Social and Behavioral Sciences Commons^™

The Search For A Massachusetts Chancellor: Autonomy And Politics In Higher Education, Richard A. Hogarty

New England Journal of Public Policy

Political scientists have not devoted much attention to the politics of higher education. Their reluctance is hard to explain since the material for study is close at hand and the subject offers ample research opportunities. The search for a chancellor conducted by the Massachusetts Board of Regents in 1986 aroused considerable public attention and controversy. This case study examines that controversy along with the tensions that arise when academic and political forces collide. Few searches in academia are perfect and none is a morality play. This one proved to be no exception. This article is an attempt to reconstruct the …

Roxbury, Boston, And The Boston Smsa: Socioeconomic Trends 1960-1985, Sally Brewster Moulton

New England Journal of Public Policy

Socioeconomic trends for a primarily black and poor urban area, Roxbury, Massachusetts, are compared to those of the surrounding city of Boston and the Boston Standard Metropolitan Statistical Area (SMSA) for the period 1960 to 1985. Patterns in income, poverty, labor force participation, educational attainment, and racial composition are examined for each of the three areas. The chief purpose of the analysis is to determine the nature of gaps between Roxbury residents and the rest of the metropolitan area as well as the ways in which such gaps have changed over time.

The findings indicate that, despite growth in income, …

The Catholic Church And The Desegregation Of Boston's Public Schools, James E. Glinski

New England Journal of Public Policy

Recent studies of Boston 's desegregation crisis, most notably J. Anthony Lukas's Common Ground, have been highly critical of the Catholic church and its local leader, Humberto Cardinal Medeiros, archbishop of Boston. Their criticisms have been that the church, guided by the ineffective leadership of Cardinal Medeiros in an effort to save its own schools, allowed its schools to become havens for those Bostonians attempting to escape busing. This article is an account of the church's effort to develop a desegregation policy that would allow it to preserve its own schools but not at the expense of court-ordered desegregation …

Recent Trends In The Economic Status Of Boston's Aged: Determinants And Policy Implications, William H. Crown

New England Journal of Public Policy

The economic status of the older population has improved significantly since the early 1970s. Yet poverty rates among certain groups of elderly, especially older minorities, have declined very little. To understand the reasons for these seemingly contradictory trends, changes in the income composition of the elderly in Boston are compared to changes in income for the elderly in the United States. This analysis suggests that low-income older persons were largely bypassed by one of the major factors in income growth among the older population — growth in pension income.

Despite the persistence of poverty among significant segments of the older …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

For months on end we were subjected to the rituals of irrelevance: to posturing as patriotism, incoherence as eloquence, innuendo as nuance, character assassination as candor, sound-bites as substance, carefully memorized one-liners as expressions of spontaneity, self-righteousness as self-deprecation. Misstatement, outright fabrication, deliberate falsehood, and conscious distortion were spewed out by spin-masters, merchants of manipulation, propagandists, pollsters, shysters of the slick and technicians of the fast fix, all in the name of the democratic process. Nor were the two presidential candidates, Michael Dukakis and George Bush, themselves immune to the malaise, proving themselves extraordinarily adept time and again at not …

List Of Terms

New England Journal of Public Policy

Lists and defines terms relevant to the study of HIV/AIDS that are used throughout this issue of the New England Journal of Public Policy.

Neuropsychiatric Complications Of Hiv Infection: Public Policy Implications, Alexandra Beckett, Theo Manschreck

New England Journal of Public Policy

The human immunodeficiency virus (HIV) infects the central nervous system (CNS), causing symptoms in most persons with AIDS-related complex (ARC) and AIDS, and in a significant proportion of those classified as asymptomatic seropositive. The most common clinical syndrome secondary to CNS infection is known as HIV encephalopathy. When sufficiently disabling, HIV encephalopathy is known as AIDS dementia, and must be reported to the Centers for Disease Control as a case of AIDS.

AIDS dementia is a complex of cognitive, affective, behavioral, and motor symptoms which varies widely in its presentation. In some persons, cognitive impairment predominates, manifesting in a loss …

Aids: Prophecy And Present Reality, Victor De Gruttola, William Ira Bennett

New England Journal of Public Policy

Mathematical modeling of the AIDS epidemic can be useful for policymakers even though precise projections are not possible at this time. Models are useful in establishing ranges for current and future prevalence of HIV infection and incidence of AIDS, as well as in predicting the effect of a given intervention strategy. Most decision makers are using models implicitly when they use epidemiological information as a basis for policy; formulating a model explicitly permits examination of the underlying assumptions. By creating and testing a variety of models, an investigator can determine whether the models reflect more the underlying assumptions or the …

Behavioral Change In Homosexual Men At Risk Of Aids: Intervention And Policy Implications, Suzanne B. Montgomery, Jill G. Joseph

New England Journal of Public Policy

With more than fifty thousand cases of acquired immunodeficiency syndrome (AIDS) diagnosed since its initial recognition in 1981 and no cure or vaccine in sight, experts agree that prevention is of the utmost importance. Yet very little research has investigated how existing social-psychological and health behavioral knowledge can be applied to the special circumstances of programmatic responses to AIDS. One of the central aims of our own research group has been to describe the psychosocial determinants of successful behavioral risk reduction among homosexual men, the largest affected group. This work is reviewed and its implications for the development of intervention …

Aids: An Overview, Loretta Mclaughlin

New England Journal of Public Policy

"We stand nakedly in front of a very serious pandemic, as mortal as any pandemic there ever has been," said Halfdan Mahler, director-general of the World Health Organization (WHO). "I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming. Everything is getting worse and worse with AIDS and all of us have been underestimating it, and I in particular. We're running scared. I cannot imagine a worse health problem in this century." When asked to compare AIDS to other epidemics, such as smallpox, that have infected and killed over the course …

The Acquired Immunodeficiency Syndrome In New England: An Epidemiological Review Of The First Six Years, Laureen M. Kunches, Jeanne M. Day

New England Journal of Public Policy

Between 1981 and 1987 — the six-year period following initial recognition of the acquired immunodeficiency syndrome (AIDS) — 1,475 cases were reported among residents of the six New England states. Of nearly 40,000 cases nationwide, 3.8 percent occurred among New England residents, though the region 's population represents 5.5 percent ofthe total United States population. The groups most affected include homosexual or bisexual men (65 percent) and intravenous drug users (20 percent). However, in the two southernmost states — Rhode Island and Connecticut — 32 to 40 percent of all cases have used intravenous drugs. In these states, the male:female …

Epidemiology And Health Policy Imperatives For Aids, Katherine Hill Chavigny, Sarah L. Turner, Anne K. Kibrick

New England Journal of Public Policy

The purpose of this article is to describe the statistics and epidemiological facts about the most virulent epidemic of our age, acquired immunodeficiency syndrome (AIDS). The discussion argues for broadened public policy to promote the surveillance of communities in order to enhance the effectiveness of data gathering for epidemiological reasoning, analysis, and control measures. To accomplish these goals, the essential characteristics of epidemiology are defined. The use of deductive and inductive reasoning is applied to describe and analyze known facts concerning the AIDS epidemic. Hypotheses are suggested from current amorphous and continually changing information to assist in further explanations of …

Human Retroviruses: Illustration

New England Journal of Public Policy

An illustration of human retroviruses and the life cycle of retroviruses.

Understanding The Psychological Impact Of Aids: The Other Epidemic, Marshall Forstein

New England Journal of Public Policy

HIV has created two epidemics, one of disease, the other the consequence of the psychological response to that disease. Thus far, behavioral change is the only effective means of interrupting the transmission of HIV. The underlying psychological dimensions of the societal and individual responses to AIDS are discussed, with suggestions for how both rational thinking and irrational fears and anxiety contribute to the development of public policy. Examples are given of how short-term solutions to reduce anxiety may actually create long-term problems, potentially increasing the risk of transmission of HIV. Specific psychological mechanisms that contribute to the epidemic of fear …

Hiv Antibody Screening: An Ethical Framework For Evaluating Proposed Programs, Ronald Bayer, Carol Levine, Susan M. Wolf

New England Journal of Public Policy

The acquired immunodeficiency syndrome (AIDS) poses a compelling ethical challenge to medicine, science, public health, the legal system, and our political democracy. This report focuses on one aspect of that challenge: the use of blood tests to identify individuals who have been infected with the retrovirus human immunodeficiency virus (HIV). In this article, we follow the terminology recently proposed by the International Committee on the Taxonomy of Viruses; that is, we use the term human immunodeficiency virus. This replaces the more cumbersome dual terminology of human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV).

The issue is urgent: the tests are …

The Hiv Seropositive State And Progression To Aids: An Overview Of Factors Promoting Progression, Paul H. Black, Elinor M. Levy

New England Journal of Public Policy

We have considered factors that predispose to infection by the human immunodeficiency virus as well as the clinical consequences of infection. We have also reviewed what is known about the virological status of the asymptomatic carrier, particularly the female, and the fact that pregnancy may be a cofactor for progression of HIV disease in seropositive women. Additionally, we have discussed several other cofactors that may promote the progression of HIV infection. These include intercurrent infection, excessive use of recreational drugs and alcohol, malnutrition, and stress. With respect to stress, we have reviewed evidence indicating that certain personality factors, by buffering …

Ethical Issues In Aids Research, Michael A. Grodin, Paula V. Kaminow, Raphael Sassower

New England Journal of Public Policy

There is a need for carefully controlled and scientifically rigorous research studies of the acquired immunodeficiency syndrome (AIDS). The morbidity and mortality associated with AIDS patients and the public health concerns for control of this epidemic have distorted the usual process of research. The Institutional Review Board at Boston City Hospital is suggested as an appropriate mechanism for clarifying the distinctions between research and innovative therapies and for assuring the protection of this vulnerable population of research subjects. This article addresses ethical concerns relating to the time frame of research, drug and antibody testing, vaccine trials, and questions of justice …

The Quest For An Aids Vaccine, Robert T. Schooley

New England Journal of Public Policy

More than fifty thousand cases of AIDS have been reported in the United States since the disease wasfirst described in 1981. Many times this number of people are infected with human immunodeficiency virus (HIV), which has been identified as the agent responsible for the illness. The seriousness of the disease, coupled with the relatively rapid spread of HIV, has fueled the effort for development of an effective vaccine.

Much is now known about the life cycle of the virus, and about its structural components. This information, and information about methods of transmission of the virus, form the basis for a …

Aids And New England Hospitals, Jesse Green, Neil Wintfeld, Madeleine Singer, Kevin Schulman

New England Journal of Public Policy

The Centers for Disease Control projects that nine thousand persons with AIDS will be alive in New England in 1991, representing a sevenfold increase from 1986. Our analysis indicates that more than 2 percent of medical/surgical beds in New England will be used for AIDS care by 1991, representing 766 fully occupied hospital beds. The direct cost of providing hospital care to New England's AIDS patients is projected to be $195.2 million in 1991, reflecting 3 percent of all hospital inpatient costs in the region.

AIDS treatment is very unevenly distributed among hospitals in New England. Just twenty hospitals (8 …

A Crisis In Insurance, Benjamin Lipson

New England Journal of Public Policy

As the life and health insurance industry evaluates its long-term financial goals, the cloud of Black Monday — October 19, 1987, the day the stock market collapsed — blurs its cherished investment income projections. With investment portfolios under siege, mutual life insurance companies and stock companies alike are wary of making policy-pricing miscalculations that could prove to be disastrous. As if that weren't enough, one single disease — acquired immunodeficiency syndrome — looms as the most serious threat to life and health insurers for the remainder of this century. The spread of the new disease has caused insurers to adjust …

The Role Of Education In Aids Prevention, George A. Lamb, Linette G. Liebling

New England Journal of Public Policy

The severity of the current AIDS epidemic, combined with the lack of successful biological interventions, necessitates an active educational program as the primary intervention strategy. Health education theories abound, but relatively little definitive application of these theories has been made to the issues involved with HIV transmission: sexual behavior and the sharing of intravenous drug apparatus. Significant behavior changes have occurred in some people, but the consistency of the behavior change may be difficult to sustain. Thus, the authors suggest that health education should be delivered repeatedly in culturally acceptable language and format, by community leaders, and through many different …

Introducing Aids Education In Connecticut Schools, William Sabella

New England Journal of Public Policy

Most of the nation 's schoolchildren are not infected with the AIDS virus (HIV). Since AIDS is a preventable disease, no one need become infected. In order to protect themselves, everyone, including children, must understand exactly how HIV is and is not contracted. The message of prevention, however, is controversial, since it must include advice on safer sex and drug use.

In 1984, Connecticut was forced to face the issue of a child with HIV infection entering school. The state responded by creating guidelines for prevention of disease transmission in schools and by subsequently developing an AIDS curriculum. Obstacles to …

The Aids Epidemic: A Prism Distorting Social And Legal Principles, Alec Gray

New England Journal of Public Policy

The AIDS epidemic is affecting American society in far-reaching and unexpected ways. It touches our institutions, our value systems, and our private lives. Social issues seem to change and become distorted by the epidemic 's prismlike effect. This article examines some of the major public health issues raised by the epidemic, ranging from testing to contact tracing and quarantine. It argues that while the civil rights of individuals may have to be sacrificed to stem the spread of the disease, those rights should not be abandoned unless a clear benefit to the public health would result.

Issues of discrimination in …

Minorities And Hiv Infection, Veneita Porter

New England Journal of Public Policy

This article discusses a preliminary comparison of responses to AIDS in ethnic communities and their basis in previously established support systems. The importance of public policy and its connection to racism and cultural insensitivities are discussed as they relate to communities of color at risk. Particular attention is paid to problems of communication and to the ethics involving confidentiality.

U.S. Women And Hiv Infection, P. Clay Stephens

New England Journal of Public Policy

Women are inadequately provided with HIV services and education and are differentially denied access to these. Divisions of race, ethnicity, economic class, and religion, among others, are compounded by sexual discrimination within each of these categories.

Review of current data on women with AIDS reveals that the reporting methods used convey a false impression that women are not at significant risk. Moreover, the persons indirectly affected by AIDS are predominantly women — mothers, sisters, partners, family members, teachers, and human service workers. Thus, AIDS is more of a women's issue than the statistics imply.

Women, as a gender-defined class, face …

Aids Public Policy: Implications For Families, Elaine A. Anderson

New England Journal of Public Policy

Much has been written about the AIDS crisis in the past few years. However, relatively little of this discussion has focused on AIDS as it may affect families. This report emerged from the 1987 Groves Conference on Marriage and the Family. It is a version of the chapter on public policy in AIDS and Families (ed. Eleanor Macklin, Hayworth Press, forthcoming, summer 1988), prepared by the conference's Task Force on AIDS and Families. The book details the probable impact of AIDS on individuals, families, and communities and delineates the implications for relevant professionals, organizations, and public policy. Those individuals who …

Medical Care Of Aids In New England: Costs And Implications, Stewart J. Landers, George R. Seage Iii

New England Journal of Public Policy

This article presents an overview of cost issues related to AIDS. Data from the Massachusetts Cost of AIDS Study are combined with epidemiological projections to estimate the cost of treating people diagnosed with AIDS in New England. Aggregate inpatient, ambulatory, and home care costs are estimated to be $96.9 million and $524.8 million through 1987 and 1991, respectively. These estimates represent a relatively small percentage of total health care costs for all illnesses over the same time period.

The authors find that the cost of treating AIDS does not affect all health care providers uniformly and therefore argue that appropriate …

Call To Action: A Community Responds, Larry Kessler, Ann M. Silvia, David Aronstein, Cynthia Patton

New England Journal of Public Policy

This article will examine the early formation of the AIDS Action Committee of Massachusetts, and what it has become. It will examine particular philosophical and organizational conflicts, some unique to AIDS organizing, that have influenced the direction the group has taken. It will try to tease out some of the factors that have made the organization successful in delivering services, providing education, and affecting city and state policy. It will also examine some of the unresolved conflicts that threaten the organization.

Politics And Aids: Conversations And Comments, Steven Stark

New England Journal of Public Policy

As AIDS has emerged as a medical and social concern, it has become a political issue as well. In a series of interviews, we asked some leading authorities for their opinions on how AIDS is emerging as a political issue, particularly during the campaign of 1988. In all cases, the comments that follow represent an edited version of their remarks. Those participating were Ronald Bayer, director of the Project on AIDS and the Ethics of Public Health at the Hastings Center; William Schneider, resident fellow at the American Enterprise Institute; Jonathan Handel, a gay activist and a member of the …

Human Immunodeficiency Virus In Intravenous Drug Users: Epidemiology, Issues, And Controversies, Donald E. Craven

New England Journal of Public Policy

Intravenous drug users are the second most common risk group for acquired immunodeficiency syndrome (AIDS) in the United States, and they account for approximately 25 percent of the cases. Drug users may spread human immunodeficiency virus (HIV) by sharing contaminated drug injection paraphernalia and through sexual contact; women who use drugs can transmit the virus to their children. The rapid spread of HIV in this risk group and the fact that intravenous drug users are a source for heterosexual and perinatal transmission underscore the need for immediate intervention. In addition, many drug addicts are poor, have limited career possibilities, and …