Social and Behavioral Sciences Commons^™

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 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 …

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 …

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 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 …

We Were There, Irene Burns

New England Journal of Public Policy

Irene Burns and Robin Macdonald are friends. Neither knew Mitchell Holsman or Gretta Wren. And neither did Mitchell or Gretta know each other. All four live and work in New York City — Irene as a telecommunications consultant; Robin as a paralegal; Gretta as an office administrator; and Mitchell as a fashion designer — and all four were friends of John Krieter. It was the love inspired by that friendship that brought them together to care for him. He died of AIDS on January 24, 1988.

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 …

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 …

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.

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 …

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.

Covering The Plague Years: Four Approaches To The Aids Beat, James Kinsella

New England Journal of Public Policy

AIDS reporting has changed dramatically since 1981. But it was not until mid-1985, when Rock Hudson was diagnosed with the disease, that media outlets began playing the epidemic as a story of major proportions.

Because almost no major media institution embraced the AIDS story as an important issue, coverage of the epidemic was often the result of a reporter's initiative. Consequently, the connection the individual journalist had with the epidemic became a much stronger influence on what appeared in the news and on what Americans knew about the crisis than in any other recent major health story. This article examines …

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. …

The Big One: Literature Discovers Aids, Shaun O'Connell

New England Journal of Public Policy

Among the works discussed in this essay: An Intimate Desire to Survive, by Bill Becker; Epitaphs for the Plague Dead, by Robert Boucheron; A Cry in the Desert, by Jed A. Bryan; The World Can Break Your Heart, by Daniel Curzon; Safe Sex, by Harvey Fierstein; "The Castro," in Cities on a Hill: A Journey Through Contemporary American Culture, by Frances FitzGerald; As Is, by William M. Hoffman; Plague: A Novel About Healing, by Toby Johnson; The Normal Heart, by Larry Kramer; To All the Girls I've Loved Before: An AIDS …

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 …

The Public-Private Forum: Good Intentions Randomize Behavior, Robert Wood

New England Journal of Public Policy

Public and private institutions of higher learning coexist throughout the United States in a pattern of diversity that is unknown in any other postindustrial society — and Massachusetts is a prime example of U.S. pluralism in education. In an era of scarce resources and mounting costs, the contrary instincts for cooperation and competition are at work. This article is an account ofa voluntary attempt among private and public colleges and universities between 1973 and 1976 to forge a fragile partnership — the Massachusetts Public-Private Forum — which first flourished, then foundered. Tracing the course of its early successes and final …

Vermont Revisited, William Jay Smith

New England Journal of Public Policy

Vermont Revisited, William Jay Smith's sweet-bitter memoir of Pownal, Vermont, captures the political and social minutiae of a small, rural New England town in transition which continued to preoccupy itself in almost conspiratorial drama with its own parochial agendas, denying, even if not oblivious of, the changes at its doorstep. Yet Smith's observations of the machinations that were grist for the mill of the small-town intrigues are tinged with a sadness, with an awareness of an old order dying, of old values under siege, of a new order intruding itself — less private, more depriving if perhaps more equitable, and …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

In the public domain, ideas undergird the specific policy decisions that elected officials and administrators make in order to achieve the shared goals their communities and constituencies articulate. Ideas are the pistons that drive the engines of change. The study of change, moreover, is a study of our ambivalence toward it. On the one hand, we embrace it with some assumption of its inevitable desirability, equating it with progress, with our aspirations for social improvement, with our propensity for wanting society to be better off, though what "better off" means often remains unclear and inchoate. Public figures routinely offer us …

The Willis-Harrington Commission: The Politics Of Education Reform, Robert D. Gaudet

New England Journal of Public Policy

The 1980s have witnessed a nationwide movement to upgrade public education, including reform efforts in the New England states. Massachusetts periodically has grappled with the challenge of improving its schools. During the 1960s, the Massachusetts legislature authorized a thorough examination of education in the state. This mandate was carried out by a blue-ribbon panel that came to be known popularly as the Willis-Harrington Commission. In 1965, the commission issued a 624-page final report that included findings and recommendations relating to many aspects of public education in the state. This article chronicles the history of Willis-Harrington and discusses the problems that …

Evaluating Reagan Federalism, David B. Walker

New England Journal of Public Policy

Reagan federalism, unlike Reaganomics, has achieved far less than was anticipated in 1981. In this article, the extent of real change in the intergovernmental system is gauged by assessing recent intergovernmental developments in light of the time perspective (1980, 1981, and 1987); the relative significance of federalism within the cluster of Reagan political precepts; the interplay of key actors in the national policy process; and the views of state and local officials. Also highlighted are the reasons that national policy activism has been reduced but not rolled back. Overall, contemporary U. S. federalism is still found to be a nation-centered …

A Public Manager Looks Back: What I Wish I'D Been Taught, Dan H. Fenn

New England Journal of Public Policy

The author, a practitioner-teacher of public administration, writes that the special context of government in the United States, whether federal, state, or local, needs to be specifically explored by schools for would-be public managers. The constitutionally established system of fractionated power at once makes government jobs extraordinarily difficult and provides great opportunities for those who see themselves as partners in the policy-making process and want to put their stamp on the events of their times. Despite the view of the general public, government is made to order for entrepreneurs who are adept at accreting and maintaining power regardless of the …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

Less than ten years ago, the Sun Belt states were the focus of the kind of excessive attention we have come to associate with our propensity to assign cause, time, place, and date to account for little-understood social phenomena. The decline of the Northeast was virtually irreversible, according to the new wisdom, the rise of the West and Southwest obviously inevitable. Change had more to do with "the mysterious hand of Providence" or the caprice of oil sheiks than with policy — we prefer being comforted, it seems, to being informed.

Explanations of our condition that reinforce our perceived beliefs …

State Management Systems: The Case For Internal Controls, Joseph A. Mchugh

New England Journal of Public Policy

This article contends that recent managerial improvements in the federal government can and should be replicated by the states. Although effective internal controls in federal agencies and programs had been mandated in 1950, little progress was made until the late seventies and early eighties, when Congress enacted several laws to strengthen federal financial management and the executive branch initiated a modernization program. This happy confluence of events brought significant improvements to federal management as a whole. Now it's time for similar progress in state operations. State and even local administrators should adopt the best features of the federal model in …

Trust, Self-Interest, And Representation In Economic Policymaking: Rhode Island Reconsidered, Thomas J. Anton, Darrell M. West

New England Journal of Public Policy

Industrial policy has become an increasingly central focus of political debate as American society struggles with new and troubling economic realities. Yet despite the importance of this subject, little is known about how the public gains or processes information on these matters, or about the evaluative standards used to judge industrial-policy proposals. A recent referendum in Rhode Island offered a unique opportunity to study these questions. Citizens participated directly in the debate over new industrial policy by soundly rejecting the Greenhouse Compact, a novel and comprehensive plan to "reindustrialize" Rhode Island. Here we report the results of a public opinion …

Originally From Dorchester: Arrivals And Departures In A Neighborhood, Kathleen Kilgore

New England Journal of Public Policy

In "Originally from Dorchester," her portrait of a neighborhood that wrestled — and continues to wrestle — with problems of race, ethnicity, cultural values, economic development, and mobility, Kathleen Kilgore captures the nuances of the small gesture, whether of defiance or gentility, that reveal the underside of social conflict more eloquently than databases or court findings. "The neighborhood," Kilgore writes, "weakened and aged, and forcibly resisted change." But it then began to adapt, the influx of the young and the upwardly mobile providing a lifeline that facilitated a process of renewal and accommodation, in which, in the best sense, diversity …

Mature Industrial Communities: The Realities Of Reindustrialization, Jeanne H. Armstrong, John R. Mullin

New England Journal of Public Policy

This article analyzes the reindustrialization problems facing mature-industry communities in Massachusetts. The findings are based upon our planning consulting work and research projects involving forty cities and towns. The range of these communities includes those which have recovered, are on their way to recovery, and are stable; those which are declining; and those whose status is indeterminate. A variety of factors are reviewed, including unionization; work-force characteristics; the relationship between small and large plants; the characteristics of local companies; location; financing; the availability of land; and the role of local planning. Finally, we present recommendations concerning local action and possible …

The Fund For New England: A New Environmental Philanthropy, Charles H. W. Foster

New England Journal of Public Policy

New England has a new, regional philanthropy, the Fund for New England, which is concerned with the advancement of natural resources and environment in the six-state region. The fund is one of a class of new regional environmental funds/trusts that are emerging across the country. The history of New England's own effort is described at the outset of the article, which also explores the experience and potential of the fund and its national counterparts with regard to advancing the novel concept of contributions in lieu of environmental fines. Finally, the process followed in establishing and operating the fund is examined …

Remembering Who We Were: Boston Books, 1986, Shaun O'Connell

New England Journal of Public Policy

Shaun O'Connell's essay, "Remembering Who We Were," gives a Boston perspective to our search for self, identity, and possibility. For its writers, he concludes, "Boston remains a vibrant state of mind, an occasion for sustained verbal reflection, a site of personal and cultural conflict, a city still in the making." And while there may be anxieties "beneath its high-tech prosperity, its high-style glitz and its political clout ... over the separations between the people we once were and those we have become or those we might become" — that "might" will be immeasurably strengthened if policymakers adhere to policies that …

The Double Character Of Daniel Webster, Irving H. Bartlett

New England Journal of Public Policy

Between 1815 and 1852, when people in New England wanted advice on matters of public policy, they sought out Daniel Webster. His extraordinary reputation rested in large measure on his ability to play a conservative role, to assure his followers that the federal Union was sound and that their role in a rapidly changing democratic society was consistent with their historic legacy. In 1850 the message failed and Webster fell.

A Second Chance: Meeting The Needs Of Adult Learners, Elizabeth F. Fideler

New England Journal of Public Policy

Changing demographics and economic factors are focusing national attention on adult learning as a major resource for solving many of the nation 's social and economic dilemmas. However, adult learners, the poor especially, face obstacles to educational advancement even where tuition is waived or incentive grants are given. Despite the considerable recent growth of adult education, the vast number of those who need it the most are not as yet participating. This article examines adult-education practices and participation in general — in the areas of literacy, occupational education, and higher learning — and conditions in Massachusetts in particular. It explains …