NCAIDS Year 4 (August 1992-September 1993)

"This is a short, sometimes angry report tinged with sadness and foreboding. It is short because all of what we say here has been said many times before. It is sometimes angry because the carefully considered, widely heralded recommendations contained in our previous reports have been so consistently underfunded or ignored. It is sad because a potentially preventable disease continues to expand relentlessly and cause loss of life in young Americans on an unprecedented and unacceptable scale. The human immunodeficiency virus (HIV) has profoundly changed life on our planet. America has not done well in acknowledging this fact or in mobilizing its vast resources to address it appropriately. Many are suffering profoundly because of that failure, and America is poorer because of this neglect. We are apprehensive because the situation will inexorably worsen without immediate action."

Preface to "AIDS: An Expanding Tragedy, the Final Report of the National Commission on AIDS," June 1993

In its fourth year, the National Commission on AIDS conducted its final hearings, which focused on leadership in the HIV/AIDS epidemic response and how to better mobilize it; behavioral research; and AIDS in the Workplace. The commission also issued five interim reports (including recommendations to President Bill Clinton, who took office in January 1993) and its final report, "AIDS: An Expanding Tragedy."

The ninth interim report, "The Challenge of HIV/AIDS in Communities of Color" (December 1992) closely examined the disproportionate impact of HIV/AIDS on Black, Hispanic, Native American, and Pacific Islander communities, and the ways in which racial inequalities enable the spread of HIV and impede effective responses. "Mobilizing America's Response to AIDS: Recommendations to President Clinton" (tenth interim report, January 1993) outlined six initiatives, including creating a federal AIDS Coordinator's Office and directing the HHS Secretary to develop a National Strategic Plan to confront the epidemic. "HIV/AIDS: A Challenge for the Workplace" (eleventh interim report, June 1993) called upon all employers to provide AIDS education and training, and make accommodations for employees with HIV disease. "Preventing HIV Infection in Adolescents" (twelfth interim report, June 1993) urged that teenagers be given tough, explicit, and culturally appropriate instruction about protecting themselves from HIV infection. The thirteenth interim report, "Behavioral and Social Sciences and the HIV/AIDS Epidemic" (July 1993) explored the many psychosocial contexts of risk-taking behaviors that make people vulnerable to HIV infection, and the ways that behavioral research, especially into sexuality and substance use, could inform better prevention, education, and treatment efforts.

Through its investigations and the subsequent reports, the commission members drew a clear, detailed picture of the immensely complex problem that was AIDS. In each specific area they examined, the same themes repeated, and many of the NCAIDS recommendations did as well. The final report, "AIDS: An Expanding Tragedy," summarized the commission's advice in seven points: 1) Leadership is essential: leaders should develop the vision and plan for controlling the epidemic, and speak out about it to their constituencies; 2) access to basic health, including preventive, medical, and social services, should be a right for all; 3) the U.S. must have a vital and responsive public health system, and rebuild its public health infrastructure; 4) the best science is essential: it must be adequately funded and not constrained by ideologies or political convenience; 5) health care solutions should offer a broad continuum of comprehensive services to those with chronic relapsing disease; 6) partnerships and cooperation/collaboration between government agencies, academe, and communities on education, prevention, and financing, are essential; and 7) the human face of AIDS should be ever before us—HIV/AIDS policies and programs should always respect personal dignity and autonomy, respect confidentiality, and reduce discrimination. The final report reflected the commissioners' frustration that so few of their findings and recommendations had been acted upon, even though AIDS was one of the leading causes of death in people aged 24-45, and cases were increasing among heterosexuals and adolescents. The introduction noted, "The failure to respond adequately represents at best continued dogged denial, and at worst a dismaying hidden and unvoiced belief that this is 'just' a disease of gay men and intravenous drug users, both groups that are perceived as disposable." (p. 1) By this time, roughly 1 million had been infected, 290,000 had developed AIDS, and 180,000 had died of it. With no effective treatment or vaccine in sight (despite intensive research efforts), and prevention efforts lagging, the commissioners warned that cases and deaths could increase exponentially in the coming years. They asked Americans, especially political leaders, to step up and prevent that terrible future.