Social and Behavioral Sciences Commons^™

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 …

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 …

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.

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.

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 …

New England And National Resources: For People With Aids, Arc, Or Hiv Infection, Their Families, And Friends, Diane Fentress, Betsy Anne Youngholm

New England Journal of Public Policy

A listing of resources and services, compiled in 1988 for this issue, for people with AIDS, ARC, or HIV, as well as their families and friends.

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.

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 …

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 …

The Port Sudan Small Scale Enterprise Program, Eve Hall

Poverty, Gender, and Youth

Euro-Action ACORD (EAA) is a consortium of 20 European and Canadian aid agencies working in refugee farming settlements in Central and Southern Sudan, and with various rural development projects in other parts of Africa, which responded to a request from the Sudanese Commissioner of Refugees to work in Port Sudan. This was the first time the agency considered working with poor urban people, and staff were determined to understand the economic and social forces which governed life in the slums. The program noted a number of findings that will help determine its future: reaching out to women where they live …

University Of Texas At Tyler Catalog, 1988-1990, University Of Texas At Tyler

Catalogs

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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 …

Men's Basketball Media Guide 1988-1989, Indiana State University

Intercollegiate Athletics

No abstract provided.

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

On occasion, the New England Journal of Public Policy will devote an entire issue to consideration of a public policy matter of major importance. The AIDS epidemic is such a matter, with a likely impact of overwhelming consequence well into the twenty-first century. The epidemic raises fundamental questions regarding the nature of individual freedom, our responsibilities to others, the always delicate balance between private rights and the public interest, and society's obligation to its "out" groups — whose members it has stigmatized, discriminated against, ridiculed, and treated as less than full and equal citizens. Indeed, it requires us to ask …

Human Retroviruses: Illustration

New England Journal of Public Policy

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

Aids In Children: An Overview Of The Medical, Epidemiological, And Public Health Problems, Ellen R. Cooper

New England Journal of Public Policy

Cases of AIDS in children under thirteen years of age have been described since 1982. Diagnosis is more difficult in children than in adults, owing to the more varied clinical presentation and the difficulty in interpretation of laboratory tests. Current diagnostic criteria of HIV infection are reviewed, as well as symptomatology, natural history, and controversies surrounding management and therapy. Without a full appreciation of the transmissibility of HIV, issues including school and day-care attendance and foster family placement remain emotionally charged. Conflicting public policies contribute to fears on the part of the general public. Because ofthe unique implications for the …

Hiv Antibody Testing: Performance And Counseling Issues, Michael Gross

New England Journal of Public Policy

This article assesses the performance of currently used tests for exposure to human immunodeficiency virus (HIV), the infectious agent associated with acquired immunodeficiency syndrome (AIDS); suggests, in view of that information, guidelines for counseling people seeking HIV antibody testing; and evaluates the claim that because antibody test results will effect behavior change in those who are infected, all members of high-risk groups should be tested.

HIV testing is likely to yield a high proportion of false-positive results in low-risk populations and infants born to infected mothers. A negative result may not establish freedom from infection in high-risk groups or the …

Aids And A-Bomb Disease: Facing A Special Death, Chris Glaser

New England Journal of Public Policy

In 1979 it was called "gay cancer," and it took the life of an acquaintance. Then "gay-related immune deficiency," or GRID, claimed neighbors, friends of friends, fellow activists. I began grief and death counseling with a segment of the population ordinarily concerned with life's ambitions and enjoyments: men in their twenties and thirties. Hospital visits and memorial services became more frequent.

By 1983, when it had come to be called AIDS, my own friends began to be affected. One was a man I dated in seminary, and I was devastated to learn of his illness only upon receiving a notice …

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 …

New Hampshire: The Premarital Testing Debacle, Susan D. Epstein

New England Journal of Public Policy

In 1987, the New Hampshire Division of Public Health Services had a bill introduced in the legislature to improve contact tracing and establish statewide public education on HIV infection, transmission, and disease control. This article traces the bill, and issues surrounding the bill, through the legislative process and focuses on an unexpected intervention by the governor through a proposed amendment to add mandatory premarital testing. Its conclusions offer advice to other states on how best to avoid political exploitation of AIDS/HIV issues.

By the summer of 1987, the AIDS issue in New Hampshire had become devoted to everything but AIDS. …

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 …

The Clinical Spectrum Of Hiv Infections: Implications For Public Policy, Kenneth H. Mayer

New England Journal of Public Policy

The term acquired immunodeficiency syndrome (AIDS) is a definition developed by the Centers for Disease Control to explain the epidemic of immunosuppression first seen in the United States among gay and bisexual men and intravenous drug users in the early 1980s. It is now known that the human immunodeficiency virus (HIV) is the necessary agent for the compromise of the immune system which results in AIDS; however, there is a wide range of manifestations associated with HIV infection. Individuals with AIDS tend to have severe opportunistic infections or malignancies, and the vast majority ofindividuals die within two years after the …

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 …

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 …

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 …

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 …

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 …

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 …

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 Initiatives In Massachusetts: Building A Continuum Of Care, Nancy Weiland Carpenter

New England Journal of Public Policy

The Health Resource Office was officially established within the Massachusetts Department of Public Health in August 1985 to coordinate policy, education, research, and service response to the AIDS epidemic, and to focus attention on the social and economic impact of the disease. The actual work of the office was begun earlier, in October 1983. This article reviews the activities of the Health Resource Office from October 1983 through June 1987 in allocating resources for AIDS and ARC programs and services. It then describes the conceptual model that evolved during this period for the continuum of services needed to reduce HIV …