NCAIDS Year 2 (August 1990-July 1991)
"This report . . . brings out the fact that, in an important sense, the only thing new about our present quandary is the virus, that most of what we are experiencing represents old problems that have been poorly patched and bandaged or ignored entirely. The HIV epidemic did not leave 37 million or more Americans without ways to finance their medical care—but it did dramatize their plight. The HIV epidemic did not cause the problem of homelessness—but it has expanded it and made it more visible. The HIV epidemic did not cause collapse of the health care system—but it has accelerated the disintegration of our public hospitals and intensified their financial problems. The HIV epidemic did not directly augment problems of substance use—but it has made the need for drug treatment for all who request it a matter of urgent national priority."
During its second year, the NCAIDS expanded its inquiries, gathering information on specific populations, public health infrastructure, and prevention. Commissioners visited and heard from HIV patients and public health administrators in Puerto Rico, Native American communities, Hispanic, Black, and Asian communities, gay, lesbian, and bisexual communities, and in correctional facilities. Because of the many overlaps between IV drug use, HIV disease, poverty, and the prison system, they held hearings on drug abuse. They also looked closely at the special difficulties of women with HIV. The fourth interim report "HIV Disease in Correctional Facilities," (March 1991) found that prison health care departments—rarely comprehensive—were not managing AIDS well; not only were HIV cases increasing among prison inmates, but those inmates were rapidly acquiring tuberculosis and other infections; routine testing, access to specialists, and to counseling were often lacking; prisoners were often automatically segregated, losing access to religious services, work programs, libraries, and visitations; lack of education of both inmates and staff created fear and discrimination towards those with HIV, and punitive policies; that former inmates re-entered the community with little added knowledge about HIV disease or how to prevent it.
In its fifth interim report, the commission focused on the "twin epidemics" of intravenous (IV) drug use and HIV/AIDS. They again criticized the Bush administration's National Drug Control Policy for virtually ignoring the well-established links between substance use and HIV infection and for relying on interdiction of drug supplies and imprisonment of users, which helped increase HIV transmission in communities and in prisons. The report urged expansion of drug abuse treatment capacity, consistently funded research on the connections between HIV and drug use, making injection equipment available through needle exchange programs (to decrease needle sharing), and more federal leadership in addressing these related problems.
The second annual report, "America Living With AIDS: Transforming Anger, Fear, and Indifference into Action" praised the courage of those living with HIV disease, and the compassion and dedication of those who had helped develop prevention, care, and advocacy programs. The commissioners noted the substantial progress made in improving and extending the lives of people with HIV, and the better-coordinated responses within the Public Health Service. And yet, they said, Congress had only appropriated one-third of the designated funding for the Ryan White Comprehensive AIDS Resources Emergency ("CARE") Act of 1990, intended to provide funding to regions hard hit by HIV/AIDS. They also noted other obstacles to progress, including persistent discrimination, along with conservative efforts to limit research into the behaviors that put people at risk for AIDS (sex and drug use), and to prohibit frank discussion of these in educating the public, especially young people. The report also included a detailed chapter on health care financing in the context of AIDS, particularly the limited and variable coverage available from private and public insurance schemes. Systemic reform, it concluded, would be needed to achieve genuinely appropriate access to health care for all Americans. Again, the commission called for a comprehensive national HIV plan for preventing and treating HIV disease, and universal health care; provision of drug abuse treatment on demand; and greater access to clinical trials and experimental new HIV drugs. While giving much credit to the early and pivotal work of the CDC and NIH in addressing the epidemic, the commission again criticized the general lack of government leadership at all levels in the response to HIV/AIDS.