Confronting AIDS : directions for public health, health care, and research / Institute of Medicine, National Academy of Sciences.

Format:

Book

Contributor:

Institute of Medicine (U.S.). Committee on a National Strategy for AIDS.

Language:

English

Subjects (All):

AIDS (Disease)--Prevention--Government policy--United States.

AIDS (Disease).

AIDS (Disease)--United States--Prevention.

AIDS (Disease)--Research--Government policy--United States.

AIDS (Disease)--Research--United States.

AIDS (Disease)--Treatment--Government policy--United States.

AIDS (Disease)--Treatment--United States.

Physical Description:

1 online resource (xvi, 374 pages)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1986.

Language Note:

English

Summary:

This volume examines the complex medical, social, ethical, financial, and scientific problems arising from the AIDS epidemic and offers dozens of public policy and research recommendations for an appropriate national response to this dread disease.

Contents:

Confronting AIDS

Copyright

Preface

TERMINOLOGY

STRUCTURE OF THE REPORT

ACKNOWLEDGMENTS

Contents

Abstract

1 Confronting AIDS: Summary and Recommendations

STATUS OF THE EPIDEMIC

Infection and Transmission

Clinical Manifestations of the Disease

Statistical Dimensions of the Epidemic

THE FUTURE COURSE OF THE EPIDEMIC

OPPORTUNITIES FOR ALTERING THE COURSE OF THE EPIDEMIC

Public Education

Preventing HIV Infection Among IV Drug Users

Public Health Measures

Surveillance

Mandatory Screening

Voluntary Testing

The Role of Coercive Measures in Public Health Efforts

Funding for Education and Other Public Health Measures

Discrimination and AIDS

CARE OF PERSONS INFECTED WITH HIV

Health Care Costs Resulting from HIV Infection

The Financing of Health Care for HIV-Related Conditions

FUTURE RESEARCH NEEDS

Basic Research

The Natural History of HIV Infection

Epidemiologic Approaches

Animal Models

Antiviral Agents

Vaccines

Social Science Research Needs

Funding for Research on AIDS and HIV

INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION

Rationale for U.S. International Involvement

Risks of Infection Outside the United States

International Research Opportunities

GUIDANCE FOR THE NATION'S EFFORTS

What Is Needed?

Establishment of the Commission

MAJOR RECOMMENDATIONS

2 Understanding of the Disease and Dimensions of the Epidemic

THE CAUSATIVE AGENT OF AIDS

Features of Retroviruses

Related Viruses

PATHOGENESIS OF AIDS

NATURAL HISTORY OF THE DISEASE

CLINICAL MANIFESTATIONS OF HIV INFECTION

Opportunistic Infections

Kaposi's Sarcoma

Other Malignancies

Neurologic Complications Associated with HIV Infection

Pediatric AIDS

MODES OF TRANSMISSION OF HIV

Sexual Transmission

Parenteral Transmission.

Maternal-Infant Transmission

POPULATION GROUPS AT INCREASED RISK OF HIV INFECTION

Homosexual Men

Intravenous Drug Users

Hemophiliacs

Recipients of Blood Transfusions

Heterosexual Contacts of HIV-Infected Persons

Infants and Children

Health Care Workers

EPIDEMIOLOGIC STUDIES AND FINDINGS

National Disease Reporting

Epidemiologic Research

Case-Control Studies

Prospective Cohort Studies

Serologic Surveys

Findings of Epidemiologic Studies

The Prevalence of HIV Infection

AIDS Cases By Risk Group

AIDS Case Trends by Geographic Area

AIDS Case Trends by Sex, Race, and Age

AIDS Case Trends in Disease Presentation and Mortality

HIV INFECTION AND AIDS OUTSIDE THE UNITED STATES

African Countries

Other Countries

REFERENCES

3 The Future Course of the Epidemic and Available National Resources

PROJECTIONS BY THE PUBLIC HEALTH SERVICE

PROBLEMS IN MAKING PROJECTIONS

THE EPIDEMIC WITHIN AND BEYOND HIGH-RISK GROUPS

THE PROPORTION OF SEROPOSITIVE INDIVIDUALS WHO WILL DEVELOP AIDS

LONG-TERM PROSPECTS

NATIONAL RESOURCES FOR DEALING WITH AIDS AND HIV

Impediments to Involvement

Mechanisms for Coordinating Activities

4 Opportunities for Altering the Course of the Epidemic

PUBLIC EDUCATION

What Should Be the Content of Public Education?

What Are the Aims of Public Education?

Who Needs Education?

Who Should Do the Educating?

Assessing Educational Interventions

A Special Case-Changing Behavior among IV Drug Users

Drug Abuse Treatment Programs

Distribution of Sterile Needles and Syringes

Recommendations

PUBLIC HEALTH MEASURES

Tests for Infection with HIV

Blood Banking

Reporting Schemes

Contact Tracing and Notification

Compulsory Measures.

Compulsory Measures among Institutionalized Populations

Compulsory Closing and Regulation of Facilities

FUNDING FOR EDUCATION AND OTHER PUBLIC HEALTH MEASURES

Recommendation

DISCRIMINATION AND AIDS

5 Care of Persons Infected with HIV

ROLES OF HEALTH CARE PROVIDERS

HEALTH CARE SETTINGS FOR AIDS PATIENTS

Hospital Care

Outpatient Care

Community-Based AIDS Care

NEEDS OF SPECIFIC PATIENT POPULATIONS

PSYCHIATRIC AND PSYCHOSOCIAL SUPPORT

Needs of Patients with AIDS

Needs of Patients with ARC

Needs of Patients with Subclinical HIV Infections

Needs of Seronegative Persons

ETHICAL ASPECTS OF PROVIDING CARE

COSTS OF HEALTH CARE FOR HIV-RELATED CONDITIONS

Direct Costs of Care for AIDS Patients

Costs of Care for ARC Patients and Seropositive Individuals

Indirect Costs of HIV-Related Conditions

Cost Implications of Projected AIDS Cases

Projected Hospitalization Facilities

Conclusions and Recommendations

FINANCING OF HEALTH CARE FOR HIV-RELATED CONDITIONS

Sources of Financing

Medicaid

Medicare

Private Insurance

Improving the Coverage of Health Care Costs

Emerging Issues

Policy Issues

6 Future Research Needs

THE STRUCTURE AND REPLICATION OF HIV

Retroviral Structure

Retroviral Replication

Definition of the Structural and Functional Constituents of HIV

Determination of the Structure of the HIV Virion

Interrupting Infection by HIV

NATURAL HISTORY OF HIV INFECTION

Transmission of HIV

The Immune System Response to HIV Infection

The Immunologic Consequences of HIV Infection

Recommendations.

EPIDEMIOLOGIC APPROACHES TO UNDERSTANDING THE TRANSMISSION AND NATURAL HISTORY OF HIV INFECTION

Recommendations on Surveillance

Recommendations on Natural History of HIV Infection

Recommendations on Transmission of HIV

Recommendations on the Need for Improved Serologic and Virologic Tests

ANIMAL MODELS

HIV Infection of Chimpanzees

HIV-Related Viruses in Old World Primates

Lentiviruses of Ungulates

ANTIVIRAL AGENTS

Drug Evaluation in Vitro

Drug Evaluation in Humans

Current Antiviral Agents under Clinical Study

Suramin

HPA-23

Azidothymidine (AZT)

Ribavirin

Foscarnet

Alpha Interferon

New Antiviral Agents against AIDS

Animal Retrovirus Vaccines

Vaccines against HIV

Models of Vaccine Delivery

Approaches to HIV Vaccine Development and Evaluation

Breaking the Chain of Transmission

Reducing Public Fear and Its Effects

Organizing Health and Social Services

FUNDING FOR RESEARCH RELATED TO AIDS AND HIV

Current Levels of and Mechanisms for Funding

Centers for Disease Control

National Institutes of Health

Other Federal and State Agencies

Industry

Current NIH Funding Mechanisms

Distribution of Funds among Agencies and to Specific Research Areas

Assessing Desirable Levels of Research Support

7 International Aspects of AIDS and HIV Infection

PROJECTIONS OF THE DISEASE OUTSIDE THE UNITED STATES

INTERNATIONAL ORGANIZATIONS

RATIONALE FOR U.S. INTERNATIONAL INVOLVEMENT

Foreign Policy Considerations

Health Improvement Assistance

International Spread of Diseases

Opportunities for Mutually Beneficial Research.

Agencies and Organizations with International Responsibilities or Operations

Importation

INFECTION RISKS OUTSIDE THE UNITED STATES

Sexual Exposure

Exposure Through Blood Transfusion

IV Drug Use

Use of Unsterile Needles and Implements

Lack of Evidence for Transmission by Insect Vectors and Casual Contact

Conclusions

INTERNATIONAL RESEARCH OPPORTUNITIES

THE U.S. CONTRIBUTION TO INTERNATIONAL EFFORTS

CONCLUSIONS AND RECOMMENDATIONS

Appendixes

A Clinical Manifestations of HIV Infection

Protozoal Infections

Pneumocystis carinii Pneumonia

Toxoplasma gondii

Cryptosporidium

Isospora belli

Fungal Infections

Candida

Cryptococcus

Bacterial Infections

Mycobacterium Tuberculosis

Mycobacterium Avium-Intracellulare

Salmonella Infections

Pyogenic Bacteria

Viral Infections

Herpes Simplex Virus

Herpes Zoster

Cytomegalovirus

Other Infections in Members of Risk Groups

Malignancies and Other Neoplastic Diseases

Kaposi's Sarcoma in Non-AIDS Populations

Non-Hodgkin's Lymphoma in AIDS

Hodgkin's Disease in Homosexual Men

Other Cancers in AIDS

Neurologic Complications

Clinical and Pathologic Features of Neurologic Diseases

Aseptic Meningitis

Subacute Encephalitis

Myelopathy

Peripheral Neuropathies

HIV Infection of the Nervous System

Cellular Localization of HIV

Unsolved Problems

Clinical Features and Diagnosis

Diagnostic Criteria

References

B Serologic and Virologic Testing

Performance Characteristics of the Tests

Bibliography

C Risk of HIV Transmission from Blood Transfusion

D U.S. Public and Private Sector Resources for Fighting AIDS

Public Sector

Federal

State, City, and Local Authorities

Private Sector.

Commercial Entities.

Notes:

Report prepared by the Committee on a National Strategy for AIDS of the Institute of Medicine.

Includes bibliographies and index.

ISBN:

9786610221417

9781280221415

1280221410

9780309554954

0309554950

9780585168388

0585168385

OCLC:

427404721