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

• STEERING COMMITTEE
• Preface
• Abstract
• 1. Confronting AIDS: Summary and Recommendations
  • Status of the Epidemic
  • The Future Course of the Epidemic
  • Opportunities for Altering the Course of the Epidemic
  • Care of Persons Infected with HIV
  • Future Research Needs
  • International Aspects of AIDS and HIV Infection
  • Guidance for the Nation's Efforts
  • Major Recommendations
• 2. Understanding of the Disease and Dimensions of the Epidemic
  • The Causative Agent of AIDS
  • Pathogenesis of AIDS
  • Natural History of the Disease
  • Clinical Manifestations of HIV Infection
  • Modes of Transmission of HIV
  • Population Groups at Increased Risk of HIV Infection
  • Epidemiologic Studies and Findings
  • HIV Infection and AIDS Outside the United States
  • 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
  • References
• 4. Opportunities for Altering the Course of the Epidemic
  • Public Education
  • Public Health Measures
  • Funding for Education and Other Public Health Measures
  • Discrimination and AIDS
  • References
• 5. Care of Persons Infected with HIV
  • Roles of Health Care Providers
  • Health Care Settings for AIDS Patients
  • Needs of Specific Patient Populations
  • Psychiatric and Psychosocial Support
  • Ethical Aspects of Providing Care
  • Costs of Health Care for HIV-Related Conditions
  • Financing of Health Care for HIV-Related Conditions
  • References
• 6. Future Research Needs
  • The Structure and Replication of HIV
  • Natural History of HIV Infection
  • Epidemiologic Approaches to Understanding the Transmission and Natural History of HIV Infection
  • Animal Models
  • Antiviral Agents
  • Funding for Research Related to AIDS and HIV
  • References
• 7. International Aspects of AIDS and HIV Infection
  • Projections of the Disease Outside the United States
  • International Organizations
  • Rationale for U.S. International Involvement
  • Infection Risks Outside the United States
  • International Research Opportunities
  • The U.S. Contribution to International Efforts
  • Conclusions and Recommendations
  • References
• Appendixes
  • A Clinical Manifestations of HIV Infection
  • B Serologic and Virologic Testing
  • C Risk of HIV Transmission from Blood Transfusion
  • D U.S. Public and Private Sector Resources for Fighting AIDS
  • E The Centers for Disease Control's Surveillance Definition of AIDS
  • F CDC Classification System for HIV Infections]
  • G PHS Plan for Prevention and Control of AIDS and the AIDS Virus
  • H List of Background Papers
  • I List of Presentations at Public Meetings
  • J Acknowledgments
  • K Biographical Notes on Committee Members
• Glossary

Support for this project was provided by the National Research Council (NRC) Fund, a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from several sources: a consortium of private foundations, including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation, the William and Flora Hewlett Foundation, the John D. and Catherine T. MacArthur Foundation, the Andrew W. Mellon Foundation, the Rockefeller Foundation, and the Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of U.S. science and technology and with public policy issues with technological content; and the National Academy of Sciences and the National Academy of Engineering endowments.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The National Academy of Sciences was established in 1863 by Act of Congress as a private, nonprofit, self-governing membership corporation for the furtherance of science and technology, required to advise the federal government upon request within its fields of competence. Under its corporate charter the Academy established the National Research Council in 1916 and the National Academy of Engineering in 1964.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.