 20003
American Red Cross National Headquarters
202-544-1076
AIDS Education Program
17th and "D" Sts., NW
National AIDS Network (NAN)
Washington, D.C. 20006
1012 14th St., NW, Suite 601
202-639-3223
Washington, D.C. 20005
202-347-0390
Appendices
27
National Institutes of Health (NIH)
U.S. Public Health Service (PHS)
Building 1, Room 307
Public Affairs Office
Bethesda, MD 20892
Hubert H. Humphrey Building
301-496-5787
Room 725-H
For NIH Brochures and Publications:
200 Independence Ave., SW
Washington, D.C. 20201
Building 31, Room 2B03
202-245-6867
301-496-4143
National Leadership Coalition on AIDS
1150 17th St., NW, Suite 202
Washington, D.C. 20036
202-429-0930
Unless your company has special needs, there is no reason to produce in-house educational
Educational Materials
brochures or videos. Currently, a variety of high-quality educational materials are available
on the market. The following materials are provided as source material only. They are cited
as typical educational material which is readily available.
Produced by the U.S. Public Health Service, the Surgeon General's Report on Acquired Immune Deficiency
Syndrome has received wide circulation, and Understanding AIDS was mailed to each household in
the U.S. These brochures contain basic discussions of AIDS, how HIV is transmitted, the
relative risks of transmission, and how to prevent AIDS. See page 8 for additional information.
The following brochures are available from the American Red Cross (contact your local Red
Brochures
Cross Chapter for ordering information):
AIDS and Your Job . Are There Risks?
Informate de la que el SIDA
A general AIDS introduction emphasizing the
A general information Spanish-language
safety of casual contact with people with AIDS
brochure.
or ARC.
AIDS and the Safety of the Nation's Blood Supply
AIDS: The Facts
A discussion of the AIDS antibody test and its
A general information brochure.
use in screening the nation's blood supply.
28
AIDS Education: A Business Guide
Other brochures available
The Facts about AIDS and How Not to Get If
Teens & AIDS: Playing it Safe
A general information brochure.
A brochure for teenagers about AIDS, absti-
nence, and how to avoid the dangers of risky
American Foundation for AIDS Research
sexual practices.
(AmFAR)
1515 Broadway, 36th Floor
American Council of Life Insurance/Health
New York, NY 10036
Insurance Association of America
212-333-3118
1001 Pennsylvania Avenue, NW
Washington, D.C. 20004-2599
Asian Americans and AIDS (Equivalent titles in
202-624-2372
Japanese, Korean, Tagalog, Chinese, and
Vietnamese)
Multicultural Training Resource Center
(MTRC)
1540 Market St., Suite 320
San Francisco, CA 94102
415-861-2142
Videotapes
Videotapes are available for purchase, rental, or may be available for loan from your local
American Red Cross Chapter or AIDS service agencies.
A Letter from Brian
Answers About AIDS
A 25-minute video for use with teenagers.
Features U.S. Surgeon General Koop giving an
Parent, teacher/leader, and student materials
overview of AIDS and frankly answering ques-
included with the video. Produced by the Amer-
tions from students in a classroom setting.
ican Red Cross with funds from the American
Council of Life Insurance and the Health
American Red Cross, contact local chapter
Insurance Association of America.
Beyond Fear
American Red Cross, contact local chapter
A general discussion of AIDS in three segments:
the virus, the individual, and the community.
AIDS: Everything You and Your Family Need to Know,
Available in twenty minute segments or a 30-
But Were Afraid to Ask
minute version. Produced by the American Red
A general discussion of AIDS which first
Cross with funds from the American Council
appeared as an HBO special. Endorsed by the
of Life Insurance and the Health Insurance
American Foundation for AIDS Research
Association of America.
(AmFAR). Available in segments of different
length. (16-minute to 1-hour)
American Red Cross, contact local chapter
Ambrose Home Video Publishing
Don't Forget Sherrie
Department 1087
Provides black and urban youth with information
381 Park Ave., Suite 1601
on reducing the risk of AIDS.
New York, NY 10016
800-526-4663
American Red Cross, contact local chapter
212-696-4545 (NY)
Appendices
29
Sex, Drugs, and AIDS
The AIDS Movie
A frank video which speaks to teenagers in their
A story of three people with AIDS who share
own language. Some sexually explicit language.
the realities of the disease and how to protect
Appropriate for teenagers and young adults.
against it.
San Francisco AIDS Foundation
New Day Films
333 Valencia Street
22 Riverview Drive
Fourth Floor
Wayne, NJ 07470
San Francisco, CA 94103
201-633-0212
415-864-4376
A variety of multi-component programs, like the American Red Cross AIDS Prevention Program
Multi-Component Programs
for the Workplace (contact local chapter), are available from non-profit organizations and for-
profit companies. See the AmFAR AIDS Information Resources Directory listed above (p. 26)
for descriptions of these programs.
Public Health Service AIDS Hotline
National Sexually Transmitted Diseases Hotline
Telephone Hotlines (Toll Free)
800-342-AIDS
American Social Health Association
800-342-2437
800-227-8922
AIDS Information Hotline
National Gay Task Force
800-221-7044
212-807-6016 (NY State)
AIDS Data
Where to Find AIDS Information Online
Online Sources
A comprehensive listing of online and periodical
A description of online sources that provide
AIDS information services.
AIDS information. Reprinted from Online
1988 (March): 93-105. Contact Steve Clancy
c/o Chris Hall
or Rochelle Clary at:
National AIDS Network (NAN)
1012 14th St., NW, Suite 601
University of California, Irvine
Washington, D.C. 20005
P.O. Box 19556
202-347-0390
Irvine, CA 92713
714-856-7309
Computerized AIDS Information Network (CAIN)
A consumer on-line data base with electronic
communication capabilities.
1213 N. Highland
Los Angeles, CA 90038
213-464-7400
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AIDS Education: A Business Guide
Sample Corporate Policies on AIDS
American businesses have responded to AIDS in varying degrees and ways. Some companies
have chosen to write new policies specifically for AIDS. Most companies have simply adapted
existing catastrophic illness policies to include AIDS. Samples of existing company policies
on AIDS can be obtained by writing or calling the American Foundation for AIDS Research
(AmFAR) at the above (p. 26) address and phone number.
State AIDS Prevention Program Project
Additional information on AIDS can be obtained from the following state AIDS prevention
Directors and Coordinators
program Project Directors and Coordinators.
ALASKA
CALIFORNIA
DISTRICT OF COLUMBIA
Secretary of Epidemiology
Office of AIDS
Office of AIDS Activity
AIDS Employee Education
California Department of
1875 Connecticut Ave., NW
Coordinator
Health Services
Suite 837
Division of Public Health
P.O. Box 92732
Washington, DC 20009
P.O. Box 240249
Sacramento, CA 94234-7320
202-637-3679
Anchorage, AK 99524-0249
916-445-0553
DELAWARE
907-561-4406
AIDS Office
Health and Social Services
ALABAMA
Department of Public Health
Division of Public Health
Department of Public Health
1111 Market St.
AIDS Program Office
State Office Building
San Francisco, CA 94103
3000 Newport Gap Pike
Room 657
415-864-5571
Bldg. G
434 Monroe St.
Wilmington, DE 19808
Montgomery, AL 36130
Department of Health Services
302-995-8422
205-261-5017
AIDS Program Office
313 N. Figueroa St.
FLORIDA
ARKANSAS
Room 1014
Health and Rehabilitation
Department of Health
Los Angeles, CA 90012
Services
AIDS Prevention Program
213-974-7803
AIDS Program
4815 West Markham
1317 Winewood Blvd.
Room 455
COLORADO
Tallahassee FL 32301
Little Rock, AR 72205-3867
Department of Health
904-487-2478
501-661-2140
AIDS Education & Training/
STD Control Program
GEORGIA
ARIZONA
4210 E. 11th Ave.
Office of Infectious Diseases
Division of Disease Prevention
Denver, CO 80220
AIDS Projects
Office of Health Promotion
303-331-8320
Community Health Section
and Education
878 Peachtree St., NE
3008 N. 3rd St., Room 103
CONNECTICUT
Room 109
Phoenix, AZ 85012
AIDS Program Coordinator
Atlanta, GA 30309
602-230-5819
Department of Health
404-894-5304
Services
150 Washington St.
Hartford, CT 06106
203-566-1157
203-566-4800 (bulk orders)
Appendices
31
HAWAII
INDIANA
MARYLAND
MISSISSIPPI
Department of Health
AIDS Activity Office
AIDS Administration
Department of Health
AIDS/STD Project
State Board of Health
Health and Mental Hygiene
AIDS Prevention Program
1250 Punchbowl St.
1330 W. Michigan St.
201 West Preston St.
P.O. Box 1700
Room 117
Indianapolis, IN 46206-1964
Baltimore, MD 21201
Jackson, MS 39215-1700
Honolulu, HI 96813
317-633-0851
301-225-5013
601-960-7728
808-548-4580
KANSAS
MAINE
MONTANA
IOWA
Bureau of Epidemiology,
Office on AIDS
Montana AIDS Prevention
Department of Health
AIDS Section
Department of Human
and Surveillance Program
Division of Disease
Kansas Department of
Services
Department of Health
Prevention
Health and Environment
State House Section, # 11
Cogswell Building
Lucas State Office Building
Mills Bldg., Suite 605
Augusta, ME 04331
Helena, MT 59620
Des Moines, IA 50319
109 SW 9th St.
207-289-3747
406-444-2454
515-281-6438
Topeka, KS 66612
913-296-5588
MICHIGAN
NEBRASKA
IDAHO
Special Office on AIDS Pre-
AIDS Program
Department of Health and
KENTUCKY
vention (SOAP)
Department of Health
Welfare
Kentucky AIDS Project
Center for Health Promotion
301 Centennial Mall South
Bureau of Preventive
Department of Health
P.O. Box 30035
P.O. Box 95007
Medicine
Services
Lansing, MI 48909
Lincoln, NE 68509-5007
450 W. State St.
275 E. Main St.
517-335-8399
402-471-2937
Boise, ID 83720
Frankfort, KY 40621
208-334-5939
502-564-7112
MINNESOTA
NORTH CAROLINA
AIDS Prevention Services
AIDS Control Program
ILLINOIS
LOUISIANA
Section
State of North Carolina
AIDS Activities Section
AIDS Project
Division of Disease
Department of Health
Illinois Department of Public
Office of Public Health
Prevention
P.O. Box 2091
Health
Department of Health and
Department of Health
Raleigh, NC 27702
100 W. Randolph St.
Hospitals
717 SE Delaware St.
919-733-3419
Suite 6-600
P.O. Box 60630
Minneapolis, MN 55440
Chicago, IL 60601
New Orleans, LA 70160
612-623-5698
NORTH DAKOTA
312-917-4846
504-568-5508
AIDS Project
MISSOURI
Department of Health
AIDS Activity Office
MASSACHUSETTS
Department of Health
State Capitol Building
Chicago Department of
AIDS Program
Bureau of AIDS Prevention
Bismarck, ND 58505
Health
Massachusetts Department of
P.O. Box 570
701-224-2378
50 W. Washington
Public Health
Jefferson City, MO 65102-
Room 233
150 Tremont St.
0570
NEW HAMPSHIRE
Chicago, IL 60602
Boston, MA 02111
314-751-6438
Division of Public Health
312-744-4312
617-727-0368
Services
Bureau of Disease Control
6 Hazen Dr.
Concord, NH 03301
603-271-4477
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AIDS Education: A Business Guide
NEW JERSEY
OKLAHOMA
SOUTH DAKOTA
VIRGINIA
Department of Health
Department of Health
Department of Health
STD Control Section, AIDS
AIDS Division
AIDS Division
AIDS Prevention and
Program
CN 360, 363 W. State St.
P.O. Box 53551
Surveillance Project
Madison Bldg.
Trenton. NJ 08625
Oklahoma City, OK 73152
523 East Capitol
109 Governor St., Room 722
609-984-6000
405-271-4636
Pierre, SD 57501
Richmond, VA 23219
605-773-3364
804-275-4844
NEW MEXICO
OREGON
Health and Environment
AIDS Coordinator
TENNESSEE
VIRGIN ISLANDS
AIDS Prevention Program
Department of Human
AIDS Education Coordinator
AIDS Surveillance and
P.O. Box 968
Resources
Department of Health and
Prevention
Santa Fe, NM 87504-0968
1400 SW 5th Ave., Room 710
Environment
Department of Health
505-827-0086
Portland, OR 97201
100 9th Ave., N
P.O. Box 1026
503-229-5792
Nashville, TN 37219-5405
Christiansted
NEVADA
615-741-7387
St. Croix, Virgin Islands
Division of Health
PENNSYLVANIA
615-741-7500
00821-1026
STD Control
AIDS Education Manager
800-525-AIDS (Tennessee
809-773-1059
505 E. King St.
P.O. Box 90, Room 912
only)
Room 200
Harrisburg, PA 17108
WASHINGTON
Carson City, NV 89710
717-787-5900
TEXAS
Division of Health
702-885-4800
Bureau of AIDS and STD
Office on AIDS
800-842-AIDS (Nevada only)
PUERTO RICO
Control
Mail Stop LP-20
STD Control Program
Texas Department of Health
Olympia, WA 98504
NEW YORK CITY
Call Box STD
1100 W. 49th St.
206-753-3460
Department of Health
Caparra Heights Station
Austin, TX 78756
AIDS Program Services
San Juan, PR 00922
512-458-7207
WEST VIRGINIA
125 Worth St., Room 222
809-754-8118, ext. 230
AIDS Program
New York, NY 10013
utah
1800 Washington St., E
212-566-7103
RHODE ISLAND
AIDS Control Program
Charleston, WV 25305
Department of Health
Bureau of Epidemiology
304-348-5358
NEW YORK STATE
Disease Control
Utah Department of Health
Department of Health
75 Davis St., Room 105
288 N. 1460 West
WISCONSIN
AIDS Education and Training
Providence, RI 02908
P.O. Box 16660
AIDS Program
ESP Tower Bldg., Room 372
401-277-2362
Salt Lake City, UT 84116-
Wisconsin Department of
Albany, NY 12237
0700
Health
518-486-1320
SOUTH CAROLINA
801-538-6191
1 W. Wilson St.
Health and Environmental
Madison, WI 53702
OHIO
Control
VERMONT
608-267-9007
AIDS Activities Office
AIDS Prevention Project
Department of Health
Department of Health
STD Control Division
STD Control Program
WYOMING
Epidemiology Division
2600 Bull St.
P.O. Box 70
AIDS Health Education and
246 N. High St., 8th Floor
Columbia, SC 29201
Burlington, VT 05401
Risk Reduction Program
Columbus, OH 43266-0588
803-734-5482
802-863-7245
Preventive Medicine
614-466-5480
Hathaway Building, 4th Floor
Cheyenne, WY 82002
307-777-5800
Appendices
33
Common Questions and Answers About AIDS
Q Saliva, sweat and tears why can't the AIDS virus be transmitted that way?
A This may be the most frequently-asked question about AIDS.
Remember that for HIV (human immunodeficiency virus) to infect someone, it must get
from inside an infected person's body to inside someone else's body, via fluid, to cause
harm. Two research studies have indicated that HIV could sometimes be present in saliva
or tears. These reports received a great deal of press attention. There have been no reports
of anyone finding the virus in sweat.
What did not get enough attention in the press were (1) in people who were known
to be infected, the presence of the virus in saliva and tears was rare;
Remember that
(2) even when found, the virus was present in such small quantities and
was SO heavily diluted, that it was unlikely to be of any risk to anyone.
the virus is fragile
outside the body.
Remember that the virus is fragile outside the body. Even if the virus
were present in a person's saliva or tears, and even if it managed to remain alive on
the surface of something, it still cannot do any harm unless it is allowed inside someone's
body. So, the odds are astronomically against it ever happening.
Q Can mosquitoes transmit AIDS?
A There have never been any cases of anyone getting HIV infection from mosquitoes.
A mosquito only spreads germs that use the mosquito as part of the germ's life cycle.
The malaria organism, for example, has to spend part of its life in an anopheles mosquito
in order to mature, so mosquitoes can spread malaria.
However, syphilis, hepatitis, and many other blood-borne infections such as HIV infection
are not spread by biting insects. Mosquitoes don't go immediately from person to person.
A mosquito will usually bite and feed about once every 48 hours. Even if the virus were
there, it would be in incredibly tiny quantities and would die before the next bite. Also,
if mosquitoes were transmitting HIV, we would see many more cases of AIDS in those
parts of the country where mosquitoes are common.
The answer is - No, mosquitoes do not transmit AIDS.
Q What about swimming pools and hot tubs?
A HIV infection cannot be spread via swimming pools or hot tubs.
There are a number of reasons why swimming pools and hot tubs are safe. Remember
that in order to do any harm, HIV-infected cells must get from inside the body of an
infected person to inside the body of someone else and live cells must constantly be in
a life-sustaining body fluid.
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AIDS Education: A Business Guide
If an infected person abundantly bled into pool water, virus and blood cells would be destroyed.
Even if the pool were improperly chlorinated or not chlorinated at all, the virus could still
not be transmitted.
So, the virus doesn't really have a chance in a swimming pool or hut tub. Pools and hot
tubs are safe.
Q Why isn't the virus transmitted through food handling?
A The basic principles of transmission apply here as well. To do any harm, the virus must
be carried by live cells in a life-sustaining, fluid environment from inside the body of
an infected person to inside the body of an uninfected person.
No foods have the ability to keep cells alive, and live infected cells are rapidly destroyed
in the stomach. The Centers for Disease Control says "all epidemiologic and laboratory
evidence indicates that blood-borne and sexually-transmitted
The Centers for Disease Control says,
infections are not transmitted during the preparation of serving of
"all epidemiologic laboratory evidence
food or beverages... The CDC guidelines about AIDS in the
indicates that blood-borne and sexually-
workplace clearly state that "food service workers known to be
infected (with the AIDS virus) need not be restricted from work
transmitted infections are not transmitted
unless they have evidence of other infection or illness for which
during the preparation of serving of food
any food service workers should also be restricted."
or beverages. "
Serving or eating utensils pose no risk. Soap and water kill cells.
The kind of dishwashing equipment used in restaurants, company
cafeterias or even home dishwashers rapidly and easily kill any cells and any amount
of virus.
Q Why should I trust medical authorities? They have been wrong before!
A Because AIDS is such a highly-publicized and highly-politicized disease, the medical
authorities have been more careful about this disease than any in history.
Since 1981, regulations have required the reporting of every case of AIDS diagnosed anywhere
in the United States to the Centers for Disease Control in Atlanta. Other studies have
traced cases back nearly 10 years. Considerable expertise and expense have been devoted
to learning about AIDS, particularly the way in which the disease might be transmitted
from person to person.
Each case of AIDS reported in the United States is carefully analyzed as to the possible
methods by which the disease was acquired by that patient. Each patient is questioned
about possible methods of exposure.
Appendices
35
In addition, large group studies have been conducted over time with several thousand
volunteer participants, some of whom have the disease, and others only the infection.
Risk activities are documented and statistically correlated.
These continuing studies are conducted by independent research groups in several different
cities. The data collected by each group from thousands of participants is carefully analyzed
and correlated with data from other studies.
Several studies have also traced the health of doctors, nurses, and other health care workers
in hospitals where AIDS patients are treated. Additional studies have carefully monitor-
ed the health of children living in the same household with a child who has AIDS.
Similar studies are conducted in Europe, Canada, Africa, and Australia. Scientists from
these different areas exchange data and compare findings. The results of all of these separate
investigations are striking in their consistency.
Q
What are the symptoms of HIV-related illnesses?
A
HIV disease cannot be diagnosed from symptoms alone. In fact, a person can be infected
with HIV, but remain without symptoms for several years. However, there are several
symptoms that, in combination or if present for an extended period of time, may suggest
HIV disease, and are cause for checking with a physician.
The symptoms of HIV-related illnesses are:
unexplained, persistent fatigue (two or more months);
unexplained fever, shaking chills, or drenching night sweats lasting longer than
several weeks (recurrent or persistent over two or more months);
unexplained weight loss of more than 15 pounds or 10% of body weight;
swollen glands (enlarged lymph nodes usually in the neck, armpits or groin)
which are otherwise unexplained and last more than two months;
persistent white spots or unusual blemishes in the mouth;
persistent diarrhea (two or more months), not explained after medical workup;
pink to purple flat or raised blotches or bumps occurring on or under the skin,
inside the mouth, nose, eyelids or rectum. Initially, they may resemble bruises
but do not disappear. They are usually harder than the skin around them;
persistent dry cough which has lasted too long (two or more months) to be
caused by a common respiratory infection, especially if accompanied by shortness
of breath.
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AIDS Education: A Business Guide
Please note that this list is very similar to the symptoms of other diseases. Some of them
may be symptoms of stress. You cannot tell if someone has an HIV-related illness just
by looking or just because that person has one or more of these symptoms. Only a doctor
is capable of diagnosing an HIV-related illness, and he or she will need supporting laboratory
tests to make that diagnosis.
One or more of these symptoms for a prolonged period is a good reason to see a doctor.
The symptoms might not mean HIV infection, but they may mean that some disease
is operating in the body that could be serious unless properly treated.
Q What about the AIDS antibody test?
A "Antibodies" are substances that are produced by the immune system to help eliminate
a specific foreign invader that can cause disease. The body produces specific antibodies
for each specific invader. Production of antibodies is an essential element of the human
immune response.
The AIDS antibody test
Polio antibody is designed to help attack and destroy the polio virus.
detects the presence of those
Measles antibody is designed to deal only with the measles. Viral HIV
antibodies in a person's blood.
antibody is produced by the body as a response to the presence of
the AIDS virus. Each different antibody can be identified in the blood.
It is not a test for AIDS.
Unlike measles antibody, which can protect the body from measles,
and unlike polio antibody, which can protect the body from polio, antibody to HIV does
not appear to provide complete protection against the AIDS virus. However, since the
body produces this antibody whenever it is infected with HIV, it can serve as a marker
for and diagnosis of HIV infection.
The HIV antibody test detects the presence of this antibody in a person's blood. It is
not a test for AIDS, though it now appears that most of those who do test positive for
the presence of this antibody will go on after a long incubation period to develop HIV-
related illnesses or full-blown AIDS.
The HIV antibody test has been used by blood banks since 1985 to screen out HIV-
infected blood. However, since it may take the body's immune system up to three months
on average to develop antibody to HIV, if an infected person donates blood during that
three-month period, the blood may not test positive for AIDS antibodies. As a result,
there is still a small risk of contracting HIV infection from receiving a blood transfusion.
Physicians are well aware of this remaining small risk and now order transfusions only
when absolutely necessary.
Appendices
37
The blood test is also utilized by physicians to assist in diagnosing cases of HIV infection
and full-blown AIDS. It is being used to screen military recruits, military service persons,
applicants for immigrant status to the United States, and to assess risk of AIDS by some
life and health insurance policies.
A negative test result, as long as it is performed at least three months after any possible
exposure to the virus, is a pretty good indicator that the person tested has never been
infected by the virus. A positive test result, when verified by a confirmatory test, quite
reliably indicates that the person has been infected with HIV. He or she should consult
a physician regarding the medical implications of a positive test result. It is important
that persons contemplating taking this test receive expert counseling before and also after
the test, irrespective of test results.
Regardless of one's test results, anyone who has not been in a mutually monogamous
relationship for at least the last six years should take the necessary precautions to prevent
contracting or transmitting HIV. Abstaining from sexual intercourse and intravenous drugs,
or participating in a mutually monogamous relationship with an
uninfected partner are the most effective ways to prevent
Anyone who has not been in
transmission of the virus. Otherwise, proper and regular use of
latex condoms and a spermicide, and not sharing drug works
a mutually monogamous relationship
are the next best methods of reducing the risks of transmitting
for at least the last six years should
or contracting HIV infection.
take the necessary precautions to prevent
Q Can using a condom protect me from getting the AIDS virus?
contracting or transmitting the virus.
A
Abstinence or sexual intercourse with one faithful uninfected partner are the only totally
effective prevention strategies. Use of condoms with each act of sexual intercourse (vaginal,
anal, or oral) can reduce, but do not completely eliminate, risk of infection with HIV
and other sexually transmitted diseases.
Latex condoms provide protection against HIV and other viral sexually transmitted diseases;
membrane condoms do not.
For condoms to be effective, they must be used properly. A condom and a water-based
lubricant containing a spermicide must be used with each act of sexual intercourse. The
condom must be put on and completely unrolled before any genital activity occurs. Oil-
based lubricants weaken latex condoms and should not be used.
Condoms are a way of reducing the risk of infection with HIV, but they are not a foolproof,
completely safe method for avoiding infection.
38
AIDS Education: A Business Guide
Q
What about exposure to someone's blood?
A
Blood should be treated carefully, regardless of AIDS. Although intact skin is an effective
barrier against HIV and blood-borne germs, they are common enough and serious enough
so that blood should always be dealt with carefully. After contact with another person's
blood, one should immediately wash one's hands thoroughly.
An effective way to clean up quantities of spilled blood is by using an ordinary solution
of regular household bleach - one part of bleach to ten parts of water, just as it says
on the label. Products like Lysol or Tide can also be used. Use common sense about
blood contact in the event of a serious accident.
Minor amounts of blood, like the tiny bit of blood that can result from a minor paper
cut or pin stick, are not a cause for concern. A common antiseptic or hand washing
will remove any risk of HIV infection.
Q
Is it possible for someone to be a carrier of the AIDS virus and still look healthy?
A
There is no risk to you from
Yes. You cannot tell by looking whether someone is carrying HIV
in his or her system, nor would the individual know whether he
working with a person who actually
or she is carrying the virus.
has AIDS or with someone who may
If a person thinks he or she might be a carrier, it is a good idea
be healthy but is carrying
for that person to consider taking the HIV antibody test. It would
the virus.
be especially important for a woman contemplating pregnancy to
take the test if either she or the prospective father might possibly
have been exposed to the virus.
As far as the workplace is concerned, it does not matter whether one is a carrier or
not, since there is no risk to anyone from working with a person who actually has AIDS
or with someone who may be healthy but is carrying the virus.
Q
Why is it safe to donate blood?
A
Some people have the mistaken impression that donating blood is risky. This is not true
because people who donate blood cannot be exposed to anything. Blood donors are provided
with a sterile, throw-away needle that is used only once. Nothing enters the donor's body
that can do any harm. There is no way for any virus to enter the donor's blood-stream
when donating blood at a blood bank.
Before the blood screening programs were instituted in the nation's blood banks in 1985,
some people were exposed to HIV through receiving transfusions of someone else's
contaminated blood. With the implementation of the blood screening program, the risk
of getting HIV infection and AIDS from a blood transfusion has decreased substantially.
Appendices
39
The blood banks always need blood. Unless you have some reason to think that you
might already be infected with HIV, please help out by donating blood at your local blood
bank or blood drive.
There is absolutely no risk in donating blood.
Q If, as you say, the medical evidence is so definite and this disease isn't a danger to us, why
is AIDS still such a big deal? Parents are picketing schools, people with AIDS are being fired,
the military is testing everyone, and laws are being proposed to bar people from food-handling
jobs.
A AIDS raises a lot of fundamental, serious, and very sensitive questions and issues that
have nothing to do with disease or medicine - questions and issues about which many
people have extremely strong and very vocal opinions.
AIDS also has many elements that make it a sensational topic for the press: sex, drugs,
blood, death.
We can expect that AIDS will remain
Much of the excitement about AIDS doesn't really relate to the
disease or to HIV itself. It relates to strongly-held beliefs and
a controversial disease for some time,
opinions about the behaviors that are often responsible for
so long as it remains connected with our
transmitting the virus, and about those people who SO far most
beliefs and traditions and differing
often have been diagnosed with AIDS.
points of view about morality.
AIDS is a relatively new disease for most people. Since there
is no cure, it's scary. We're all afraid of something we aren't used to and that we don't
fully understand. And, of course, parents are even more concerned about a new disease
where their young children are concerned. They are often not willing to listen to the
evidence unless someone will give them an ironclad guarantee that there is absolutely
no possible risk under any circumstances. No one is going to give them ironclad guarantees
about any aspect of their child's safety and well-being away from the home. Neither can
the parents absolutely guarantee the safety and well-being of the child even when the
child is at home.
We can expect that AIDS will remain a controversial topic for some time, SO long as
it remains connected with our beliefs and traditions and differing points of view about
morality.
We each have our own deeply-held beliefs on such matters and we are each entitled to
those beliefs. But if we are to be responsible about this disease, we must not let the
more emotional issues - however valid and important they may be to us - cloud our
understanding of the medical facts about the disease and about the way it is spread. Whatever
our feelings about how HIV infection is spread, we are still left with the fact that AIDS
is not spread in the workplace.
40
AIDS Education: A Business Guide
Q
Who gets AIDS?
A
People who have died of AIDS in the United States have been male and female, young
and old, rich and poor, white, black, Hispanic, Asian, and American Indian. The male
homosexual population was the first in this country to feel the effects of the disease.
A significant number of intravenous drug users were also infected. Today members of
these two groups constitute the largest number of AIDS cases. The remaining categories
include hemophiliacs, transfusion recipients, and heterosexuals and their infants
(transmission can occur from an infected female to an uninfected male, or from an infected
male to an uninfected female).
It is clear that anyone can get AIDS. Engaging in high risk behavior like having unprotected
sex (oral, vaginal, or anal intercourse) or using intravenous drugs is a far more significant
index of who will become infected with HIV than where one lives or what one's sexual
orientation is.
a What happens when a person becomes infected with the AIDS virus?
If is clear that
A
It is not known exactly how many of those infected with HIV will
anyone can get AIDS.
actually develop AIDS, but it is now believed that most of them will,
in the long run, develop symptoms. (In the past, this condition was
known as ARC, AIDS Related Complex.)
Among them, a substantial number will develop full-blown AIDS, with symptoms of specific
life-threatening diseases such as pneumocystis carinii pneumonia (PCP) or Kaposi's sarcoma
(KS).
It can take anywhere from a few months to several years or more after HIV infection
for HIV-related diseases to develop.
It is difficult to generalize how serious the disease will be at any point. Some people
with symptoms of HIV infection or even full-blown AIDS can have long periods of good
health alternating with periods of illness. Some die very quickly; most remain generally
healthy and very active for extended periods. Each case may be quite different.
Q
-
Can AIDS be treated or cured?
A
There is so far no treatment that will destroy HIV in the human body or that will restore
the immune system. Research on antiviral and immunorestorative drugs is under way
in the United States and other countries. In many patients, the drug AZT retards viral
multiplication and, as a result, reduces the risk of complicating infections and prolongs
life.
Appendices
41
People with AIDS, however, are often successfully treated for specific opportunistic infections
and may lead active lives for long periods of time. People with AIDS, like people with
other life-threatening illnesses such as cancer or heart disease, may need extra social and
emotional support.
Researchers are not optimistic about the development of any effective vaccine or cure
for AIDS in the immediate future. A cure would require a two-fold solution: a way to
stop the virus from doing any further damage in the body and a way to restore the damage
that has been done. Just as we do not yet have a literal "cure" for many cancers, even
after decades of research, a true cure for AIDS may remain elusive for a long time but
it is reasonable to expect that progression from HIV infection to full-blown AIDS will
be slowed or stopped in the foreseeable future by treatments presently in experimental
studies.
However, AIDS is preventable and is not easily spread. Education is currently our best
preventive measure.
Q If AIDS is a venereal disease, why isn't it curable like other
People with AIDS are often successfully
venereal diseases?
treated for specific infections and may lead
A Not all veneral diseases are curable even today; most were
active lives for long periods of time.
not curable until antibiotics became available in the 1940's.
Veneral diseases are now referred to as "sexually transmitted diseases." They have been
a problem for centuries. Gonorrhea and syphilis were epidemic diseases in many countries
as late as the 20th century. These diseases were incurable, painful, disfiguring, and often
led to death.
Syphilis was especially dangerous, usually leading to insanity and death. Many famous
people had the disease. Beethoven and Mozart are said to have died from syphilis. Winston
Churchill's father died of syphilis. Syphilis wasn't consistently curable until 1944.
Herpes, a sexually transmitted disease caused by a virus, is still incurable. A few years
ago, the press gave a great deal of attention to the epidemic of herpes infection. Little
is written about it today, even though there are more new cases of herpes diagnosed
today than there were then. The press and the public simply lost interest in the topic.
HIV infection may be curable someday, but as with many other diseases, the development
of a cure will take time.
Q I thought science had solved the problem of epidemics. Why are we having an epidemic now?
A Epidemics of infectious diseases have come along every few generations since the beginning
of recorded history. Even as one epidemic ended, people always knew that another one
42
AIDS Education: A Business Guide
would eventually come along. Our generation, however, thought that we had developed
the medical technology that would make epidemics a thing of the past. We were wrong.
All living things on Earth, including viruses and bacteria, constantly undergo genetic
mutations. Some result in organisms that are unusually harmful to humans. When that
happens, an epidemic may erupt.
In 1918 and 1919, an epidemic of influenza killed 400,000 Americans in a single year,
and millions of people worldwide. That virus mutated itself out of existence.
In this country, an epidemic of polio lasted from the 1930s until well into the 1950s,
when a vaccine for polio was finally developed. General immunization stopped the epidemic.
There have been periodic outbreaks of bubonic plague in this country, even into this
century. Thanks to antibodies against the bacterium that causes it, this disease is not
frightening anymore.
Epidemics may always
We tend to take a short view of history sometimes, and tend to exaggerate
be a periodic part
our faith in technology. Science may eventually solve the problem of AIDS.
of human existence.
But we should be prepared for some other mysterious disease to come
along in the future, which will take time for technology to eliminate.
This is a strong argument for continuing the support of biomedical research programs.
Epidemics may always be a periodic part of human existence.
Q
I don't care what you say about AIDS not being a risk at work. I don't want to work with
a person who is carrying that virus. What are you going to do for me and my concerns?
A
Well, suppose that someone was afraid of working with YOU for some reason that had
no medical, scientific, or logical basis. We would certainly talk with the person, explain
that their fears of working with you were unfounded, offer some counseling if necessary,
and try to work it out.
a
I have some questions about AIDS that I don't want to discuss here today. Where can I get
some confidential information?
A
Talk with your doctor. If your doctor isn't yet familiar with AIDS, ask him or her to
become educated about AIDS so he or she can answer your questions. Don't be surprised
if your physician is not familiar with AIDS. It is a new specialty for many doctors.
(Note: Some employees may find it difficult to talk to a family doctor. Make sure your
business or company provides other resources for an employee to get additional or personal
information about AIDS. Please indicate how they are available to employees. Also, the
Resources section of this manual provides a variety of AIDS hotline phone numbers.)
Appendices
43
Centers for Disease Control Guidelines on AIDS in the Workplace
Summary of Centers for Disease Control Guidelines on AIDS in the Workplace, November 1985
The CDC has issued recommendations to provide employers with guidance on the health risks of
employing a person with AIDS:
1 The basic recommendation is that an employee with AIDS need not be restricted from
work in any area unless they have evidence of other infections or illnesses for which any
employee in that area of work should also be restricted.
2 Where blood or other body fluids are present, make use of the following personal protective
equipment:
Use gloves where blood, blood products, or body fluids will be handled;
Use gowns, masks, and eye protectors for procedures that could involve
more extensive splashing of blood or body fluids;
Use pocket masks, resuscitation bags, or other ventilation devices to
resuscitate a patient to minimize exposure that may occur during emergency
mouth-to-mouth resuscitation. Employers should place these devices where
the need for resuscitation is likely.
The following workplace practices should be observed:
Wash hands thoroughly after removing gloves, and immediately after contact
with blood or body fluids;
Use disposable needles and syringes whenever possible. Do not recap, bend,
or cut needles. Instruments that penetrate the skin, e.g., tattooing and
acupuncture needles or ear-piercing devices, should be used once and disposed
of or be thoroughly cleaned and sterilized. Instruments not intended to
penetrate the skin, but which may become contaminated with blood (e.g.
razors) should be used for only one client and disposed of, or thoroughly
cleaned and disinfected. Place sharp instruments in a specially-designated,
puncture-resistant container located as close as practical to the area where
they are used. Handle and dispose of them with extraordinary care to prevent
accidental injury.
Follow general guidelines for sterilization, disinfection, housekeeping, and
waste disposal. Use appropriate protective equipment. Place potentially
infective waste in impervious bags and dispose of them as local regulations
require.
44
AIDS Education: A Business Guide
Clean up blood spills immediately with detergent and water. Use a solution
of 5.25 percent sodium hypochlorite (household bleach) diluted between
1-10 and 1-100 parts water for disinfection.
No special precautions are required for personal service workers whose
services do not involve a risk of blood contamination.
3 The CDC does not recommend a prohibition on employment of a person with AIDS working
in food services. No evidence exists of transmission of either HIV or hepatitis B virus
during the preparation or serving of food or beverages.
4 Workers with AIDS in a setting such as an office, school, factory or construction site have
no known risk of transmitting the infection to co-workers, clients or consumers.
5 The CDC finds the greatest risk of transmission of HIV in the health-care workplace, especially
those health-care workers who take part in invasive procedures, such as surgery. It is the
CDC's position that even health-care workers who are known to be infected with HIV,
but who do not perform invasive procedures, "need not be restricted from work unless
they have evidence of other infection or illness for which any (health-care worker) should
be restricted."
OSHA Enforcement
Various OSHA standards apply to exposure to the hazards of potential infection of both the
HIV and hepatitis B viruses. These standards cover personal protective equipment, sanitation,
and waste disposal.
In addition, the General Duty Clause of the OSHA Act requires employers to provide "employment
and a place of employment which are free from recognized hazards. Employers must comply
with either the federal OSHA standards and the General Duty Clause or with state standards.
States with approved plans to operate their own occupational safety and health program enforce
standards comparable to the federal standards and are encouraged to enforce state counterparts
to the General Duty Clause. State plan standards, unlike federal standards, apply to state, county,
and municipal workers as well as to private employers.
Workers whose employers will not correct hazardous situations may complain to federal OSHA
or to the appropriate state OSHA in states that operate their own OSHA programs. Complainants'
identities will not be revealed to employers. OSHA also investigates employee complaints of
discriminatory actions by employers against employees who have exercised safety and health
rights.
For more information on OSHA inspection and compliance contact the OSHA office of Health
Compliance and Assistance (202-523-8036).
NOTES
NOTES
NOTES
Underwritten by:
Drexel Burnham Lambert
AT&T
Pacific Mutual
American Council of Life Insurance
Health Insurance Association of America
FY.I. too
HILL AND KNOWLTON
here chriss Good / foit but this does may confirmenen 1 conor. our
Ed McNally
Hill and Knowlton
Public Affairs Worldwide Co.
Washington Harbour
901 31st Street, N.W.
Washington, D.C. 20007-3838
202-333-7400
Telecopy 202-333-1638
Telex 440143 HKDC
much line about to a a cure for E.
March 6, 1990
just received this
The Honorable
lead
David F. Demarest, Jr.
Assistant to The President
doday (3/26/90)
for Communications
The White House
Washington, D.C. 20500
Dear Dave:
Enclosed is the material I mentioned during our
telephone conversation. As we discussed, an
important message which the American people need to
hear is that money currently being spent on AIDS
research will have a lasting impact on diseases
other than HIV. The new doors being opened and new
tools being discovered via current research will be
of untold benefit to future generations in every
segment of American society.
As I mentioned, we are closely working with Dr.
Mathilde Krim of AMFAR (American Foundation for Aids
Research), Dr. Samuel Broder, Director of the Cancer
Research Institute at the National Instititues of
Health and Dr. Robert Gallo, Chief of the Laboratory
of Tumor Cell Biology at NIH.
I do hope Dr. Krim's letter provides "fodder" for
the speechwriters as they prepare The President's
remarks for the National Leadership Coalition on
AIDS scheduled for March 29th.
Sincerely,
Daine Elaine D. Crispen
Senior Vice President
1515 BROADWAY
SUITE 3601
AMFAR
NEW YORK. NY 10036-8901
(212) 19-0033
R
FAX: 212) 719-0712
BOARD OF DIRECTORS
National Chairman
Elizabeth Taylor
March 23, 1990
Chairman of the Board
loei Weisman. D.O
Founding Co-Chairs
Michael S. Gottlieb. M.D.
Mathilde Krim. Ph.D.
Mr. James Jennings
President
Mervyn F. Silverman. M.D. M.P H.
HILL & KNOWLTON
In Memoriam
901 31stStreet, N.W.
Sheldon Andelson. Esq.
Peter Scott. Esq.
Washington, D.C. 20007-3838
Directors
Arthur I. Ammann. M.D.
Burr Bacharach
Jonathan Canno
Peter F. Carpenter
Dear Jim:
Kenneth Cole
Mrs. Michael Eisner
Susie Field
Harvey Fineberg. M.D., Ph. D.
Following our conversation, I have taken the
Michael Fuchs
David Geffen
liberty of forwarding some language that
William Haseltine. Ph.D.
addresses the issue of how AIDS research can
Arnold Klein. M.D.
Mrs John W. Kluge
affect all Americans:
Barry Krost
Philip Lee. M.D.
Philip B. Miller
Woodrow A. Myers. Jr.. M.D. M.B.A.
Dollars spent for AIDS research are dollars
Rev. Randolph Nugent
Carole Bayer Sager
spent for the better health of all
Wallace Sheft. C.P.A.
The Rt. Rev. William E. Swing
Americans. Even more than the technologies
Rosemary Tomich
Abigail Van Buren
developed by the space program, the benefits
Mrs. Lew Wasserman
of bio-medical science moving forward will
Director Emeritus
Mrs. Albert D. Lasker
touch all of us in decisive ways.
NATIONAL COUNCIL
Woody Allen
Warren Beatty
AIDS research is broad-based biological
Leonard Bernstein
Barry Bostwick
research. It includes research on a class
Benjamin J. Buttenwieser. Esq.
Joseph A. Califano. Jr.. Esq.
of viruses now increasingly believed to be
Rosalynn Carter
Leo Castelli
the cause not only of AIDS, but of several
Sammy Davis. Jr.
currently incurable chronic degenerative or
Phil Donahue
Douglas Fairbanks. Jr.
malignant diseases such as muscular
Morgan Fairchild
Harvey Fierstein
dystrophy, multiple sclerosis and at least
Lawrence Fouraker. Ph.D.
Georgia Frontiere
two forms of leukemia.
Katharine Graham
Robert D. Haas
George Hamilton
Ashton Hawkins. Esq.
AIDS research also concerns itself with the
Marilyn Home
Mrs. Lyndon Baines Johnson
functioning of the immune system: it is
Arthur B. Krim. Esq.
Helen Kushnick
clarifying the role played by this system in
Angela Lansbury
fighting viruses, microbes and cancer cells
Marguerite Littman
Greg Louganis
and we will learn, through AIDS research,
The Rt. Rev. Paul. Moore. Jr.
Tony Randall
how to restore failing immune defenses.
Robert Rauschenberg
Jonas Salk, M.D.
Nothing could have more relevance to a wide
Liz Smith
Michael I. Sovern. Esq.
array of conditions, from common infections
Barbra Streisand
Jack Valenti
and cancers to potentially life-saving organ
Raquel Welch
and bone marrow transplantations.
LOS ANGELES OFFICE
5900 WILSHIRE BOULEVARD
SECOND FLOOR. EAST SATELLITE
AIDS research also addresses the prevention
LOS ANGELES. CA 90036-5032
(213) 857-5900
and treatment of the devastating infections
FAX: (213) 857-5920
and cancers that are common -- and often
fatal -- complications in people with AIDS
as well as in all those with a weakened
FOR AIDSR
Mr. James Jennings
Page 2.
March 23, 1990
immune defense system, such as debilitated old people and
infants. For them, AIDS research has already produced
methods for the effective treatment of shingles and the
prevention of a deadly form of pneumonia.
Similarly, AIDS research has lead to the discovery of two
new drugs for the treatment of herpetic infections,
including those infections that lead to serious birth
defects or blindness. Many other new drugs to combat
viruses are now in development because the pharmaceutical
industry is responding to the challenge of AIDS.
AIDS research has also spurred the application of modern
molecular technologies to the development of vaccines and
even the use of cellular and genetic engineering for
therapy.
The intensive research effort developed to combat AIDS is
opening vast new frontiers in disease prevention and
treatment. It is making real today what was thought
impossible only a few years ago.
James Mason, M.D., Assistant Secretary for Health,
Department of Health and Human Services, has said that the
fruits of research in one area cross over into others.
"The breakthroughs in AIDS largely have come because of
work that was done in cancer research, and the research
that is being done in AIDS will benefit us" in other
areas. "In other words, biomedical research is never SO
targeted." Knowledge about damage of immunological
functions from AIDS will be applicable to "cancer and a
whole series of other diseases,' Mason asserted.
This last paragraph quoting Dr. Mason is taken from the FDC
Reports, Inc., March 19, 1990, p. 6.
I hope this information is useful. Please call me if I may be
of any further help.
Mathilde Krim, Ph. D.
Founding Co-Chair
MK/hb
HUMAN
HEALTH
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
OF
DEPARTMENT
National Institutes of Health
National Cancer Institute
Bethesda, Maryland 20892
Building 37
Room 6A09
Tel: (301) 496-6007
Fax: (301) 496-8394
March 26, 1990
Mr. James Jennings
Hill and Knowlton
Public Affairs Worldwide Co.
901 31st Street, N.W.
Washington, D.C. 20007-3838
Dear Jim:
In response to your inquiry about how AIDS touches all of us, please
consider the following points which I have limited to the broad medical
implications of AIDS research. Obviously, the economic, social, moral,
and global-political implications are even wider.
It is true that most of the major advances in AIDS research came out of
basic cancer research. Conversely, one can easily imagine that out of
AIDS research will come major advances in several other areas of medical
research, even more so than any other area of research. Let me
illustrate with some specific examples.
1. Cancer. It should not be forgotten that AIDS is very
frequently associated with the development of some cancers.
Two are particularly common: B-cell lymphomas (a cancer of the
lymph glands) and Kaposi's sarcoma. In fact, in association
with infection with the AIDS virus, these have become the
fastest increasing cancers. What is important is that from
AIDS research new information on the mechanisms of how these
tumors develop has already become available. I predict that
within 1990-91 new treatments for these cancers will also come
directly from AIDS research.
2. Basic understanding of the immune system. AIDS is primarily a
failure of a central cell of the immune system. Other than
direct studies on the AIDS virus, basic research in AIDS is
basic research of our immune system. The immune system is at
the heart of many human health problems from infectious disease
to aging and cancer. Out of AIDS research new understanding of
the function of immune cells has already occurred.
Ltr, Mr. Jennings, 3/26/90, Page 2
3. The cause of AIDS is a special kind of virus called a
retrovirus. The AIDS virus has two cousins which also cause
serious diseases in man, including two forms of leukemia and
neurological diseases similar to multiple sclerosis. Thus, the
studies of these kinds of viruses in general will have spin-
offs to an understanding of these problems.
4. Basic molecular biology, i.e., basic mechanisms within the
cell. Unexpectedly, out of AIDS research has come mechanisms
and insights into some areas of the molecular biology of the
cell which are novel.
5. New drugs for infectious diseases. Patients with AIDS develop
an incredible number and type of infectious diseases. This has
spawned areas of research which have led to new and improved
treatment of some of these infectious diseases.
6. Anti-viral chemicals. Before AIDS there were almost no
chemicals against a virus and too little research in the whole
area. Viruses, of course, unlike bacteria are not killed by
antibiotics but require more subtle approaches to control. The
AZT story is a story of pioneering research not just for AIDS
but for the history of anti-viral agents.
7. Vaccines. No AIDS vaccine exists as yet. No vaccine has ever
been successful against a virus which shows considerable
variation. (Influenza is sort of an exception but its
variation is not at the magnitude of the AIDS virus and the
vaccine is not always successful.) The point here is that if a
successful AIDS vaccine is made it will mean this kind of
problem (the virus variation problem) will have been solved.
This will have immediate impact for infectious diseases in
general and viral diseases in particular.
I close by reminding you that if we (Americans) solve this problem it
will be one of the greatest things we could do for the world and for our
own self esteem.
Sincerely yours,
Bor
Robert C. Gallo, M.D.
RCG: am
HILL AND KNOWLTON
Hill and Knowlton
Public Affairs Worldwide Co.
Washington Harbour
901 31st Street, N.W.
Washington, D.C. 20007-3838
202-333-7400
Telecopy 202-333-1638
Telex 440143 HKDC
March 27, 1990
The Honorable
David F. Demarest, Jr.
Assistant to The President
for Communications
The White House
Washington, D.C. 20500
Dear Dave:
Attached is some additional information which might
be helpful to The President for his remarks this
Thursday before the National Leadership Coalition on
AIDS.
I realize the speech has already been tasked and
know how difficult last-minute material is to deal
with, but I wanted you to have this critical
information to see if it could be worked into the
text.
Being experts in the field, I didn't want the
material from Dr. Krim and Dr. Gallo to go unheeded.
Again, many thanks for your attention to this
matter.
Sincerely,
Elaine D. Crispen
Senior Vice President
Attachments