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Ides
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Mdex
A
Acquired immune deficiency syndrome
(AIDS)
age trends, 4-5, 36
animal models of, 18, 124; see also
Animal models/experiments
budget for, 22, 88
cases by risk group, 34, 51-52
clinical manifestations, 3, 36, 203-206,
214-216
definition/defining, 2-3, 36-37, 81, 105,
173, 207-217
demographic impact, 52, 109
diagnosis, 71, 214-216
disease presentation, 106
economic costs in U.S., 16, 104-105, 108
etiologic agent, 2, 33-35; see also
Human immunodeficiency virus
geographic differences in clinical
manifestations, 106
incidence, 36
incubation period, 29, 61, 66, 83
infectiousness, 5, 29' 61
international scope of, 22-23, 159-160,
195
mortality, 29, 52
parallels and contrasts with past
epidemics, 1, 27-28
227
patterns of spread, 23, 33, 40, 70,
159-160
progression from HIV infection to, 2,
34, 35-36, 37-38, 52, 127, 159, 173
projected cases and deaths, 57, 108, 171
reporting of cases, 159
social response to, 2, 29; see also
. _. . . .
. Jlscrlmlnatlon
as a special case, 1, 29-30
worldwide cases, 22-23, 159
see also Cofactors in AIDS; HIV
infection; Human immunodeficiency
virus; Pediatric AIDS
Africa
AIDS cofactors in, 40
blood supply contamination, 40
heterosexual transmission of HIV in, 3,
40
parenteral transmission in, 40
seroprevalence in, 174
AIDS-associated retrovirus, see Human
immunodeficiency virus
AIDS Federal Policy Bill, 11, 81
AIDS patients
costs of care for, 104-106
health care needs of specific
populations, 13-14, 94-96, 106
life expectancy, 108
minorities, 15, 27, 98-99
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228 INDEX
obligation of health care providers to
treat, 8, 51, 52, 67-68
wage and productivity losses, 16, 106,
107
AIDS-related complex, 3, 37; see also
Human immunodeficiency virus
American Medical Association
guidelines on physicians' duty to warn,
11, 80
policy statement on obligation to treat
AIDS patients, 15, 99
recommendations on drug abuse
treatment program enrollments, 85
American Nurses' Association, position on
obligation to treat AIDS patients,
15, 99
Animal models/experiments
baboons, 147
chimpanzees, 20, 21, 124, 142, 147-148,
191
development of, 147-149
facilities for, 149-150
genetically immunodeficient mice, 148
non-HIV-related retroviruses, 147
recommendations, 21, 145, 148, 149
rhesus macaques, 20, 21, 147, 148
simian, bovine, and feline lentiviruses,
18, 21, 124, 147
small animals, 21-22, 149
superinfection experiments, 142, 147
supplies of animals, 21, 148-149, 191
transgenic mouse, 149
vaccine development, 20-21, 142, 144,
145
Antibodies to HIV
antienvelope, 134
neutralizing, 134, 142-143
Antibody tests for HIV
availability of, 71
confidentiality of results, 10, 72-74, 79,
181
false results, 9, 35, 71
funding for, 88
home test kits, 10-11, 79-80
sensitivity and specificity, 9, 10, 71, 76, California
79
techniques, 71, 79, 190
Antiviral agents
2',3'-dideoxycytidine, 132, 137
ideal characteristics, 191
soluble CD4 preparation, 131
AZT, see Zidovudine
Behavioral change
B
in IV drug abusers, 30
in prostitutes, 10, 79
ways for inducing, 9, 10, 30, 70, 74
see also Public education about AIDS
Bisexual men, see Homosexual men
Blacks
AIDS prevalence among, 8, 51, 52,
67-68
education on AIDS, 8, 13, 68, 89
pediatric AIDS cases in, 95
seroprevalence among, 41, 47, 48, 52,
78, 84
Blood donations
lack of risk in, 67
self-screening, 76, 180
Blood donors
confidentiality of, 73
screening of, 34, 183
seroprevalence among, 39, 47-48
Blood products
heat treatment of factor concentrate, 49
screening, 71, 75-76
World Health Organization safety
initiative, 161
Blood transfusion recipients
AIDS cases in U.S., 34, 51-52
incidence of new infections in, 4, 49
progression from HIV infection to
AIDS, 36, 52
risk of infection, 3, 45, 76, 172
Blood transfusions, HIV transmission
through, 34, 39, 42
Bovine immunodeficiency virus, 124
Brown University Center for Health Care
Research, 110
Bubonic plague, 1, 27
C
confidentiality of HIV test results in, 73
expenditures for AIDS prevention, 184
health care financing, 112
Prostitutes Education Program, 79
syphilis increases, 41
Candidiasis, oral, 36, 214, 215
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INDEX 229
Casual contact, evidence against
transmission by, 6, 29, 39, 67, 80,
96, 172
CD4 cells, 130, 133
Centers for Disease Control
Costs, see Health care costs
classification system for HIV
infections, 38, 202-206
definition of AIDS, 2-3, 105, 203-205,
207-217
effectiveness of surveillance efforts, 167
HIV surveys and studies, 50
paid advertising for AIDS education, 7,
65
review of explicitness of educational
materials, 66
universal precautions for health care Discrimination
personnel, 10, 76, 98
Central nervous system, HIV detection in,
133-134
Children, see Infants and children
Cofactors in AIDS
in Africa, 40
chronically activated immune systems,
40
data needs on, 59
history of sexually transmitted
diseases, 40
host immunoregulatory and infectious
pathogens, 135
Colorado, HIV reporting requirements, 73
Condoms
commercial advertising, 8, 69
education about, 8, 67, 69, 176
effectiveness, 68-69
prostitute use of, 78
regulation and quality control, 69
virucidal agents used with, 69
Confidentiality
about cause of death, 73
exceptions to, 11, 73
health records and medical charts, 72-74
and physicians' duty to warn, 11,
80-81
recommended protections, 9, 72, 74,
101, 181
record of public health officials in
preserving, 81
Consolidated Omnibus Budget
Reconciliation Act, 114
Contact tracing and notification, 11, 43,
80-82, 179
D
Deaths
age and gender trends, 4-5, 29
of celebrities, 67
in New York City, 5, 52
projections, 57, 108, 162, 171
publication of cause of, 73
in San Francisco, 5, 52
Dementia
care of AIDS patients with, 14, 96, 108
as part of Centers for Disease Control
definition, 3, 36, 215
by health insurance companies, 113
protections against, 6, 62-63, 72, 113
public health responses complicated by,
6, 29, 63
range and scope, 63
Drug abuse education
for adolescents, 13, 87
by former drug abusers, 13, 87
recommendations, 12, 13, 65, 87
Drug abuse treatment programs
ADAPT, 87
counselors for, 12, 13, 85
coupon program, 86
expansion of slots in, 12, 84-85, 86
funding, 13, 84, 85, 88
importance in preventing AIDS, 5, 62
methadone maintenance, 84-85, 87
serologic testing in, 12-13, 87
third-party coverage for, 88
waiting lists for entry into, 12, 13,
84-85, 86, 88
Drugs
AZT, see Zidovudine
clinical trials, 19, 131, 132, 138-139,
192
development and testing, 18-20,
136-140
FDA approval process, 19, 137-140
HIV targets for design of, 131, 136
investigational new drug (IND) status,
17, 19, 117, 137, 139
liability issues, 139
"magic bullet," 28
Medicaid coverage for, 114-115
roundtable on, 146-147
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230 INDEX
scarcity, 138
screening of compounds for, 136-137
for syphilis treatment, 28
treatment IND, 17, 19, 117, 137, 139,
144
trimetrexate, 19, 138
see also Antiviral agents
E
Education, see Public education about
AIDS
Employee Retirement Income Security
Act, 115
Enzyme-linked immunoassay (ELISA)
tests, 71
Epidemic
AIDS as a series of overlapping
epidemics, 49
future course, 29-30, 41, 174, 175
in heterosexual population, 41
historical parallels to AIDS, 1, 27-28
Epidemiological research
case-control studies, 40
health care worker infection with HIV
44
on heterosexual transmission, 40, 44
partners of infected hemophiliacs, 44
prospective cohort studies, 34, 35-36,
37, 44, 49, 181, 190
recommendations, 5, 53
for seroprevalence determinations, 82
Epidemiological surveillance
blinded surveys, 51
case definition for AIDS, 207-217
Centers for Disease Control program 50
difficulties in, 43
at drug abuse treatment centers, 47
effectiveness, 30
of health care workers, 44
populations selected for, 50-51, 190
self-selection bias in, 4, 48, 51
at sexually transmitted disease clinics,
47
Ethical issues
access to health care, 16, 63, 98-99,
110-111
clinical trials of drugs and vaccines,
19-20, 139-140, 145
employment of infected individuals, 6,
63-64, 100-101
in health care financing, 113
historical parallels, 1, 27
marketing of unproven therapies, 20,
142
obligation to care for HIV-infected
persons, 15, 27, 98-99, 186
obligations of at-risk individuals, 9, 74,
186
physicians' duty to warn, 11, 80-81
terminal care decisions, 186-187
F
Fear of AIDS
effects of, 63, 178
in health care providers, 98-100
Federal Rehabilitation Act, applicability to
seropositive individuals, 63-64
Feline immunodeficiency virus, 124
Financing, see Funding; Health care
~ .
nnanclng
Findings and recommendations
access to health care, 16-17, 111, 117,
118
AIDS as a special case among diseases,
1, 29
AIDS-related complex, 3, 37
animal models/experiments, 21, 145,
148, 149
antidiscrimination measures, 6, 63, 64,
185
barriers to public health measures, 6,
62
biomedical research, 18, 135-136
budget for research, 22, 151
cause of AIDS, 2, 33
clinical trials, 19-20, 140, 145
condom use, 8, 69
confidentiality protections, 9, 72, 74,
101, 181
contact notification programs, 11, 82
counseling and psychiatric/psychosocial
support, 9, 10, 12-13, 16, 74, 87,
103-104
drug abuse treatment programs, 12, 13,
84, 85, 87, 178
drug development and testing, 19, 20,
117, 139, 140, 146-147
education of seropositive children, 182
educational programs, 7, 8, 13, 65-69,
87, 175-178, 199
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INDEX 23 1
epidemiological research, 5, 53
facilities for research, 22, 150
funding, 13, 88, 135-136, 184
health care facilities, 14, 95, 96,
185-186, 188
health care financing, 16-17, 111, 117,
118, 188
health care personnel, 15-16, 79,
101-103
international research, 164, 197
models and modeling, 5, 60, 174-175
National Commission on AIDS/HIV
infection, 25-26, 167, 198, 199
needle distribution to drug abusers, 86, Health care
179
occupational risks of HIV infection, 15,
100
paid advertising by Centers for Disease
Control, 7, 65
precautions by health care workers, 10,
76-77
prevention and control measures, 5,
11-12, 82-87, 174-175, 184
reagents for research, 22, 151
reporting of test results, 11, 82, 180
restrictive measures for HIV carriers,
11-12, 83, 182
screening, 10, 75-79, 101, 196
social science research, 9, 67, 75, 79,
104
test standards and quality assurance, 9,
71
Florida
testing, 9, 10-11, 12-13, 15, 74-75, 79,
87, 101, 196
training of health care providers, 15,
102
U.S. international responsibilities, 23,
163, 197
vaccine development and testing, 20,
21, 145, 146-147, 193
mandatory screening for HIV infection,
78-79
pediatric AIDS cases, 95
syphilis increases, 41
Funding
animal models, 148
biomedical research, 18, 135-136, 194
diversion from other research and
treatment strategies, 6, 30, 62, 194
drug abuse treatment programs, 84, 85
educational programs, 7, 13, 88, 177,
181-185
facilities for research, 150, 194
health care cost research, 110
primate research, 149-150, 194
see also Health care financing
G
Genital ulcers, 40
H
access to, 16-17, 19, 63, 98-99,
110-111, 117, 118, 139-140
basic approach, 93
community-based, 14, 95, 96, 105, 109,
110, 186
day care, 95
decline in high-prevalence areas, 29
deficiencies, 13, 30
demonstration projects, 110, 183
discharge planning, 13-14, 94
ethical issues in, 1, 11, 15, 27, 80-81,
97-101
foster care, 14, 96
geographic burdens, 29, 111, 117
home hospice care, 14, 95, 105
hospital, 29, 105, 106, 185, 187-188
incentive payments for, 14
infection control precautions, 10,
14-15, 76, 97, 98
long-term, 95
nursing homes, 14, 95, 96, 115
recommendations, 16-17, 95, 96,
99-102, 103-104, 111, 117, 118,
185-186
residential care, 14, 95, 96
respite care, 95
sexually transmitted disease clinics,47,
62
special-patient needs, 13-14, 94-96, 186
specialized AIDS clinics, 93, 96
see also Psychiatric/psychosocial support
Health care costs
average lifetime cost per AIDS case,
16, 104, 178
direct, for AIDS patients, 104-106, 187
estimation, 105
geographic variations in, 105-107, 109
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232 INDEX
hospital, 105, 106, 109
indirect, of HIV-related conditions, 16,
106-107, 186-187
for long-term care, 96
Medicaid, 111
national expenditures, 107-108
projections, 16, 108
reimbursement for, 96, 109, 114-115
research on, 16, 109-110, 188
type-of-patient factor in, 106, 109
zivoduvine (AZT) treatments, 108
Health care financing
deficiencies, 16, 30, 94, 110-111, 113
eligibility for, 111-112, 114-115, 116
Employee Retirement Income Security
Act and, 115
for experimental therapies, 17, 114,
117-118
federalgrant program, 17, 116-117
Medicaid, 17, 111-112, 114-115, 188
Medi-Cal, 112
Medicare, 112, 109, 116, 188
recommendations, 117-118, 188-189, 200
sources, 111-113
strategies, 17, 113-118
waiting period, 17, 112, 116
see also Health insurance
Health care personnel
AIDS units/teams, 13-14, 93-94
collaborative surveillance study, 44
education and training, 15, 101-102, 186
emergency care personnel and
surgeons, 15, 98
funding for, 88
HIV exposure through accidental
needle sticks, 39, 44
private physicians, 62
psychological stress in, 15-16, 103-104,
185, 187-188
right to know serologic status of
patients, 73
risks to, 14, 97-98
screening for HIV infection, 15, 76-77,
100-101
seropositivity in, 15, 100-101
universal precautions, 10, 14-15, 76, Hispanics
97, 98
volunteers, 105, 186
Health care planning
data needs for, 70
problems, 30
Health insurance
antidiscrimination laws governing, 113
drug abuse treatment coverage, 88
early-stage coverage, 38
ethical issues, 113
extension of coverage period, 114
inadequate coverage, 17, 111, 188
incentives and subsidies for AIDS
patient coverage, 17, 113-114, 116
limitations on coverage, 17, 112-113
state risk pools, 17, 115-116
Health Resources and Services
Administration, 102, 110
Helper/inducer cells, see CD4 cells
Hemophiliacs
AIDS cases in U.S., 51
incidence of new infections in, 4, 49
progression from HIV infection to
AIDS, 36
risk of transmission for sexual partners
of, 43
seroprevalence among, 4, 47
Hepatitis B virus
occupational risks to health care
personnel, 97
similarities between HIV spread and,
33, 97
Heterosexual contacts
AIDS cases in U.S., 51
seroprevalence among, 39, 41, 42, 47
Heterosexual transmission
in Africa, 3, 40, 196
chain of, 12, 41, 78, 84
efficiency of, 39, 43
from men to women, 39, 41-42
study design, 39
from women to men, 39, 41-42
Heterosexuals, prevalence of HIV
infection in, 39, 41, 42
High-risk groups
case distribution, 51-52
contact tracing among, 82
disease trends by, 46-47, 51-52, 160
education of adolescents in, 87
social stigma and prejudice toward, 6, 61
AIDS prevalence among, 8, 51, 52, 68
educational programs on AIDS, 8, 13,
68, 89
pediatric AIDS cases in, 95
seroprevalence among, 41, 47, 48, 78, 84
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INDEX 233
HIV infection Hospital patients
activation, 134 screening for HIV infection, 48-49
age and, 43, 112 seroprevalence among, 48-49
asymptomatic period, 37, 172, 173, 181, Human immunodeficiency virus (HIV-1)
204 antibodies, 134
cells susceptible to, 131 antibody testing of, see Antibody tests
classification system for, 38
definition, 203-206
as a disease or continuum of
conditions, 3, 37-38
diagnosis, 37-38
diversity of isolates, 133
geographical differences in
epidemiology, 46
incidence, 4, 5, 34, 49, 58
interruption of, 130-132
laboratory evidence of, 212-213
macrophage role in, 18, 133, 143, 145
modeling transmission dynamics, 58
national estimates, 4, 49-50
natural history of, 132-135, 189-190
pathogenesis, 35, 133, 135, 171-172
persistence, 133-134
prevalence, see Seroprevalence
progression to AIDS, 2, 34, 35-36,
37-38, 52, 127, 159, 173
spread of, 39, 52, 196
susceptibility to, 40, 133
symptoms and stages, 3, 37-38, 133
treatment, 37-38, 174; see also Drugs;
Treatment strategies
Homosexual men
adolescents, 68, 75
AIDS cases in U.S., 51, 52
attitudes about testing, 74
costs of treating, 106
discrimination against, 63
disease progression in, 2, 34, 35-36
education of, about AIDS, 8, 68, 89,
176-177
epidemiological studies of, 2, 34,
35-36, 43, 49
high-risk behavior, 40, 41, 43
incidence of new infections in, 4, 49
population size estimates, 59
presenting diagnosis for AIDS patients,
106
risk of HIV transmission, 3, 43
seroprevalence among, 2, 4, 34, 35-36,
39, 46, 68, 173
wage losses, 107
for HIV
antigenic drift in, 143
biology of, 18, 123-136
cell-mediated immune response to,
134-135, 143, 144
control of viral gene expression, 127
cytopathic particle generation, 128
detection, see Testing/tests for HIV
entry into cell, 131, 141
envelope glycoprotein, 18, 125, 128,
130, 131, 134, 141
fragility and lethality, 65
gene products, 124-125, 129
genes involved in replication, 125,
129-130
genome structure/characteristics, 18,
124-127
host tissues, 132-133
infectiousness, 5, 43-44, 59, 61, 133
in vitro production, 127
lentivirus analogy, 124, 133, 134
long terminal repeats, 125
nucleotide sequences, 125, 126, 129
production-inhibiting gene, 130
protein immunoregulatory activity, 145
reading frames, 125, 128
regulatory genes, 128, 129
replication of, 18, 124-125, 127-128,
129, 130, 132
syncytia formation, 131, 135
target cells, 18, 130-131, 133
tat-III and artitrs genes, 125, 129-130
taxonomic assignment, 124
transactivation response element, 129
transcription and translation of RNA,
128, 131-132
transmission, see Parenteral
transmission; Transmission of HIV
Human immunodeficiency virus (HIV-2)
detection, 124
genome structure, 127
prevalence, 18, 123
regulatory genes, 130
taxonomic assignment, 124
transmission and pathogenesis, 123
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234 INDEX
Idaho, HIV reporting requirements, 73
Illinois, mandatory screening for HIV
infection, 77-79
Immune system
cell-mediated immune response to HIV,
134-135
chronic activation and susceptibility to
HIV infection, 40
Infants and children
AIDS cases in U.S., 51-52
care needs of AIDS patients, 14,
95-96, 109
progression from HIV infection to
AIDS, 52
schooling of infected individuals, 182
seroprevalence among, 48
Infection, see HIV infection
Insect vectors, evidence against exposure
by, 39, 67, 172
Institutionalized populations, mandatory
testing of, 10, 70
International AIDS efforts
U.S. contributions to, 23, 162-164,
196-197, 201
U.S. responsibilities, 30
see also World Health Organization
International issues
prevalence of AIDS/HIV infection,
159-160, 174, 194-195
rationale for U.S. involvement in
international efforts, 161-162, 195
reporting of AIDS cases to World
Health Organization, 159
International resources for fighting AIDS
organizations, 195-197, 201
U.S. contribution to, 30
Intravenous (IV) drug abusers
AIDS cases in U.S., 51
bleach distribution to, 12, 86-87
care needs of, 14, 94-95, 106
costs of treating, 106, 109
counseling for HIV infection, 12-13,
87
data needs on, 59
distribution of sterile needles and
syringes to, 12, 86-87, 179, 200
efficiency of HIV transmission among,
3, 42-43, 45
former, as counselors, 12, 85, 87
heterosexual transmission of HIV
infection through, 12, 41, 8
high-risk behaviors, 41, 42-43, 196
incidence of new infections in, 49
presenting diagnosis for AIDS patients,
106
seroprevalence among, 4, 34, 41,
46-47, 84, 87
testing of, 12, 87
women, 84
see also Drug abuse treatment programs
J
Job Corps entrants, seroprevalence among,
48
K
Kaposi's sarcoma, 106, 205, 214, 216
L
Legal issues
confidentiality of test results, 9, 72, 81
criminal penalties or civil liability for
intentional transmission, 83
discrimination, 63-64, 72, 81
distribution of sterile needles and
syringes, 86
education about AIDS, 66
informed consent for testing, 71-72
new drug/vaccine therapies, 139-140,
145
personal liberty restrictions, 12, 83-84
reporting of HIV infection, 180
third-party warnings, 11, 80-81
Lentiviruses
disorders caused by, 124
similarity to HIV-1, 124, 133
Life insurance, distinction among
applicants, 64
Louisiana, mandatory screening for HIV
infection, 77
Lymphadenopathy, see Persistent
generalized lymphadenopathy
M
Macrophages, role in HIV infection, 18,
133, 143, 145
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INDEX 235
Massachusetts
confidentiality of HIV test results in, 73
HIV prevalence among women giving
birth, 48-49
Maternal-infant transmission
IV drug abuse and, 95
risk, 3, 35, 42, 45
Miami, seroprevalence among prostitutes,
78
Military personnel, seroprevalence among,
39, 48
Minnesota, insurance risk pools, 116
Models/modeling
data needs for, 5, 58-60
difficulties, 58, 174-175
IOM/NAS workshops on, 60
prevalence and incidence of AIDS/HIV
infection, 5, 36
of progression from seropositivity to
AIDS, 2, 36
research recommendations, 5, 60
transmission dynamics of HIV
infection, 58
types, 58
uses, 57, 60
Monitoring, see Epidemiological
surveillance
N
National Cancer Institute, drug screening
program, 136-137
National Center for Health Services
Research and Health Care
Technology Assessment, 109
National Center for Health Statistics, HIV
surveys and studies, 50-51
National Commission on HIV Infection
and AIDS, 14-26, 165-167, 198-199
National Institute of Allergy and Infectious
Diseases
AIDS clinical trial units, 20, 140
AIDS Research and Reference Reagent
Program, 22, 150-151
National Cooperative Drug Discovery
Groups, 18-19, 136
National Institutes of Health
grants for health care training, 102
Office of AIDS Research, 166
National Research Council Committee on
AIDS Research and the Behavioral,
Social, and Statistical Sciences, 59,
67
Needle sticks, accidental, HIV transmission
through, 4, 44, 45, 97-98, 196
Needles and other unsterile implements,
HIV infection from, 40
Neurologic complications
care needs of patients with, 14, 96
prevalence and severity, 135
types, 205
Nevada
mandatory testing of prostitutes for
HIV, 78
seroprevalence among prostitutes, 78
New Jersey
burden on health care system in, 111
drug abuse treatment programs, 86
mandatory testing for HIV, 79
pediatric AIDS cases, 95
posthospital residential care program, 95
seroprevalence among IV drug abusers,
4, 47
seroprevalence among prostitutes, 78
New York City
burden on health care system in,
107-108, 111, 187-188
Covenant House, 79
deaths from AIDS, 5, 52
drug abuse treatment programs, 84-85
educational programs in, 8, 68
pediatric AIDS cases, 77, 95, 109
seroprevalence among homosexuals in,
34
seroprevalence among infants, 86
seroprevalence among IV drug abusers
in, 4, 34, 42, 47, 49, 109
seroprevalence among women
delivering babies, 49, 52
syphilis increases, 41
o
Opportunistic infections in AIDS, 205
Oregon, insurance risk pools, 116
p
Palo Alto Medical Foundation Research
Institute, 109-110
Parenteral transmission
accidental needle sticks, 4, 44, 45
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236 INDEX
in Africa, 40
blood transfusions, 34-35, 36; see also
Blood transfusions; Hemophiliacs
through needles and other unsterile
implements, 88
see also Intravenous (IV) drug abusers
Pediatric AIDS
care needs for patients, 14, 95-96, 109
cases in U.S., 51-52, 77, 95
family disruption, 95, 14
transmission routes, 35, 51
Perinatal transmission, see Maternal-infant
transmission
Persistent generalized lymphadenopathy,
36, 37, 204
Pneumocystis carinii pneumonia, 106, 138,
173, 205, 214, 216
Polio epidemics, 28
Presidential Commission on the Human
Immunodeficiency Virus Epidemic,
24, 165-166
Prevention strategies
for blood products, 49, 88
budget for, 88, 183
contact tracing and notification, 70
criminal penalties or civil liability for
intentional transmission, 83
importance of, 60
isolation and quarantine, 11-12, 28, 83
for IV drug abusers, 30, 62, 85-87,
178-179; see also Drug abuse
treatment programs
from programs for other sexually
transmitted diseases, 62
resources for, 13, 87-89
see also Behavioral change; Condoms;
Public education about AIDS;
Public health measures; Vaccines
against HIV
Projections
accuracy, 108
AIDS cases and deaths, 57, 108, 162,
171
data needs for, 5, 58-60
economic costs of AIDS, 16, 108
progression from HIV infection to
AIDS, 36, 57
see also Models/modeling
Prostitutes
case-control studies in Africa, 40
IV drug abuse by, 10, 41, 78
mandatory screening of, 10, 78 - 79
prevention strategies, 10, 79
seroprevalence among, 40, 41, 47, 78
Psychiatric/psychosocial support
for AIDS patients, 186
with antibody testing, 9, 70, 72, 74, 78,
79, 88-89, 101
for health care workers, 15-16, 103-104
recommendations, 9, 10, 12-13, 16, 74,
87, 103-104
Public education about AIDS
for adolescents, 66-67, 68, 87
all-household mailing, 24, 167
at colleges, 7, 66-67, 88
content of, 7, 65-66, 176
culturally specific programs, 8, 68
"dirty words" issue, 66
funding for, 7, 13, 88, 177, 181-185
gaps in, 67
historical parallels to syphilis epidemic,
28
moral issues, 7, 65
obstacles, 7, 64, 65, 69
paid advertising, 7, 64-65, 69
public service announcements, 65
recommendations, 7, 8, 65-69, 87,
175-178, 199
resources for, 13, 87-89
school-based, 7, 66-67, 88, 177
statutes allowing or mandating, 66
success of, 67-68
Public health measures
classification of programs, 61-62
complication by discrimination, 2, 29, 63
contact tracing and notification, 11,
80-82
criminal penalties, 83
historical parallels to syphilis epidemic,
28
isolation or quarantine, 11-12, 28, 83
recommendations, 5, 11-12, 82-87,
174-175, 184
Q
Quarantine, 11-12, 28, 83
R
Recommendations, see Findings and
recommendations
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INDEX 237
Research
basic biomedical, importance of, 18,
135-136
budget, 22, 151
HIV "starter kit," 22, 151
international opportunities, 196-197
see also Epidemiological research;
Social science research
Research needs
diversion of resources from other
important conditions, 6, 30
on educational campaigns, 8
epidemiological studies, 5, 52-53
facilities, 22, 149-150
international data base on activities, 24,
164
reagent distribution center, 22, 150-151
see also specific subject areas
Reverse transcriptase, inhibition of, 18,
131-132, 137
Robert Wood Johnson Foundation AIDS
Health Services Program, 110
Roundtable on Development of Drugs and
Vaccines Against AIDS, 146-147
S
San Francisco
AIDS case trends, 34, 107
burden of AIDS patients on health care
system in, 107-108
community care resources, 105
contact tracing program in, 82
deaths from AIDS, 5, 52
educational programs, 8, 68
Men's Health Study, 34
seroprevalence among homosexual men
in, 34, 46
seroprevalence among IV drug abusers
in, 4, 49
Screening for HIV
of blood and blood products, 34-35,
71, 75-76, 179
of blood and plasma donors, 49
at drug abuse treatment centers, 47
health care workers, 76-77, 100-101
historical parallels to syphilis epidemic,
28
hospital patients, 10, 48, 70, 77
institutionalized populations, 70
mandatory, 10, 75-79, 180-181
newborns, 50
organs and tissues for transplantation,
76
premarital, 10, 77-78
prenatal, 77
of prostitutes, 10, 78-79
public health objectives achieved
through, 8-9, 70
recommendations, 10, 75-79, 101, 196
semen for banking, 76
sites for, 47, 50, 89, 183
Serologic testing, see Antibody tests for
HIV; Screening for HIV;
Testing/tests for HIV
Seropositive individuals
age trends, 48
asymptomatic, 64, 70
discrimination against, 63-64
employment of, 6, 63-64, 100-101
health care workers, 76-77, 100-101
insurability, 113
progression to AIDS, 35-36
reporting of, 11, 80
students and teachers, 6, 63-64
Seroprevalence
in Africa, 174
age and, 48
among blacks, 41, 47, 48, 52, 84
among blood donors, 39, 47-48
data needs on, 59
among hemophiliacs, 4, 47
among heterosexual partners, 39, 41,
42, 47
among Hispanics, 41, 47, 48, 52, 84
among homosexual men, 4, 34, 35-36,
39, 46, 52, 68
among hospital patients, 48-49
among infants, 48, 52, 86
among IV drug abusers, 4, 34, 41,
46-47, 49, 52, 84, 87
among Job Corps entrants, 48
among military inductees and
personnel, 39, 48
modeling, 5, 58
national estimates, 4, 49-50
among prostitutes, 40, 41, 47
studies for determining, 82
among women, 40, 47, 48-49, 52
Sexual behavior
data needs on, 59
see also Behavioral change
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238 INDEX
Sexual transmission of HIV
efficiency of routes, 3-4, 45
men to women, 39, 41-42, 44
multiple partners and, 40, 43
partner tracing, 11, 43, 80-82, 179
prevention, see Behavioral change;
Condoms
receptive anal intercourse, 40, 42, 43,
45, 80, 172
vaginal intercourse, 39, 40, 41-42, 45,
80, 172
women to men, 39, 41-42, 44
see also Heterosexual transmission
Sexually transmitted disease clinics
AIDS prevention role, 6, 62
HIV screening through, 47, 50, 89
Shooting galleries, 42-43
Simian immunodeficiency virus (SIV), 21,
124, 130, 147, 148
Smallpox epidemics and eradication effort, 28
Social science research
needs, 5, 59-60, 67, 193, 200
recommendations for, 5, 67, 193, 200
Social stigma
complication of public health measures
by, 2, 29
see also Discrimination
Surveillance, see Epidemiological
surveillance
Syphilis
epidemiological parallels to AIDS
epidemic, 1, 27-28
increase in, correlated with HIV United States
infection rates, 41, 89
premarital screening for, 77
T
T lymphocytes
historical parallels to syphilis epidemic,
28
home-based, 10-11, 79-80
infants, for maternal infection, 48
informed consent for, 71-72, 101, 181
opponents of, 74
patient care and, 70
psychological effects of, 9, 70
purposes, 70
sites, 47, 50, 89, 183
standards and quality assurance, 9, 71
voluntary, 9, 72, 181
Texas, mandatory screening for HIV
infection, 77
Transmission of HIV
biological factors in, 43
determinants other than route, 45
efficiencies, 3-4, 39, 41-45, 172
intentional, criminal penalties or civil
liability for, 83
international patterns, 159-160
misunderstandings about, 8, 67
modes, 3-4, 8, 38-42, 65, 133, 172
see also Casual contact; Cofactors in
AIDS; Maternal-infant
transmission; Parenteral
transmission; Sexual transmission
Treatment strategies, see Antiviral agents;
Drugs; Vaccines against HIV
U
CD4 receptor on, 130-131
cytotoxic, 134, 141
as predictor of HIV transmission, 44
reduction in AIDS patients, 35
Testing/tests for HIV
anonymous, 48, 51
behavioral impacts, 9, 74-75
budget for, 88
confidentiality of results, 9, 10, 71-74,
79, 101
counseling with, 9, 10, 13, 70, 72, 74,
78, 79, 88-89, 101, 181, 193
AIDS cases by risk group, 51-52
contributions to international efforts!
23, 162-164, 196-197
economic costs of AIDS, 104-105; see
also Health care costs
patterns of disease spread in, 3, 40
payments to World Health
Organization, 163
rationale for international involvement,
161-162
U.S. Department of Health and Human
Services
joint infection control guidelines with
U.S. Department of Labor, 98
paid advertising for AIDS education, 7,
65
U.S. Food and Drug Administration
budget for AIDS research, 151
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INDEX 239
drug approval process, 19, 137-140
expedition of review, 19, 138
resources for drug approval process, 139
treatment IND, 17, 19, 117, 137, 139,
144
vaccine approval process, 20-21,
144-145
U.S. Public Health Service
Executive Task Force on AIDS, 24,
166
Intragovernmental Task Force on AIDS
Health Care Delivery, 117
National AIDS Program Office, 24, 166
projections of AIDS cases and deaths,
57
see also Public health measures
Utah, ban on marriage of antibody-positive
individuals, 77
V
Vaccines against HIV
animal trials, 20, 142, 144, 145
baculo-derived gpl60, 142
development approaches, 141-144, 189,
192-193
difficulties in developing, 20, 142-143
FDA approval process, 20-21, 144-145
HIV structural characteristics
important to development of, 125
human trials, 144, 145
immunogenic carriers, 143
inhibition of gpl20-CD4 interaction,
131, 141, 143
injury and compensation schedules, 146
legal liability issues, 145-146
passive immunization, 142
purified gpl20, 142
whole killed virus, 144
W
Western blot analysis, 71
Wisconsin
HIV reporting requirements, 73
insurance subsidy program, 116
World Health Organization, AIDS-related
activities, 23, 145, 160-161
z
Zidovudine (AZT)
action, 132
approval process, 138
in combination with biological response
modifier, 19, 137
comparison of other drugs with, 139
effectiveness, 37, 108, 132
Medicaid coverage for treatment, 114
side effects, 132
treatment costs, 108
trials in asymptomatic individuals, 70,
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Representative terms from entire chapter:
drug abuse
