AIDS: An Overview of Issues

This report discusses the many difficult policy dilemmas associated with the AIDS epidemic, including past Congressional funding to support AIDS research and education efforts, strategies for controlling the spread of the AIDS virus, and methods and resources available for the care and treatment of persons with AIDS.

Order Code IB87150 AIDS: AH OVERVIEW O F I S S U E S Updated March 21, 1 9 8 8 by J u d i t h A. J o h n s o n and Pamela W. Smith, C o o r d i n a t o r s Science Policy Research Division Congressional Research S e r v i c e CONTMTS SUMMARY ISSUE DEFINITION BACKGROUND AND ANALYSIS introduction Education and Risk Reduction Public Health Measure Pamela Smith and Judith Johnson Mark Merlis Judith Johnson Health Care and Social Services Mark Merlis Legal Issues Nancy Jones State Laws and Regulations Labor Issues Ann Wolfe Gail McCaP lion International Problems and Response Lois McMugh Actions by the Reagan Administration Pamela Smith Congressional Actions Pamela Smith LEGISLATION FOR ADDITIONAL READING AIDS: AN OVERVIEW OF ISSUES Many m e d i c a l e x p e r t s c o n s i d e r AIDS t o be t h e g r a v e s t p u b l i c h e a l t h t h r e a t of t h i s c e n t u r y . S t a t i s t i c s on c a s e s and d e a t h s are a l r e a d y a l a r m i n g , and a r e p r o j e c t e d t o worsen: t h e c u r r e n t U.S. c o u n t o f o v e r 56,000 c a s e s and 31,000 d e a t h s i s p r e d i c t e d t o r i s e t o 270,000 c a s e s and 179,000 d e a t h s by 1991, w h i l e t h e worldwide t o t a l of AIDS c a s e s , now e s t i m a t e d a t between 100,000 and 150,000, may r i s e t o between 500,000 and 3 m i l l i o n by 1991. P u b l i c p o l i c y i s s u e s c o n c e r n i n g AIDS a r i s e i n a number of a r e a s . P o l i c y d e b a t e s o n e d u c a t i o n a l e f f o r t s have f o c u s e d on t h e e x p l i c i t n e s s and v a l u e c o n t e n t of AIDS i n f o r m a t i o n , t h e r e l a t i v e r o l e s of F e d e r a l and Local c o n t r o l s , and t h e e f f e c t i v e n e s s of mass e d u c a t i o n v e r s u s e f f o r t s t a r g e t e d a t r i s k g r o u p s i n c l u d i n g d r u g u s e r s , m i n o r i t i e s , and young p e o p l e . Public h e a l t h m e a s u r e s t o c o n t r o l t h e s p r e a d of t h e d i s e a s e h a v e i n v o l v e d d e b a t e s o v e r t h e u s e f u l n e s s and s c o p e of t e s t i n g i n t h e a b s e n c e o f a c u r e o r v a c c i n e , and o v e r t h e u t i l i t y of q u a r a n t i n e . R e s e a r c h on a n AIDS v a c c i n e i s p r o g r e s s i n g , b u t s c i e n t i f i c , l e g a l , and s o c i a l d i f f i c u l t i e s p r o m i s e t o be i m p o r t a n t o b s t a c l e s i n i t s development. T h e r e i s growing c o n c e r n a b o u t r e s o u r c e s a v a i l a b l e t o p r o v i d e a d e q u a t e t r e a t m e n t and s u p p o r t s e r v i c e s t o t h o s e i n f e c t e d . Severe s t r a i n s may b e f e l t from mounting c o s t s f o r Government-financed h e a l t h c a r e , d i s a b i l i t y payments, h e a l t h i n s u r a n c e , and l o s s e s on u n i n s u r e d patients. I n a d d i t i o n , t h e p h y s i c a l c a p a c i t y of t h e h e a l t h c a r e s y s t e m may p r o v e i n a d e q u a t e t o meet t h e n e e d s of AIDS p a t i e n t s f o r l o n g - t e r m c a r e , home a n d community-based h e a l t h c a r e , and h o s p i c e s e r v i c e s . Many d i f f i c u l t l e g a l i s s u e s h a v e a r i s e n from a t t e m p t s t o c o n t r o l t h e s p r e a d o f AIDS. There i s s t r o n g l e g a l a u t h o r i t y t o p r o t e c t t h e p u b l i c h e a l t h ; however, c e r t a i n s i t u a t i o n s and p r o p o s a l s have l e d t o c h a r g e s of i l l e g a l d i s c r i m i n a t i o n a g a i n s t p e o p l e i n f e c t e d o r t h o u g h t t o be i n f e c t e d w i t h t h e AIDS v i r u s . P r i v a c y i s s u e s have a l s o been r a i s e d . Many S t a t e s have i n c o r p o r a t e d AIDS i n t o t h e i r laws o r r e g u l a t i o n s , e i t h e r s p e c i f i c a l l y o r by l i n k i n g i t t o o t h e r comnunicable d i s e a s e s . I n t h e workplace, e m p l o y e r s and l a b o r u n i o n s i n c r e a s i n g l y a r e c o n c e r n e d w i t h AIDS p o l i c i e s . The U.S. P u b l i c H e a l t h S e r v i c e h a s d e v e l o p e d a set o f o b j e c t i v e s t o c o n t r o l AIDS by t h e y e a r 2000, h a s p u b l i s h e d a n AIDS I n f o r m a t i o n / E d u c a t i o n P l a n , and i s c o o r d i n a t i n g a N a t i o n a l AIDS I n f o r m a t i o n Campaign. The P r e s i d e n t i a l Commission on AIDS h a s made an i n t e r i m r e p o r t w i t h b r o a d r e c o m n e n d a t i o n s on d r u g a b u s e , h e a l t h c a r e , and r e s e a r c h . Many p u b l i c h e a l t h e x p e r t s and h e a l t h o f f i c i a l s have been c r i t i c a l o f t h e Government's r e s p o n s e , a l l e g i n g l a c k of l e a d e r s h i p and c o o r d i n a t i o n i n t h e f i g h t a g a i n s t AIDS. I n t e r n a t i o n a l e f f o r t s on AIDS i n c l u d e t h e World H e a l t h O r g a n i z a t i o n ' s l e a d e r s h i p on a g l o b a l s t r a t e g y and t h e i n c o r p o r a t i o n o f t h e d i s e a s e i n t o p o p u l a t i o n , h e a l t h , and e d u c a t i o n programs i n many countries. Over 65 b i l l s on AIDS have been i n t r o d u c e d i n t h e 1 0 0 t h C o n g r e s s a d d r e s s i n g s u c h i s s u e s a s t h e e s t a b l i s h m e n t of a N a t i o n a l Commission on AIDS; a u t h o r i z a t i o n of programs f o r AIDS e d u c a t i o n , p r e v e n t i o n , t r e a t m e n t , c a r e , and r e s e a r c h ; and s u p p o r t of c o u n s e l i n g and t e s t i n g s e r v i c e s , t o g e t h e r w i t h t h e e s t a b l i s h m e n t of c e r t a i n p r i v a c y , c o n f i d e n t i a l i t y , and nond,iscrimination requirements. ISSUE DEFIYITIOU A s s o c i a t e d w i t h t h e AIDS epidemic a r e some o f t h e most d i f f i c u l t p o l i c y dilemmas o u r s o c i e t y f a c e s . P a s t C o n g r e s s e s have p r o v i d e d f u n d s t o s u p p o r t r e s e a r c h and e d u c a t i o n e f f o r t s , b u t h a v e n o t d e a l t l e g i s l a t i v e l y w i t h more c o m p r e h e n s i v e a p p r o a c h e s t o t h e d i s e a s e . Issues f o r t h e 100th C o n g r e s s i n c l u d e s t r a t e g i e s f o r c o n t r o l l i n g t h e s p r e a d of t h e AIDS v i r u s , e s p e c i a l l y m e a s u r e s d i r e c t e d toward p e o p l e a l r e a d y i n f e c t e d a s w e l l a s t h o s e a t h i g h r i s k o f i n f e c t i o n ; methods and r e s o u r c e s a v a i l a b l e f o r t h e c a r e and t r e a t m e n t of p e r s o n s w i t h AIDS; c o n c e r n s a b o u t AIDS e d u c a t i o n , c i v i l e i g h t s , and o t h e r l e g a l i s s u e s ; t h e p o t e n t i a l economic impact of t h e e p i d e m i c ; and t h e U.S. r o l e i n t h e g l o b a l r e s p o n s e t o AIDS. BACKGROUND AND ANALYSIS Introduction Acquired Immune D e f i c i e n c y Syndrome (AIDS) i s a v i r u s - c a u s e d c o n d i t i o n which compromises t h e n a t u r a l d i s e a s e - r e s i s t i n g s y s t e m s o f i t s v i c t i m s , t h u s r e n d e r i n g them e x t r e m e l y s u s c e p t i b l e t o i n f e c t i o n s . At p r e s e n t , t h e d i s e a s e h a s proven f a t a l eo most o f i t s v i c t i m s w i t h i n two y e a r s of c l i n i c a l m a n i f e s t a t i o n . Over 56,000 c a s e s o f AIDS, and o v e r 31,000 d e a t h s , h a v e been r e p o r t e d i n t h e United S t a t e s a l o n e . The World H e a l t h O r g a n i z a t i o n (WHO) e s t i m a t e s t h a t t h e worldwide t o t a l o f AIDS c a s e s i s between 100,000 and 150,000. I t i s c u r r e n t l y e s t i m a t e d t h a t 1 t o 1.5 m i l l i o n Americans, and 5 t o 10 m i l l i o n p e r s o n s worldwide, a r e i n f e c t e d w i t h t h e AIDS v i r u s . By t h e end of 1991, a c c o r d i n g t o P u b l i c H e a l t h S e r v i c e e s t i m a t e s , more t h a n 270,000 c a s e s of AIDS, w i t h more t h a n 179,000 d e a t h s , w i l l have occurred i n t h e United S t a t e s . The N a t i o n a l C e n t e r f o r H e a l t h S t a t i s t i c s p r e d i c t s t h a t AIDS w i l l be o n e of t h e 10 l e a d i n g c a u s e s o f d e a t h by 1991, and t h a t i t w i l l b e t h e l e a d i n g c a u s e of d e a t h f o r p e o p l e between t h e a g e s of 25 and 4 4 . Of t h e e s t i m a t e d 54,000 t o 64,800 p e o p l e who w i l l d i e of AIDS i n t h i s c o u n t r y i n 1991, 75% w i l l be between t h e a g e s o f 25 and 44. D i r e c t m e d i c a l c o s t s f o r t h e e s t i m a t e d 174,000 p e o p l e a l i v e w i t h AIDS d u r i n g 1991 c o u l d amount t o $8-16 b i l l i o n ; e a r n i n g s l o s t due t o i l l n e s s and p r e m a t u r e d e a t h from AIDS i n 1991 c o u l d t o t a l a n o t h e r $55 b i l l i o n . The f u t u r e i n t e r n a t i o n a l AIDS s i t u a t i o n i s e x p e c t e d t o be a t l e a s t a s serious. WHO estimates t h a t by 1991, between 500,000 and 3 m i l l i o n c u r r e n t l y i n f e c t e d i n d i v i d u a l s w i l l d e v e l o p AIDS. While homosexual men a c c o u n t f o r 65% of c u r r e n t U.S. AIDS v i c t i m s , t h e r i s i n g numbers among i n t r a v e n o u s ( I V ) d r u g u s e r s , m i n o r i t i e s , and i n f a n t s a r e of growing c o n c e r n . Cumulative p e d i a t r i c AIDS c a s e s , c u r r e n t l y numbering 900, a r e p r o j e c t e d t o i n c r e a s e t o more t h a n 3 , 0 0 0 c a s e s by t h e c l o s e o f 1991, T h e r e i s a l s o c o n c e r n a b o u t t h e s p r e a d of t h e d i s e a s e among h e t e r o s e x u a l s . While q u a n t i f i c a t i o n o f t h e m a g n i t u d e and r a t e o f s p r e a d o f t h e d i s e a s e i s l e s s t h a n p r e c i s e and s u b j e c t t o r e v i s i o n , i t i s c l e a r t h a t t h e d i s e a s e a l r e a d y has profound p o l i c y consequences. A c r i t i c a l l y i m p o r t a n t p a r t of t h e U.S. commitment t o t h e f i g h t a g a i n s t AIDS i s i t s b i o m e d i c a l r e s e a r c h program, l e d by t h e N a t i o n a l I n s t i t u t e s o f H e a l t h (NIH). NIH s u p p o r t o f r e s e a r c h on AIDS h a s i n c r e a s e d from $44 m i l l i o n i n FY84 t o $467 m i l l i o n i n FY88. Avenues of r e s e a r c h a t N I H and e l s e w h e r e have i n c l u d e d i d e n t i f i c a t i o n and c h a r a c t e r i z a t i o n o f t h e virus, e p i d e m i o l o g i c i n v e s t i g a t i o n s , and r e s e a r c h on v a c c i n e s and a n t i v i r a l drugs. I n t e n s i v e work i s ongoing i n a l l o f t h e s e a r e a s . In a d d i t i o n , t h e N a t i o n a l Academy o f S c i e n c e s h a s recommended a n e x p a n s i o n of s o c i a l s c i e n c e r e s e a r c h r e l a t i n g t o AIDS, p a r t i c u l a r l y i n t h e f i e l d of b e h a v i o r a l change. The r e m a i n d e r o f t h i s i s s u e b r i e f w i l l d i s c u s s s e v e r a l p o l i c y i s s u e s : e d u c a t i o n ; pub1 i c h e a l t h m e a s u r e s ; h e a l t h c a r e d e l i v e r y and f i n a n c i n g i s s u e s ; l e g a l i s s u e s ; S t a t e laws and r e g u l a t i o n s ; l a b o r and employment i s s u e s ; and i n t e r n a t i o n a l e f f o r t s . A c t i o n s by t h e A d m i n i s t r a t i o n and C o n g r e s s i o n a l a c t i v i t i e s a r e sumnarized. Details about each of t h e s e i s s u e s a r e p r o v i d e d i n o t h e r CRS p u b l i c a t i o n s , l i s t e d i n t h e For A d d i t i o n a l Reading s e c t i o n . Education and Risk Reduction Most p e r s o n s c a r r y i n g t h e AIDS v i r u s were i n f e c t e d e i t h e r t h r o u g h s e x u a l c o n t a c t o r t h r o u g h t h e s h a r i n g o f n e e d l e s by I V d r u g a b u s e r s . P u b l i c h e a l t h e x p e r t s a g r e e t h a t t h e c h i e f way o f r e d u c i n g f u r t h e r s p r e a d of t h e v i r u s i s t h r o u g h e d u c a t i o n a l e f f o r t s i n t e n d e d t o i n d u c e v o l u n t a r y changes i n "high r i s k " behavior. Although f u n d i n g f o r e d u c a t i o n a c t i v i t i e s h a s been s u b s t a n t i a l l y i n c r e a s e d i n t h e FY88 a p p r o p r i a t i o n , t h e methods and c o n t e n t o f i n f o r m a t i o n and r i s k r e d u c t i o n a c t i v i t i e s remain t h e s u b j e c t of d e b a t e . C u r r e n t e d u c a t i o n a l e f f o r t s i n v o l v e b o t h t h e u s e of mass media t o p r o v i d e t h e whole p o p u l a t i o n w i t h i n f o r m a t i o n a b o u t how AIDS i s . s p r e a d a n d how i n f e c t i o n c a n be p r e v e n t e d , and more c o n c e n t r a t e d programs aimed a t members o f t h e h i g h e r r i s k g r o u p s . The S u p p l e m e n t a l A p p r o p r i a t i o n s B i l l f o r FY87 (P.L. 100-71) i n c l u d e d $20 m i l l i o n f o r a mass m a i l i n g t o a l l American h o u s e h o l d s , and t h e r e a r e p r o p o s a l s f o r a t e l e v i s i o n campaign, p o s s i b l y u s i n g p a i d commercial time. The Department h a s d e l a y e d t h e m a i l i n g , b u t i t h a s been d i r e c t e d by t h e FY88 C o n t i n u i n g R e s o l u t i o n t o c o m p l e t e t h e m a i l i n g by J u n e 30, 1988. The FY88 A p p r o p r i a t i o n a l s o i n c l u d e s s u b s t a n t i a l i n c r e a s e s i n f u n d i n g f o r s c h o o l - b a s e d e d u c a t i o n , from $11.3 m i l l i o n i n FY87 t o $29.9 m i l l i o n i n FY88. Some p e o p l e , p o i n t i n g t o r e c e n t c l a i m s t h a t t h e r i s k of t r a n s m i s s i o n i n t h e g e n e r a l p o p u l a t i o n may have been e x a g g e r a t e d , s u g g e s t t h a t such broad-based a p p r o a c h e s , which c o u l d be c o s t l y , might s i m p l y h e i g h t e n p u b l i c f e a r s w i t h o u t s i g n i f i c a n t l y i n f l u e n c i n g b e h a v i o r among members o f h i g h r i s k g r o u p s . Others argue t h a t , w h i l e t a r g e t e d e f f o r t s a r e n e e d e d , e d u c a t i o n of t h e g e n e r a l p u b l i c is e q u a l l y important. They c o n t e n d t h a t p e o p l e may e n g a g e i n h i g h r i s k b e h a v i o r w i t h o u t c o n c e i v i n g o f t h e m s e l v e s a s members of a r i s k g r o u p and that, for t h i s reason, i n f o r m a t i o n a b o u t t h e b e h a v i o r s must be disseminated a s widely a s possible. Education could prove h e l p f u l i n p r e v e n t i n g t h e s p r e a d o f AIDS i n t o younger p o p u l a t i o n s and o t h e r s experimenting i n sexual relations. T h e r e a r e p a r t i c u l a r concerns t h a t educational e f f o r t s r e a c h minorities. The b l a c k and H i s p a n i c p o p u l a t i o n s a r e d i s p r o p o r t i o n a t e l y a f f e c t e d by AIDS, l a r g e l y b e c a u s e o f t h e h i g h e r r a t e o f I V d r u g a b u s e i n t h e s e groups. E f f o r t s t o change h i g h r i s k behavior a r e r e p o r t e d t o have been hampered by a c o n t i n u i n g p e r c e p t i o n t h a t AIDS i s a d i s e a s e a f f e c t i n g o n l y w h i t e homosexuals. The FY88 a p p r o p r i a t i o n s e t s a s i d e s p e c i a l f u n d s f o r assistance i n minority education projects. D e b a t e o v e r t h e c o n t e n t o f AIDS i n f o r m a t i o n h a s c e n t e r e d on two m a j o r quesrions. The f i r s t , f a m i l i a r i n d i s c u s s i o n s o f s e x e d u c a t i o n , i s e x p l i c i t n e s s , p a r t i c u l a r l y i n m a t e r i a l s aimed a t s c h o o l a g e c h i l d r e n . The A d m i n i s t r a t i o n h a s emphasized Local c o n t r o l o v e r c o n t e n t ; c r i t i c s a r g u e t h a t t h i s c o u l d l e a d t o vague o r e u p h e m i s t i c p r e s e n t a t i o n s w i t h l i m i t e d impact. The s e c o n d i s s u e i s t h a t of v a l u e s . B e h a v i o r a l c h a n g e s t o r e d u c e t h e r i s k of t r a n s m i s s i o n of t h e AIDS v i r u s c o u l d i n v o l v e e i t h e r c o m p l e t e a b s t i n e n c e from h i g h r i s k a c t i v i t i e s o r t h e a d o p t i o n o f s a f e r p r a c t i c e s , s u c h a s t h e u s e of condoms o r t h e a v o i d a n c e of n e e d l e s h a r i n g , by p e r s o n s c o n t i n u i n g t o engage i n t h o s e a c t i v i t i e s . Some p e o p l e a r g u e t h a t p r o v i d i n g i n f o r m a t i o n a b o u t s a f e r p r a c t i c e s would p u t t h e Government i n t h e p o s i t i o n of i m p l i c i t l y condoning and o f f e r i n g c o u n s e l on b e h a v i o r s which many f i n d o b ~ e c t i o n a b l e o r which a r e a c t u a l l y i l l e g a l . Others say t h a t i t i s u n r e a l i s t i c t o e x p e c t t h e e n t i r e p o p u l a t i o n t o abandon e x t r a m a r i t a l s e x u a l a c t i v i t y o r d r u g a b u s e and t h a t n e u t r a l , n o n j u d g m e n t a l d i s c u s s i o n s o f p r o t e c t i v e measures h a v e a g r e a t e r c h a n c e o f c h a n g i n g behavior i n t h e short-term. Language i n t h e FY88 a p p r o p r i a t i o n f o r t h e C e n t e r s f o r D i s e a s e C o n t r o l (CDC) p r o h i b i t s f u n d i n g f o r e d u c a t i o n a l m a t e r i a l s which d i r e c t l y promote o r e n c o u r a g e homosexual a c t i v i t y , and r e q u i r e s t h a t s u c h m a t e r i a l s emphasize a b s t i n e n c e . (The S e n a t e h a s a p p r o v e d s t r o n g e r l a n g u a g e , b a r r i n g even " i n d i r e c t " e n c o u r a g e m e n t . ) Drug a b u s e p r e s e n t s s p e c i a l problems. Needle . s h a r i n g i s comnon p a r t b y b e c a u s e many S t a t e s h a v e o u t l a w e d t h e n o n - p r e s c r i p t i o n s a l e o f d r u g p a r a p h e r n a l i a , making n e e d l e s and s y r i n g e s h a r d t o p u r c h a s e . Some p e o p l e have a r g u e d t h a t r e p e a l i n g t h e s e p r o h i b i t i o n s , o r even f u r n i s h i n g f r e e n e e d l e s t o drug u s e r s , could reduce t h e r a t e of transmission. New York i s now e x p e r i m e n t i n g w i t h n e e d l e d i s t r i b u t i o n and o t h e r l o c a l i t i e s a r e p r o v i d i n g i n f o r m a t i o n on how t o d i s i n f e c t n e e d l e s . Opponents o f t h e s e m e a s u r e s a r g u e t h a t t h e e f f e c t i s t o promote c o n t i n u e d d r u g a b u s e , and t h a t a b u s e r s s h o u l d i n s t e a d be e n c o u r a g e d t o e n t e r t r e a t m e n t programs. The P r e s i d e n t i a l Commission on t h e H I V e p i d e m i c h a s n o t e d t h a t t r e a t m e n t is p r e s e n t l y unavailable o r a v a i l a b l e only a f t e r long waiting periods. It h a s recommended a " t r e a t m e n t on demand" p o l i c y , which c o u l d r e q u i r e a n e s t i m a t e d $1.5 b i l l i o n i n c r e a s e i n d r u g t r e a t m e n t f u n d i n g o v e r c u r r e n t levels. P u b l i c H e a l t h Measures The AIDS e p i d e m i c h a s f o c u s e d a t t e n t i o n on t h e e f f e c t i v e n e s s of t r a d i t i o n a l p u b l i c h e a l t h r e s p o n s e s t o d i s e a s e . Among t h e s e r e s p o n s e s a r e s c r e e n i n g o f p e r s o n s p o s s i b l y exposed t o i n f e c t i o n , q u a r a n t i n e of i n f e c t i o u s i n d i v i d u a l s , and p r e v e n t i v e measures such a s v a c c i n e s . T e s t i n g f o r AIDS a n t i b o d i e s i s o n e of t h e more c o n t r o v e r s i a l p u b l i c h e a l t h m e a s u r e s u s e d t o c o n t r o l t h e s p r e a d of AIDS. The most w i d e l y u s e d b l o o d t e s t i s c a l l e d a n enzyme-linked immunosorbent a s s a y (ELISA). It i n v o l v e s a c o l o r c h a n g e i n t h e p r e s e n c e of AIDS a n t i b o d i e s ; l a r g e r amounts of a n t i b o d y r e s u l t i n g r e a t e r i n t e n s i t y o f c o l o r . A b l o o d sample i s p o s i t i v e when a p r e d e t e r m i n e d l e v e l of c o l o r i n t e n s i t y i s r e a c h e d . While t h e b l o o d t e s t s used t o d e t e c t AIDS a n t i b o d i e s a r e v e r y a c c u r a t e , t h e r e i s no a b s o l u t e c u t o f f p o i n t f o r a p o s i t i v e t e s t . The c h a n c e o f d e t e c t i n g AIDS i n f e c t i o n i n c r e a s e s when t h e c u t o f f p o i n t i s low, b u t t h i s a l s o A higher cutoff point w i l l r a i s e s t h e number o f f a l s e p o s i t i v e r e s u l t s . i n c r e a s e t h e number of f a l s e n e g a t i v e s . The t e s t c u r r e n t l y b e i n g u s e d w a s d e v e l o p e d f o r u s e by blood banks and t h e c u t o f f p o i n t was d e t e r m i n e d w i t h t h e i r o b j e c t i v e s i n mind. Because of t h e s e r i o u s n a t u r e of a p o s i t i v e t e s t r e s u l t , c o n f i r m a t o r y t e s t s a r e u s u a l l y performed. The AIDS a n t i b o d y test h a s been used s i n c e 1985 by b l o o d b a n k s , g r e a t l y i m p r o v i n g t h e s a f e t y o f blood used f o r t r a n s f u s i o n s . I t is a l s o b e i n g u s e d , i n b o t h v o l u n t a r y and mandatory s e t t i n g s , t o d e t e r m i n e t h e a n t i b o d y s t a t u s o f v a r i o u s g r o u p s of p e o p l e . I n d i v i d u a l s wishing t o have t h e i r b l o o d t e s t e d c a n g o t o c e n t e r s o f f e r i n g t e s t i n g and c o u n s e l i n g . T h e r e i s a h i g h demand f o r t h e s e s e r v i c e s i n a r e a s i n which t h e y a r e available. Mandatory t e s t i n g h a s been a s o u r c e o f c o n s i d e r a b l e controversy. The F e d e r a l Government s c r e e n s t h e m i l i t a r y as w e l l as c e r t a i n employees of t h e S t a t e Department and t h e Department o f Labor. T h e Department o f D e f e n s e h a s e s t a b l i s h e d g u i d e l i n e s f o r t e s t i n g , education, counseling, providing health care services, protecting t h e b l o o d s u p p l y , p r o t e c t i n g t h e r i g h t s o f HIV-infected p e r s o n n e l , and r e t a i n i n g o r s e p a r a t i n g HIV-infected p e r s o n n e l . "AIDS and i n f e c t i o n w i t h t h e AIDS v i r u s " r e c e n t l y was added t o t h e l i s t o f c o n t a g i o u s d i s e a s e s f o r which i m m i g r a n t s and a l i e n s c a n be d e n i e d e n t r y i n t o t h e U n i t e d S t a t e s . A t e s t i n g program f o r a l l incoming and o u t g o i n g F e d e r a l p r i s o n e r s began on J u n e 1 5 , 1987, and t h e S t a t e s have been a s k e d t o r e q u i r e t h e AIDS t e s t f o r S t a t e and l o c a l p r i s o n e r s a s u e l l . The S t a t e s a r e a l s o b e i n g e n c o u r a g e d t o o f f e r t h e AIDS t e s t t o m a r r i a g e l i c e n s e a p p l i c a n t s . Other Federal p r o g r a m s , s u c h a s v e t e r a n s ' h o s p i t a l s , a r e b e i n g reviewed t o d e t e r m i n e i f AIDS t e s t i n g would b e a p p r o p r i a t e . P r o p o n e n t s o f i n c r e a s e d r o u t i n e and mandatory t e s t i n g a p p l a u d t h e s e new p o l i c i e s , a r g u i n g t h a t t h e g r a v i t y o f t h e AIDS e p i d e m i c demands more a g g r e s s i v e p u b l i c h e a l t h measures. They a r g u e t h a t t o e v a l u a t e t h e e f f e c t i v e n e s s of v a r i o u s p u b l i c h e a l t h measures i t i s v i t a l t o monitor t h e i n c i d e n c e o f AIDS v i r u s i n f e c t i o n i n t h e p o p u l a t i o n . Periodic t e s t i n g is j u s t i f i e d , p r o p o n e n t s s a y , by t h e l o n g l a t e n c y of t h e AIDS i n f e c t i o n and by i t s c o m n u n i c a b i l i t y d u r i n g t h a t p e r i o d . Many b e l i e v e t h a t i n d i v i d u a l s who t e s t p o s i t i v e w i l l c h a n g e t h e i r b e h a v i o r i n o r d e r t o a v o i d i n f e c t i n g o t h e r s . However, t h e r e i s l i t t l e e v i d e n c e t o s u p p o r t t h i s view. In fact, o n e s t u d y i n d i c a t e d t h a t knowledge of t e s t r e s u l t s , i f unaccompanied by c o u n s e l i n g , c o u l d c a u s e p e o p l e t o behave i n a more r e c k l e s s manner. A r e p o r t by t h e C e n t e r s f o r D i s e a s e C o n t r o l c o n c l u d e d t h a t p r e m a r i t a l t e s t i n g f o r AIDS on a l a r g e s c a l e i s n o t L i k e l y t o be v e r y e f f e c t i v e even i n a r e a s o f h i g h p r e v a l e n c e o f AIDS i n f e c t i o n b e c a u s e most h i g h r i s k p e r s o n s a r e a l r e a d y s e x u a l l y a c t i v e and a r e n o t l i k e l y t o marry. In areas of low p r e v a l e n c e , l a r g e numbers o f p e o p l e would h a v e t o b e t e s t e d t o f i n d a few i n f e c t e d i n d i v i d u a l s . C r i t i c s f e e l t h a t t h e f o c u s on mandatory t e s t i n g by t h e Government They a r g u e t h a t s i n c e t h e r e i s no c u r e o r and o t h e r s i s m i s g u i d e d . v a c c i n e f o r AIDS t h e r e i s l i t t l e t o be g a i n e d by more w i d e s p r e a d t e s t i n g . Many f e a r t h a t t h e AIDS t e s t w i l l b e used t o d i s c r i m i n a t e a g a i n s t i n d i v i d u a l s f o r employment, i n s u r a n c e , and o t h e r p u r p o s e s , and t h a t i t w i l l b e d i f f i c u l t t o e n s u r e c o n f i d e n t i a l i t y and s a f e g u a r d c i v i l l i b e r t i e s . I n a d d i t i o n , c r i t i c s b e l i e v e t h a t t h e expense involved i n i n c r e a s e d t e s t i n g would d i v e r t f u n d i n g away from o t h e r p u b l i c h e a l t h m e a s u r e s . Over c h e c o u r s e of t h e e p i d e m i c , t h e r e h a v e been a few p r o p o s a l s s u g g e s t i n g q u a r a n t i n e a s a p o s s i b l e measure f o r c o n t r o l l i n g t h e s p r e a d of AIDS. However, t h o s e d y i n g from AIDS do n o t p o s e a s g r e a t a d a n g e r a s t h e asymptomatic c a r r i e r s of t h e v i r u s . I d e n t i f i c a t i o n of t h e s e c a r r i e r s , which PHs e s t i m a t e s a t 1.5 m i l l i o n p e o p l e , would r e q u i r e s c r e e n i n g t h e e n t i r e p o p u l a t i o n of t h e U n i t e d S t a t e s on a r e g u l a r b a s i s , p e r h a p s e v e r y 6 o r 12 months. The c o s t o f t h e t e s t i n g a l o n e would be e x t r e m e l y h i g h , and t h e e t h i c a l and p r a c t i c a l problems of s u c h a program would n o t be e a s i l y r e s o l v e d . Because t h e predominant modes o f t r a n s m i s s i o n g e n e r a l l y i n v o l v e v o L u n t a r y b e h a v i o r s , most p u b l i c h e a l t h o f f i c i a l s b e l i e v e t h a t q u a r a n t i n e i s a n u n n e c e s s a r i l y h a r s h measure which h a s l i m i t e d u t i l i t y i n c o n t r o l l i n g t h e AIDS e p i d e m i c . Many b e l i e v e t h a t an AIDS v a c c i n e w i l l be t h e p r i m a r y t o o l i n p r e v e n t i n g t h e d i s e a s e , b u t much a d d i t i o n a l p r o g r e s s i n v i r o l o g y and immunology w i l l be n e c e s s a r y b e f o r e a n e f f e c t i v e v a c c i n e c a n b e r e a l i z e d . V a c c i n e s a r e c u r r e n t l y u n d e r development by r e s e a r c h e r s p u r s u i n g s e v e r a l d i f f e r e n t s t r a t e g i e s , and o n e h a s begun p r e l i m i n a r y c l i n i c a l t r i a l s i n uninfected volunteers. These i n i t i a l t e s t s w i l l c h e c k f o r s i d e e f f e c t s and d e t e r m i n e w h e t h e r t h e v a c c i n e c a n r a i s e a n imnune r e s p o n s e . Testing t h e v a c c i n e f o r i t s e f f e c t i v e n e s s i n p r o t e c t i n g a g a i n s t AIDS w i l l o c c u r i f However, many e x p e c t t h a t t h e t h e s a f e t y of t h e vaccine i s e s t a b l i s h e d . l e g a l and s o c i a l o b s t a c l e s t o f u r t h e r t e s t s and t o e v e n t u a l u s e o f a n y v a c c i n e w i 11 be f o r m i d a b l e . T e s t i n g a v a c c i n e i n humans w i l l p r o b a b l y t a k e a t L e a s t 3 y e a r s , and A large p o s s i b l y much l o n g e r b e c a u s e of t h e l o n g l a t e n c y p e r i o d . v o l u n t e e r t e s t g r o u p o f p e o p l e a t h i g h r i s k of AIDS i n f e c t i o n , who are n o t a l r e a d y i n f e c t e d b u t w i l l be c o n t i n u i n g t h e i r h i g h r i s k p r a c t i c e s , w i l l h a v e t o be r e c r u i t e d and m o n i t o r e d f o r l o n g p e r i o d s of time t o make s u r e t h a t t h e v a c c i n e i s s a f e and e f f e c t i v e . P o t e n t i a l manufacturers of an AIDS v a c c i n e w i l l be e x t r e m e l y wary of t h e i r l i a b i l i t y f o r v a c c i n e - r e l a t e d complications. The f e a r o f l a r g e awards f o r v a c c i n e i n j u r i e s h a s a l r e a d y d r i v e n many m a n u f a c t u r e r s away from t h e p r o d u c t i o n o f e x i s t i n g v a c c i n e s against familiar infectious diseases. Some have s u g g e s t e d t h a t t h e F e d e r a l Government may have t o assume much o r a l l of t h e r i s k a s was done w i t h t h e swine f l u v a c c i n e i n 1976. Health C a r e and S o c i a l S e r v i c e s While g r e a t e r p u b l i c a t t e n t i o n h a s been d e v o t e d t o means of p r e v e n t i n g t h e f u r t h e r s p r e a d of AIDS, t h e r e i s growing c o n c e r n a b o u t t h e problems o f p r o v i d i n g a d e q u a t e t r e a t m e n t and s u p p o r t s e r v i c e s t o t h o s e CRS- 7 already infected. I t h a s been e s t i m a t e d t h a t i n 1991 174,000 p e r s o n s w i t h AIDS a l i v e a t some time d u r i n g t h e t h e needs of t h i s p o p u l a t i o n w i l l be c o s t l y f o r b o t h p r i v a t e s e c t o r s , and may s t r a i n l i m i t e d h e a l t h and resources. t h e r e w i l l be year. Meeting t h e p u b l i c and social service One burden on F e d e r a l and S t a t e Government w i l l be t h e c o s t of Persons diagnosed w i t h p r o v i d i n g s u p p o r t t o t h o s e no l o n g e r a b l e t o work. AIDS and unable t o work a r e presumed e l i g i b l e f o r S o c i a l S e c u r i t y d i s a b i l i t y payments i f t h e y have s u f f i c i e n t employment h i s t o r y . Others may q u a l i f y f o r Supplemental S e c u r i t y Income ( S S I ) , t h e j o i n t F e d e r a l S t a t e program f o r low-income b e n e f i c i a r i e s . I f h a l f t h e AIDS p a t i e n t s i n 1991 r e c e i v e d payments under e i t h e r program f o r j u s t 6 months e a c h , t o t a l c o s t s t o F e d e r a l and S t a t e Government could be i n t h e range of $200 t o $300 m i l l i o n . More s i g n i f i c a n t , however, w i l l be t h e c o s t s of h e a l t h c a r e . P e r s o n s q u a l i f y i n g f o r SSI a r e a u t o m a t i c a l l y e l i g i b l e f o r Medicaid, t h e F e d e r a l S t a t e h e a l t h i n s u r a n c e program f o r t h e i n d i g e n t . I n many S t a t e s , t h e d i s a b l e d who a r e n o t r e c e i v i n g SSI may a l s o q u a l i f y f o r Medicaid i f t h e i r i n s u r a n c e o r p e r s o n a l r e s o u r c e s a r e i n s u f f i c i e n t t o c o v e r t h e i r medical bills. D i s a b l e d S o c i a l S e c u r i t y b e n e f i c i a r i e s may r e c e i v e Medicare, but A t p r e s e n t , few AIDS p a t i e n t s l i v e o n l y a f t e r a 24-month w a i t i n g p e r i o d . l o n g enough t o q u a l i f y . T h i s could change i f new t h e r a p i e s a r e developed t h a t p r o l o n g l i f e w i t h o u t reducing d i s a b i l i t y . There a r e a l s o c u r r e n t l e g i s l a t i v e proposals t o e l i m i n a t e t h e waiting period f o r persons with AIDS (H.R. 276 and S. 2 4 ) . There a r e widely v a r y i n g e s t i m a t e s of t h e r e l a t i v e s h a r e of p u b l i c and p r i v a t e p a y e r s i n t h e c o s t s of c a r i n g f o r AIDS p a t i e n t s . Most e s t i m a t e s s u g g e s t t h a t Medicaid may be c o v e r i n g 20% t o 30% of t h e c o s t s , I f t h e s e p r o p o r t i o n s went unchanged, t h e F e d e r a l Medicare, 1% t o 3%. s h a r e of d i r e c t medical c a r e c o s t could be about $1.5 b i l l i o n by 1991. The S t a t e s h a r e w i l l be almost a s l a r g e . P r i v a t e h e a l c h i n s u r a n c e c o n t i n u e s t o be t h e major s o u r c e of f u n d i n g f o r t h e medical c a r e o f AIDS p a t i e n t s , c o v e r i n g a n e s t i m a t e d 40% t o 60% H e a l t h i n s u r a n c e i s l e s s l i k e l y t h a n l i f e i n s u r a n c e t o be of a l l c o s t s . d e n i e d on t h e b a s i s of AIDS t e s t i n g , because most h e a l t h i n s u r a n c e i s p u r c h a s e d t h r o u g h employee groups r a t h e r t h a n on a n i n d i v i d u a l b a s i s . Under g r o u p i n s u r a n c e , t h e c o s t s f o r t h e s i c k a r e s p r e a d a c r o s s a l l members of t h e group. Some p e o p l e a r e concerned, however, t h a t t h e c o s t s f o r AIDS c o u l d c r e a t e imbalances i n t h e p r i v a t e i n s u r a n c e system. For example, small t o medium s i z e d f i r m s may f e a r t h a t a s i n g l e c a s e of AIDS c o u l d d r i v e up premiums f o r a l l t h e i r employees; t h i s c o u l d i n c r e a s e incentives f o r discrimination. T h i s concern h a s l e d t o c a l l s f o r a g r e a t e r r o l e f o r p u b l i c f i n a n c i n g on t h e grounds t h a t AIDS i s a n a t i o n a l Finally, problem whose c o s t s shouLd by borne by t h e n a t i o n a t l a r g e . t h e r e i s some p r o p o r t i o n of AIDS p a t i e n t s who have n e i t h e r p u b l i c n o r p r i v a t e i n s u r a n c e c o v e r a g e , o r whose coverage f a i l s t o pay t h e f u l l c o s t of t h e i r c a r e . Some p u b l i c h o s p i t a l s have r e p o r t e d mounting l o s s e s because of u n i n s u r e d AIDS p a t i e n t s o r because of i n a d e q u a t e Medicaid reimbursement, and t h e r e have been c h a r g e s th,at p r i v a t e h o s p i t a l s a r e r e f u s i n g t o a c c e p t AIDS p a t i e n t s . ' Even i f f i n a n c i n g problems prove t o be manageable, some p e o p l e s a y t h a t t h e h e a l t h c a r e s y s t e m s i m p l y may n o t have t h e p h y s i c a l c a p a c i t y t o meet t h e n e e d s o f p e r s o n s w i t h AIDS. Others argue t h a t t h e system p r e s e n t l y h a s s u b s t a n t i a l unused c a p a c i t y ; many h o s p i t a l s , f o r example, t e n d t o h a v e a h i g h number o f unoccupied beds. I t i s p o s s i b l e , however, t h a t t h e e x c e s s c a p a c i t y and t h e c a s e l o a d a r e n o t e v e n l y d i s t r i b u t e d ; t h e r e h a v e a l r e a d y been r e p o r t s o f s t r a i n s on f a c i l i t i e s i n New York and San F r a n c i s c o , where AIDS h a s had t h e g r e a t e s t impact t o d a t e . T h e s e s t r a i n s c o u l d be e x a c e r b a t e d by a l a c k of a l t e r n a t i v e s t o inpatient hospital care. Few n u r s i n g homes o r o t h e r l o n g term c a r e f a c i l i t i e s a r e w i l l i n g t o a c c e p t AIDS p a t i e n t s , b e c a u s e of i n a d e q u a t e r e i m b u r s e m e n t , t h e e x t r a s e r v i c e s some AIDS p a t i e n t s r e q u i r e , o r c o n c e r n about p o t e n t i a l infection. The problems i n p l a c i n g t h o s e p a t i e n t s who A s a r e s u l t , many c o n t i n u e t o be I V d r u g a b u s e r s a r e e s p e c i a l l y s e v e r e . p a t i e n t s r e m a i n i n a c u t e h o s p i t a l s l o n g a f t e r t h e y c o u l d h a v e been d i s c h a r g e d t o o t h e r k i n d s of f a c i l i t i e s . -- p a r t i c u l a r l y t h o s e s u f f e r i n g from While some AIDS p a t i e n t s may r e q u i r e o n g o i n g d e m e n t i a o r o t h e r c e n t r a l n e r v o u s s y s t e m problems institutional care, many a r e o n l y i n t e r m i t t e n t l y i n n e e d o f hospitalization o r other acute services. The r e s t o f t h e time t h e y c o u l d r e m a i n a t home, w i t h a d e q u a t e home h e a l t h c a r e , r e g u l a r v i s i t s f r o m n u r s e s o r o t h e r h e a l t h p r o f e s s i o n a l s and p e r s o n a l c a r e , s u c h a s a s s i s t a n c e w i t h cooking, c l e a n i n g , o r bathing. Those i n t h e f i n a l s t a g e s o f t h e d i s e a s e c o u l d b e n e f i t from h o s p i c e s e r v i c e s . San F r a n c i s c o ' s i n n o v a t i v e s y s t e m of c o o r d i n a t e d a c u t e c a r e and community s e r v i c e s f o r AIDS p a t i e n t s i s r e p o r t e d t o h a v e r e d u c e d a v e r a g e p e r p a t i e n t c o s t s w h i l e a t t h e same time p r o v i d i n g more humane c a r e . Both t h e P u b l i c H e a l t h S e r v i c e and p r i v a t e s o u r c e s have s u p p o r t e d e f f o r t s t o d e v e l o p s i m i l a r s y s t e m s e l s e w h e r e . -- Community-based a p p r o a c h e s f a c e a t l e a s t two m a j o r problems. First, reimbursement' f o r home h e a l t h s e r v i c e s and c a r e c o o r d i n a t i o n i s o f t e n i n a d e q u a t e u n d e r b o t h p u b l i c and p r i v a t e i n s u r a n c e . Some S t a t e Medicaid programs a r e working t o improve f u n d i n g ; 1986 Medicaid amendments g a v e S t a t e s g r e a t e r l a t i t u d e t o d e v e l o p s p e c i a l s e r v i c e s f o r p e r s o n s w i t h AIDS. S e c o n d , t h e s u c c e s s f u l community models have r e l i e d h e a v i l y on v o l u n t e e r s e r v i c e s , of t e n t h r o u g h s u p p o r t g r o u p s e s t a b l i s h e d by t h e homosexual comnunity. A s t h e number o f p a t i e n t s i n c r e a s e s , i t may become l e s s f e a s i b l e t o depend on t h e s e p r i v a t e r e s o u r c e s . The p r o b l e m s of d e v e l o p i n g a d e q u a t e c a r e s y s t e m s a r e compounded by d i f f i c u l t i e s i n f i n d i n g c o r n u n i t y l i v i n g s i t u a t i o n s f o r p a t i e n t s who may be w i t h o u t f a m i l y o r f r i e n d s . Placement problems a r e e s p e c i a l l y s e v e r e f o r i n f a n t s w i t h AIDS, o f t e n abandoned by m o t h e r s who a r e t h e m s e l v e s s i c k . P o t e n t i a l f o s t e r p a r e n t s a r e u n w i l l i n g t o a c c e p t t h e b u r d e n and p e r c e i v e d r i s k of c a r i n g f o r t h e s e c h i l d r e n , some o f whom spend t h e i r e n t i r e l i v e s in hospitals. The S e n a t e h a s approved t h e Abandoned I n f a n t s A s s i s t a n c e Act (S. 9 4 5 ) , which would p r o v i d e g r a n t s t o l o c a l Governments f o r d e m o n s t r a t i o n p r o j e c t s t o a d d r e s s t h i s problem. Legal I s s u e s A t t e m p t s t o c o n t r o l t h e s p r e a d of AIDS have r a i s e d numerous l e g a l i s s u e s , few o f which a r e e a s i l y r e s o l v e d . The m a j o r i s s u e s b r i e f l y t o u c h e d upon h e r e a r e t h e l e g a l a u t h o r i t y t o p r o t e c t t h e p u b l i c h e a l t h , p r e s e n t p r o t e c t i o n s a g a i n s t d i s c r i m i n a t i o n , and l e g a l i s s u e s r a i s e d by b l o o d t e s t i n g f o r a n t i b o d i e s t o t h e AIDS v i r u s . T h e r e i s s t r o n g Legal a u t h o r i t y , b o t h c o n s t i t u t i o n a l and s t a t u t o r y , t o support a c t i o n s taken t o protect the public health, I n the leading c a s e o f J a c o b s o n v. M a s s a c h u s e t t s , 197 U.S. 6 4 3 ( 1 9 0 4 ) , t h e Supreme C o u r t u p h e l d a l o c a l g o v e r n m e n t ' s requirements f o r compulsory smallpox v a c c i n a t i o n where t h e d i s e a s e was a l r e a d y p r e v a l e n t and i n c r e a s i n g . In a d d i t i o n , t h e P u b l i c H e a l t h S e r v i c e Act a t 42 U.S.C. S e c t i o n 264, a u t h o r i z e s t h e making and e n f o r c e m e n t of r e g u l a t i o n s t o p r e v e n t t h e s p r e a d o f communicable d i s e a s e s . However, t h e mere a l l e g a t i o n t h a t p u b l i c h e a l t h i n t e r e s t s a r e i n v o l v e d would n o t a u t o m a t i c a l l y i n d i c a t e s u f f i c i e n t l e g a l authority for a l l actions. C o u r t s have t e n d e d t o e v a l u a t e f i r s t t h e n a t u r e o f t h e r i s k , i . e . , was t h e r e a c o m p e l l i n g S t a t e i n t e r e s t , a n d , t h e n t o l o o k a t t h e methods used t o a c h i e v e t h e c h o s e n a c t i o n t o d e t e r m i n e i f t h e y were t h e l e a s t r e s t r i c t i v e . S e e e.g., C l e b u r n e v. C l e b u r n e L i v i n g C e n t e r , 4 7 3 U.S. 432 (1985). P e o p l e who have AIDS, AIDS-related complex (ARC), a p o s i t i v e a n t i b o d y t e s t f o r t h e AIDS v i r u s , o r who a r e t h o u g h t t o h a v e AIDS, a r e sometimes t r e a t e d d i f f e r e n t l y on t h a t b a s i s . T h i s h a s l e d t o a l l e g a t i o n s o f i l l e g a l d i s c r i m i n a t i o n based on b o t h c o n s t i t u t i o n a l r i g h t s and r i g h t s u n d e r F e d e r a l s t a t u t e s i n c l u d i n g S e c t i o n 504 of t h e R e h a b i l i t a t i o n Act o f 1973, 29 U.S.C. S e c t i o n 794, and t h e E d u c a t i o n f o r A l l Handicapped C h i l d r e n A c t , 20 U.S.C. S e c t i o n s 1400 e t s e q . They h a v e s u r f a c e d i n numerous s i t u a t i o n s , t h e most common b e i n g blood t e s t i n g , employment, e d u c a t i o n , i n s u r a n c e , and p r o p o s a l s f o r q u a r a n t i n e s . The c o n s t i t u t i o n a l r i g h t s w h i c h c o u l d a r g u a b l y be i m p l i c a t e d i n c l u d e t h e e q u a l p r o t e c t i o n a n d d u e p r o c e s s g u a r a n t e e s of t h e F o u r t e e n t h Amendment, r i g h t s t o p r i v a c y , and r i g h t s t o i n t e r s t a t e t r a v e l ( s e e e.g., S h a p i r o v. Thompson, 394 U.S. 618 ( 1 9 6 9 ) ) . S e c t i o n 504 of t h e R e h a b i l i t a t i o n Act of 1973, 29 U.S.C. Section 794, p r o h i b i t s d i s c r i m i n a t i o n a g a i n s t a n o t h e r w i s e q u a l i f i e d p e r s o n s o l e l y by r e a s o n of h a n d i c a p i n a n y program o r a c t i v i t y t h a t r e c e i v e s F e d e r a l f i n a n c i a l a s s i s t a n c e o r i n a n e x e c u t i v e agency o r t h e United S t a t e s P o s t a l Service. One o f t h e most d i s c u s s e d l e g a l i s s u e s r e l a t i n g t o AIDS i s w h e t h e r S e c t i o n 504 would a p p l y t o p e r s o n s w i t h AIDS, ARC, o r a p o s i t i v e b l o o d t e s t f o r a n t i b o d i e s t o t h e AIDS v i r u s . The Supreme C o u r t , i n S c h o o l Board of Nassau County v. A r l i n e , 94 L.Ed.2d 307 (19871, h e l d t h a t a p e r s o n w i t h t h e c o n t a g i o u s d i s e a s e of t u b e r c u l o s i s may be a h a n d i c a p p e d ' i n d i v i d u a l u n d e r s e c t i o n 504 and t h a t t h e f a c t t h a t a p e r s o n w i t h a r e c o r d of an impairment i s a l s o c o n t a g i o u s d o e s n o t l i m i t t h e c o v e r a g e of t h e s e c t i o n . The C o u r t f u r t h e r f o u n d t h a t t h e i s s u e o f w h e t h e r s u c h c o n t a g i o u s i n d i v i d u a l s a r e p r o t e c t e d by S e c t i o n 504 i s d e t e r m i n e d by w h e t h e r s u c h an i n d i v i d u a l i s " o t h e r w i s e q u a l i f i e d . " I n a footnote, the tuberculosis, gave r i s e Court observed t h a t "the handicap h e r e , both t o a physical i m p a i r m e n t and t o contagiousness. T h i s c a s e d o e s n o t p r e s e n t , and w e t h e r e f o r e d o n o t r e a c h , t h e q u e s t i o n whether a c a r r i e r of a contagious d i s e a s e such a s AIDS c o u l d b e c o n s i d e r e d , s o l e l y on t h e b a s i s of c o n t a g i o u s n e s s , a handicapped person a s d e f i n e d i n t h e ~ c t . " The C o u r t o b s e r v e d t h a t t h e R e h a b i l i t a t i o n Act was I 1c a r e f u l l y structured." The d e f i n i t i o n o f i n d i v i d u a l w i t h h a n d i c a p s i s b r o a d b u t S e c t i o n 504 c o v e r s o n l y i n d i v i d u a l s who a r e b o t h handicapped -a otherwise qua1 i f i e d . J u s t i c e Brennan found t h a t t o d e t e r m i n e w h e t h e r a n i n d i v i d u a l i s o t h e r w i s e q u a l i f i e d , a d i s t r i c t c o u r t w i l l g e n e r a l l y need t o c o n d u c t a n i n d i v i d u a l i z e d two-step i n q u i r y . F i r s t , f i n d i n g s of f a c t must be made c o n c e r n i n g t h e n a t u r e o f t h e r i s k , t h e d u r a t i o n of t h e r i s k , t h e s e v e r i t y of t h e r i s k and t h e p r o b a b i l i t i e s t h e d i s e a s e w i l l b e t r a n s m i t t e d . Second, t h e c o u r t i s t o e v a l u a t e , i n t h e l i g h t o f t h e s e m e d i c a l f i n d i n g s , w h e t h e r r e a s o n a b l e accomnodation by t h e employer i s p o s s i b l e . S i n c e t h e s e f i n d i n g s were n o t made by t h e D i s t r i c t C o u r t i n A r l i n e c a s e , t h e Supreme C o u r t remanded t h e c a s e t o d e t e r m i n e i f Gene A r l i n e was o t h e r w i s e qualified. I t would a p p e a r l i k e l y t h a t t h e Supreme C o u r t ' s r e a s o n i n g i n A r l i n e would be a p p l i c a b l e t o p e r s o n s who a r e a n t i b o d y p o s i t i v e f o r t h e AIDS v i r u s & who m a n i f e s t p h y s i c a l symptoms o f t h e i r d i s e a s e . The i s s u e s r e g a r d i n g i n d i v i d u a l s who a r e o n l y a n t i b o d y p o s i t i v e a r e l e s s c e r t a i n b u t a n argument c o u l d . b e made t h a t such i n d i v i d u a l s would a l s o be h a n d i c a p p e d p e r s o n s c o v e r e d by S e c t i o n 504 s i n c e a r g u a b l y d i s c r i m i n a t i o n a g a i n s t them would t h w a r t t h e p u r p o s e s of S e c t i o n 504 a s e x p r e s s e d by t h e Supreme Court. T h i s argument c o u l d a l s o f i n d s u p p o r t i n t h e l a n g u a g e o f t h e c o n t a g i o u s d i s e a s e amendment t o S. 557 which r e c e n t l y p a s s e d t h e House and Senate. Many s i m i l a r i s s u e s r e l a t i n g t o d i s c r i m i n a t i o n a r e a l s o r a i s e d i n o t h e r c o n t e x t s , n o t a b l y t h e a c c e s s by a c h i l d w i t h an H I V i n f e c t i o n t o e d u c a t i o n , and blood t e s t i n g . I n a recent California case, an injunction was i s s u e d b a s e d on S e c t i o n 504 p r e c l u d i n g t h e e x c l u s i o n of a HIV i n f e c t e d c h i l d from a t t e n d i n g h i s k i n d e r g a r t e n c l a s s on t h e g r o u n d s t h a t he was o t h e r w i s e q u a l i f i e d i n t h e a b s e n c e of e v i d e n c e t h a t t h e c h i l d posed a s i g n i f i c a n t r i s k of harm t o h i s c l a s s m a t e s o r t e a c h e r s . (Thomas v. A t a s c a d e r o U n i f i e d School D i s t r i c t , 662 F. Supp. 376 (C.D. Calif. 1987)). I t i s a l s o p o s s i b l e t h a t t h e e x c l u s i o n of a c h i l d f r o m s c h o o l would r a i s e i s s u e s r e l a t i n g t o t h e E d u c a t i o n F o r A l l Handicapped C h i l d r e n A c t , P.L. 94-142, a g r a n t s t a t u t e which p r o v i d e s F e d e r a l f u n d s t o t h e S t a t e s and c o n d i t i o n s t h e r e c e i p t of t h e s e F e d e r a l f u n d s on t h e p r o v i s i o n of " f r e e a p p r o p r i a t e p u b l i c e d u c a t i o n . " The t e s t i n g o f blood f o r t h e H I V v i r u s r a i s e s o t h e r l e g a l i s s u e s i n addition t o t h e issues already generally discussed. One o f t h e p r i n c i p a l l e g a l i s s u e s r a i s e d by p r o p o s a l s f o r blood t e s t i n g c o n c e r n s t h e r i g h t o f p r i v a c y o f t h e p e r s o n who i s t e s t e d . I n a d d i t i o n , i s s u e s could be r a i s e d c o n c e r n i n g 1i a b i 1 i t y d u e t o t h e p o s s i b i l i t y o f i n a c c u r a c i e s o r u n r e l i a b i l i t i e s concerning t h e t e s t i t s e l f . The v a r i o u s p r i v a c y i s s u e s r a i s e d by b l o o d t e s t i n g f o r a n t i b o d i e s t o t h e H I V v i r u s i n v o l v e q u e s t i o n s of r i g h t s g r a n t e d by F e d e r a l and S t a t e c o n s t i t u t i o n a l and s t a t u t o r y p r o v i s i o n s , a s w e l l a s o f r i g h t s t h a t have been d e v e l o p e d by t h e c o u r t s i n common law a c t i o n s f o r d e f a m a t i o n and i n v a s i o n of p r i v a c y . These i s s u e s a r e complex and u n s e t t l e d a n d , l i k e t h e o t h e r l e g a l i s s u e s r e l a t i n g t o AIDS, may t u r n on a v a r i e t y of f a c t o r s . G e n e r a l l y , r e g a r d l e s s of w h e t h e r t h e i s s u e p r e s e n t e d i s o n e i n v o l v i n g c o n s t i t u t i o n a l , s t a t u t o r y , o r comnon law a s p e c t s of p r i v a c y , t h e a p p r o a c h of a c o u r t w i l l o f t e n i n v o l v e a b a l a n c i n g of t h e i n d i v i d u a l ' s i n t e r e s t i n p r i v a c y a g a i n s t t h e need o f s o c i e t y i n c e r t a i n s i t u a t i o n s f o r d i s c l o s u r e of t h e r e s u l t s o f t h e blood t e s t . The outcome o f t h e b a l a n c i n g p r o c e s s m i g h t b e a f f e c t e d by a v a r i e t y o f f a c t o r s . F o r example, t h e c o u r t s may c o n s i d e r t h e d e a d l y and c o n t a g i o u s n a t u r e o f d i s e a s e , t h e e x t e n t t o which n o t i c e t o p u b l i c h e a l t h a u t h o r i t i e s a n d / o r t h e s e x u a l p a r t n e r s o f a n AIDS v i c t i m m i g h t h e l p p r e v e n t t h e s p r e a d o f t h e d i s e a s e , and t h e s t a t u t o r y g u a r a n t e e s , i f a n y , t o m i n i m i z e t h e p e r s o n s and e n t i t i e s t o whom The outcome of t h e b a l a n c i n g p r o c e s s may a l s o depend d i s c l o s u r e i s made. on t h e s p e c i f i c p r o v i s i o n s o f t h e c o n s t i t u t i o n a l o r s t a t u t o r y g u a r a n t e e of privacy involved. S t a t e Laos and Regulations S t a t e l e g i s l a t u r e s and o f f i c i a l s have responded t o t h e AIDS emergency by e n a c t i n g laws which a d d r e s s s p e c i f i c i s s u e s c o n c e r n i n g AIDS. A number o f States, including Arkansas, California, Colorado, C o n n e c t i c u t , I l l i n o i s , Iowa, L o u i s i a n a , Maine, Maryland, M i c h i g a n , New York, Oregon, and P e n n s y l v a n i a , a s w e l l a s t h e D i s t r i c t of Columbia, h a v e e n a c t e d l e g i s l a t i o n promoting t h e e d u c a t i o n of t h e g e n e r a l p u b l i c r e g a r d i n g AIDS. C a l i f o r n i a , Hawaii, and V i r g i n i a r e q u i r e t h a t AIDS i n f o r m a t i o n and t h e o p p o r t u n i t y t o be t e s t e d i s p r e s e n t e d t o a l l m a r r i a g e license applicants. I l l i n o i s and L o u i s i a n a r e q u i r e t e s t i n g f o r t h e presence of H I V p r i o r t o t h e issuance of a marriage l i c e n s e ; Pennsylvania and Rhode I s l a n d have s e t up s t u d i e s c o n c e r n i n g t h e f e a s i b i l i t y o f s u c h a requirement. Texas w i l l a u t o m a t i c a l l y r e q u i r e t e s t i n g p r i o r t o i s s u i n g a m a r r i a g e l i c e n s e when t h e r a t e of H I V i n f e c t i o n r e a c h e s 0.83% i n t h e State. Utah p r o h i b i t s m a r r i a g e and d e c l a r e s a m a r r i a g e v o i d when a p e r s o n h a s AIDS. The E o l l o w i n g j u r i s d i c t i o n s have e s t a b l i s h e d s t a t u t o r y r e q u i r e m e n t s g o v e r n i n g w h e t h e r o r n o t i n s u r e r s may u s e o r r e q u i r e AIDS a n t i b o d y t e s t i n g t o d e t e r m i n e t h e i n s u r a b i l i t y of a p p l i c a n t s : C a l i f o r n i a , D i s t r i c t o f Columbia, F l o r i d a , Hawaii, I l l i n o i s , Maine, Oregon, and West V i r g i n i a . Numerous S t a t e s have a l s o a d d r e s s e d s u c h c o n c e r n s as i n s u r i n g t h e s a f e t y of t h e blood supplies, p r o t e c t i n g t h e c o n f i d e n t i a l i t y of i n d i v i d u a l s who a r e t e s t e d f o r AIDS and p r o h i b i t i n g d i s c r i m i n a t i o n i n employment toward i n d i v i d u a l s w i t h AIDS. A g r e a t d e a l of state l e g i s l a t i o n was p a s s e d i n 1987 and l e g i s l a t i v e i n t e r e s t i n AIDS i s l i k e l y t o continue. Some S t a t e s h a v e d e v e l o p e d ways t o d e a l w i t h t h i s m a j o r p u b l i c h e a l t h i s s u e w i t h o u t e n a c t i n g s t a t u t e s s p e c i f i c a l l y m e n t i o n i n g AIDS. AIDS i s a comnunicable, s e x u a l l y t r a n s m i t t e d d i s e a s e . T r a d i t i o n a l l y , b o d i e s o f law e x i s t w i t h i n e a c h S t a t e which g o v e r n c e r t a i n a s p e c t s o f t h e c o n t r o l and t r e a t m e n t o f s u c h d i s e a s e s . S t a t e h e a l t h d e p a r t m e n t s may add a d i s e a s e t o t h e i r l i s t of c o n t a g i o u s d i s e a s e s ; such a n a d d i t i o n i m m e d i a t e l y g e n e r a t e s a l l t h e c o n t r o l s and p r o t e c t i o n s , s u c h a s r e p o r t a b i l i t y , t e s t i n g , and i n c e r t a i n i n s t a n c e s , i s o l a t i o n / q u a r a n t i n e , whenever a d i a g n o s i s i s made o f I t i s a l s o p o s s i b l e t h a t AIDS may q u a l i f y a s a h a n d i c a p that disease. u n d e r c e r t a i n S t a t e s t a t u t e s which g e n e r a l l y p r o h i b i t d i s c r i m i n a t i o n a g a i n s t d i s a b l e d persons. Eattor I s s u e s AIDS i s becoming an i n c r e a s i n g l y i m p o r t a n t w o r k p l a c e i s s u e . A l t h o u g h most e m p l o y e r s have n o t a s y e t d e v e l o p e d e x p l i c i t AIDS p o l i c i e s , more may be f o r c e d t o d o s o a s t h e number o f d i a g n o s e d AIDS c a s e s c o n t i n u e s t o rise. Those e m p l o y e r s who have responded h a v e g e n e r a l l y t a k e n t h e s e approaches: ( 1 ) accomnodating employees w i t h AIDS t h r o u g h f l e x i b l e s c h e d u l e s , and t h r o u g h e d u c a t i n g co-workers about t h e d i s e a s e ; ( 2 ) f i r i n g employees w i t h AIDS; o r , ( 3 ) i n i t i a t i n g AIDS t e s t i n g o f e m p l o y e e s . To d a t e t h e s e e m p l o y e r - i n s t i t u t e d AIDS p o l i c i e s h a v e p r i m a r i l y a f f e c t e d t h r e e g r o u p s of w o r k e r s : ( 1 ) employees who h a v e AIDS o r who h a v e t e s t e d p o s i t i v e f o r AIDS; ( 2 ) h e a l t h c a r e w o r k e r s ; and ( 3 ) F e d e r a l workers, including m i l i t a r y personnel. Employees w i t h AIDS a r e n a t u r a l l y c o n c e r n e d s i n c e a n AIDS p o l i c y may r e s u l t i n t h e i r d i s c h a r g e . H e a l t h c a r e w o r k e r s a r e c o n c e r n e d b e c a u s e t h e i r work i n v o l v e s e x p o s u r e t o p o t e n t i a l l y c o n t a m i n a t e d b l o o d , and h e n c e t h e r e i s a r i s k of c o n t r a c t i n g AIDS. Unions r e p r e s e n t i n g h e a l t h c a r e w o r k e r s p e t i t i o n e d t h e O c c u p a t i o n a l S a f e t y and H e a l t h A d m i n i s t r a t i o n (OSHA) u n s u c c e s s f u l l y t o a d o p t emergency e n f o r c e a b l e s t a n d a r d s t o p r o t e c t h e a l t h c a r e w o r k e r s who come i n t o c o n t a c t w i t h blood. OSHA d i d a g r e e , however, t o i n i t i a t e formal r u l e m a k i n g p r o c e d u r e s on t h i s issue. P e n d i n g s u c h r u l e s , t h e Department of Labor and t h e Department of H e a l t h and Human S e r v i c e s p u b l i s h e d i n t h e F e d e r a l R e g i s t e r o f O c t . 30, 1987, a j o i n t a d v i s o r y n o t i c e t h a t h a s been m a i l e d t o a p p r o x i m a t e l y 500,000 h e a l t h - c a r e employers. E n t i t l e d "Protection Against Occupational Exposure t o Hepat i t i s B V i r u s (HBV) and Human Imnunodef i c i e n c y V i r u s (HIV)," t h e n o t i c e a d v i s e d e m p l o y e r s s f t h e i r l e g a l r e s p o n s i b i l i t y t o a s s u r e a p p r o p r i a t e safeguards f o r h e a l t R c a r e workers. Federal workers have a l s o e x p r e s s e d c o n c e r n a b o u t w o r k p l a c e AIDS p o l i c i e s s i n c e s e v e r a l a g e n c i e s and d e p a r t m e n t s have i n s t i t u t e d AIDS t e s t i n g o f employees. F e d e r a l e m p l o y e r s a r g u e t h a t t e s t i n g i s n e c e s s a r y f o r t h e p r o t e c t i o n of n a t i o n a l s e c u r i t y a s w e l l a s i n t e r n a t i o n a l good w i l l i n s i t u a t i o n s i n v o l v i n g employees who r e p r e s e n t t h e U n i t e d S t a t e s a b r o a d . Federal employee unions have argued that these testing policies are u n c o n s t i t u t i o n a l and d i s c r i m i n a t o r y . A m a j o r i s s u e a r i s i n g from w o r k p l a c e AIDS p o l i c i e s c o n c e r n s t h e a v e n u e s o f r e d r e s s a v a i l a b l e t o employees who f e e l t h e y have been u n f a i r l y t r e a t e d a s t h e r e s u l t o f an AIDS p o l i c y . Employees w i t h o u t u n i o n r e p r e s e n t a t i o n may s e e k r e d r e s s t h r o u g h t h e c o u r t s . Employees c o v e r e d by a union c o n t r a c t have a c c e s s t o a r b i t r a t i o n i n a d d i t i o n t o t h e c o u r t s . In u n i o n i z e d w o r k p l a c e s a n AIDS p o l i c y i s l i k e l y t o b e c o n s i d e r e d a t e r m o r c o n d i t i o n of employment and t h e r e f o r e a mandatory s u b j e c t o f b a r g a i n i n g u n l e s s t h e e m p l o y e r p r o v e s t h a t s u c h a t e s t i n g program i s n e c e s s a r y t o m a i n t a i n e f f i c i e n c y a n d / o r s a f e t y of employees. In cases involving t h e d i s c h a r g e of a n AIDS v i c t i m , a r b i t r a t o r s may w e l l r e q u i r e e v i d e n c e of impairment i n j o b p e r f o r m a n c e i n a d d i t i o n t o a p o s i t i v e AIDS t e s t . I n t e r n a t i o n a l Problems and ~ e ' s ~ o n s e A s of J a n . 31, 1988, 129 c o u n t r i e s had r e p o r t e d a t o t a l of more t h a n 77,000 c a s e s of AIDS t o t h e World H e a l t h O r g a n i z a t i o n (WHO), of which o v e r 51,000 were i n t h e U n i t e d S t a t e s . Other countries r e p o r t i n g l a r g e numbers of c a s e s t o WHO i n c l u d e F r a n c e , Uganda, and B r a z i l , w i t h o v e r 2 , 0 0 0 r e p o r t e d c a s e s a p i e c e , and T a n z a n i a , West Germany, Canada, t h e U n i t e d Kingdom, and I t a l y , e a c h w i t h o v e r 1,000 r e p o r t e d c a s e s . However, i t i s w i d e l y acknowledged t h a t AIDS c a s e s a r e u n d e r r e p o r t e d i n many p a r t s of t h e w o r l d . For example, WHO e s t i m a t e s t h a t i n A f r i c a a l o n e , 50,000 p e o p l e a r e a l r e a d y showing symptoms of AIDS. Central Africa is the part of t h e w o r l d e s t i m a t e d t o have t h e l a r g e s t number of i n f e c t e d p e r s o n s and d e a t h s due t o AIDS. I n A f r i c a , H I V i s s p r e a d m a i n l y among h e t e r o s e x u a l s , l e a d i n g t o d e a t h f o r b o t h men and women and growing numbers o f c h i l d r e n . I n t h e Americas, Europe, and O c e a n i a , t h e i n f e c t i o n s o f a r i s l a r g e l y c o n f i n e d t o homosexual men and d r u g a b u s e r s , a l t h o u g h t h i s may be c h a n g i n g . Very few AIDS c a s e s seem t o have o c c u r r e d i n A s i a . Many development e x p e r t s have e x p r e s s e d c o n c e r n a b o u t t h e e f f e c t of AIDS o n economic g r o w t h and development programs, e s p e c i a l l y i n A f r i c a . Because AIDS s t r i k e s t h e most p r o d u c t i v e members of s o c i e t y ( 2 0 t o 49 y e a r s o l d ) and b e c a u s e o f t h e s i g n i f i c a n t h e a l t h problems i t c r e a t e s b e f o r e i t i s f a t a l , many a r e concerned t h a t h e a v i l y i n f e c t e d a r e a s w i l l h a v e d e c l i n i n g n a t i o n a l incomes u n t i l t h e d i s e a s e i s b r o u g h t u n d e r control. Another c o n c e r n i s t h e e f f e c t on f a m i l i e s . Many c h i l d r e n w i l l l o s e o n e o r b o t h p a r e n t s t o AIDS. Moreover, b e c a u s e i n c r e a s i n g numbers o f . c h i l d r e n w i l l d i e o f AIDS, t h e g a i n s of r e c e n t y e a r s made by t h e WHO'S C h i l d S u r v i v a l Program may b e r e v e r s e d . Development a g e n c i e s h a v e a l s o begun t o a d d r e s s t h e e f f e c t of AIDS on development programs, i n c l u d i n g i m m u n i z a t i o n , b r e a s t f e e d i n g , and p o p u l a t i o n programs. I n a more p o s i t i v e view, o t h e r s b e l i e v e t h a t b e c a u s e t h e d i s e a s e ' s s p r e a d c a n be c o n t a i n e d somewhat by improved p r e v e n t i v e h e a l t h c a r e p r a c t i c e s , t h e AIDS e p i d e m i c may r e s u l t i n improved h e a l t h c a r e i n d e v e l o p i n g c o u n t r i e s i n t h e f u t u r e . , The l a s t 2 y e a r s h a v e s e e n a d r a m a t i c i n c r e a s e i n t h e e f f o r t s of WHO, t h e l e a d many c o u n t r i e s t o c o n t r o l t h e s p r e a d o f t h e H I V v i r u s . o r g a n i z a t i o n f o r t h e i n t e r n a t i o n a l comnunity, promotes t h e v i e w t h a t t h e d i s e a s e w i l l o n l y be s t o p p e d i n a c o o r d i n a t e d e f f o r t by a l l c o u n t r i e s . It w a s Western l e a d e r s m e e t i n g i n Venice i n J u n e 1987 e n d o r s e d t h i s view. e n d o r s e d a t t h e J a n u a r y 1988 I n t e r n a t i o n a l Meeting o f t h e M i n i s t e r s of H e a l t h i n London. WHO'S S p e c i a l Program on AIDS (SPA) was e s t a b l i s h e d by t h e Director-General and e n d o r s e d by t h e E x e c u t i v e Board o f member g o v e r n m e n t s i n J a n u a r y 1987. The program w i l l r e l y o n v o l u n t a r y c o n t r i b u t i o n s made by g o v e r n m e n t s i n a d d i t i o n t o t h e i r r e g u l a r c o n t r i b u t i o n s t o WHO. WHO s p e n t $ 2 5 m i l l i o n d u r i n g 1987, and e x p e c t s t o spend $68.4 m i l l i o n i n 1988. The U.S. Agency f o r I n t e r n a t i o n a l Development (AID) i s making AIDS a The p a r t of i t s o n g o i n g p o p u l a t i o n , h e a l t h , and e d u c a t i o n programs. agency i s p r i m a r i l y working w i t h WHO t o d e v e l o p a s t r o n g m u l t i l a t e r a l program. I n FY86, A I D a l l o c a t e d $2 m i l l i o n t o t h e WHO SPA. I n FY87, t h e agency s p e n t $14 m i l l i o n f o r g l o b a l AIDS c o n t r o l , i n c l u d i n g $5 m i l l i o n t o t h e WHO SPA, $3 m i l l i o n t o f i n a n c e e x p e c t e d a d d i t i o n a l r e q u e s t s f o r - CRS 1 4 condoms, and $6 m i l l i o n f o r t e c h n i c a l s u p p o r t o f b i l a t e r a l p r e v e n t i o n and c o n t r o l programs i n c o l l a b o r a t i o n w i t h WHO. P.L. 100-202, t h e C o n t i n u i n g A p p r o p r i a t i o n s Act of 1988 ( H . J . R ~ s . 3 9 5 ) a p p r o p r i a t e d $30 m i l l i o n f o r a c t i v i t i e s r e l a t e d t o i n t e r n a t i o n a l AIDS c o n t r o l , of which $15 m i l l i o n would go t o t h e World H e a l t h O r g a n i z a t i o n and t h e Pan American H e a l t h Program. A c t i o n s by t h e Reagan A d m i n i s t r a t i o n Having d e c l a r e d t h e f i g h t a g a i n s t AIDS t o be " t h e N a t i o n ' s number o n e h e a l t h p r i o r i t y , " t h e Reagan A d m i n i s t r a t i o n h a s t a k e n s t e p s i n a number of d i r e c t i o n s t o d e v e l o p and implement p l a n s f o r c o n t r o l of t h e e p i d e m i c . A d m i n i s t r a t i o n e f f o r t s , however, have been f a u l t e d by many c r i t i c s , i n c l u d i n g many p u b l i c h e a l t h e x p e r t s , as I I t o o l i t t l e t o o l a t e . " I n 1985, t h e P u b l i c H e a l t h S e r v i c e s ' s E x e c u t i v e T a s k F o r c e o n AIDS p u b l i s h e d a c o m p r e h e n s i v e p l a n t h a t i n c l u d e d a set o f o b j e c t i v e s t o c o n t r o l AIDS by t h e y e a r 2000. An u p d a t e and e x p a n s i o n o f t h e p l a n , known a s t h e C o o l f o n t R e p o r t , came o u t o f a J u n e 1986 m e e t i n g convened by PHs. I t i s t h e s o u r c e o f t h e p r o j e c t i o n s of AIDS c a s e s , d e a t h s , i n f e c t i o n s , and c o s t s t o 1991. I n March 1987, PHS r e l e a s e d i t s AIDS I n f o r m a t i o n / E d u c a t i o n P l a n , s p e c i f y i n g t h e a u d i e n c e s t o be a d d r e s s e d ( t h e p u b l i c , s c h o o l and c o l l e g e a g e d p o p u l a t i o n s , p e r s o n s a t i n c r e a s e d r i s k o r i n f e c t e d , and h e a l t h w o r k e r s ) , t h e b a s i c e l e m e n t s of AIDS i n f o r m a t i o n and e d u c a t i o n , and t h e means t o a c c o m p l i s h t h i s e d u c a t i o n ( s u c h a s mass media campaigns, a n i n f o r m a t i o n c l e a r i n g h o u s e , and v a r i o u s s p e c i a l programs). I n December 1 9 8 7 , PHS d e l i v e r e d a r e p o r t t o t h e P r e s i d e n t ' s Domestic P o l i c y C o u n c i l t h a t reviewed c u r r e n t knowledge a b o u t t h e l e v e l of H I V i n f e c t i o n i n t h e U n i t e d S t a t e s and PHS p l a n s f o r e x p a n s i o n of s u r v e i l l a n c e a c t i v i t i e s . The r e p o r t i n d i c a t e d t h a t t h e s p r e a d of t h e AIDS v i r u s i n r e c e n t y e a r s h a s slowed. I t s a i d t h a t t h e "working e s t i m a t e " o f 1 t o 1.5 m i l l i o n p e o p l e i n f e c t e d , t h o u g h p r o b a b l y somewhat h i g h when i t was d e r i v e d i n 1986, i s s t i l l a good a p p r o x i m a t i o n g i v e n t h e l a c k o f i n c i d e n c e and p r e v a l e n c e data. I n May 1987 t h e P r e s i d e n t announced h i s i n t e n t i o n t o e s t a b l i s h a n a t i o n a l commission on AIDS. By e x e c u t i v e o r d e r on J u n e 24 he c r e a t e d t h e P r e s i d e n t i a l Commission on t h e Human I m n u n o d e f i c i e n c y V i r u s Epidemic. The p a n e l i s t o a d v i s e t h e P r e s i d e n t on t h e m e d i c a l , l e g a l , e t h i c a l , s o c i a l , and economic impact o f AIDS. I n i t s f i r s t few months, t h e Comnission was s e v e r e l y hampered i n commencing i t s work by i n t e r n a l d i s s e n s i o n , r e s i g n a t i o n s of i t s c h a i r m a n , v i c e - c h a i r m a n , and e x e c u t i v e d i r e c t o r , and I n O c t o b e r 1987, a c o a l i t i o n of mounting c r i t i c i s m o f i t s membership. p u b l i c h e a l t h and c i v i l r i g h t s g r o u p s f i l e d a l a w s u i t a g a i n s t t h e C o m n i s s i o n , a l l e g i n g t h a t i t s makeup v i o l a t e d t h e F e d e r a l A d v i s o r y C o m n i t t e e Act b e c a u s e i t l a c k e d a b a l a n c e of v i e w p o i n t s and r e p r e s e n t a t i o n of g r o u p s most a f f e c t e d by i t s work. Since t h a t d i f f i c u l t s t a r t , t h e p a n e l ' s new c h a i r m a n , r e t i r e d Admiral James D. W a t k i n s , h a s s u c c e s s f u l l y o v e r s e e n t h e a d d i t i o n of new members and s t a f f f o r t h e C o m i s s i o n , t h e f o r m a t i o n of working g r o u p s t o i n v e s t i g a t e and make r e c o w e n d a t i o n s on s e v e r a l p r i o r i t y a r e a s , h e a r i n g s i n a number of l o c a t i o n s a r o u n d t h e c o u n t r y , and r e l e a s e i n December 1987 of a p r e l i m i n a r y "roadmap" r e p o r t t o I n March 1988, t h e Comnission g u i d e t h e r e s t o f t h e omm mission's work. issued an interim report t o the President. I t c o n t a i n e d a package o f r e c o m m e n d a t i o n s o n c o m b a t t i n g AIDS among i n t r a v e n o u s d r u g a b u s e r s , b r o a d e n i n g h e a l t h c a r e s e r v i c e s f o r p e o p l e i n f e c t e d w i t h HIV, and e n h a n c i n g b a s i c b i o m e d i c a l r e s e a r c h and d r u g development. The r e p o r t h a s been w e l l r e c e i v e d e v e n by c r i t i c s o f t h e Comnission, who e x p r e s s c a u t i o u s o p t i m i s m t h a t t h e C o m i s s i o n ' s work w i l l l e a d t o a n i n t e g r a t e d n a t i o n a l s t r a t e g y on c o m b a t t i n g AIDS i n t h e U n i t e d S t a t e s . The C e n t e r s f o r D i s e a s e C o n t r o l have c o o r d i n a t e d a N a t i o n a l AIDS I n f o r m a t i o n Campaign s i n c e t h e f a l l of 1987. With t h e theme "America Responds t o AIDS," t h e campaign s p o n s o r e d " N a t i o n a l AIDS P r e v e n t i o n Month" i n October. I n t h e next year i t w i l l coordinate educational a c t i v i t i e s and e v e n t s i n c o o p e r a t i o n w i t h a n a t i o n a l a d v e r t i s i n g agency a n d w i t h n a t i o n a l and l o c a l a g e n c i e s , g r o u p s , and b u s i n e s s e s , t o i n c r e a s e AIDS a w a r e n e s s , r e d u c e f e a r , and prompt g r o u p and i n d i v i d u a l p r e v e n t i o n a c t i o n . I t w i l l a l s o t e s t and e v a l u a t e s t r a t e g i e s f o r d e l i v e r i n g p r e v e n t i o n i n f o r m a t i o n and e d u c a t i o n more e f f e c t i v e l y . A s r e p o r t e d by t h e G e n e r a l Accounting O f f i c e i n August 1987, t h e r e h a s been c r i t i c i s m by p u b l i c h e a l t h e x p e r t s , advocacy g r o u p s , and l o c a l h e a l t h o f f i c i a l s o f t h e l e v e l o f g o v e r n m e n t a l r e s p o n s e t o AIDS. The c r i t i c i s m h a s f o c u s e d on a p e r c e i v e d l a c k o f F e d e r a l l e a d e r s h i p , p a r t i c u l a r l y i n t h e AIDS p r e v e n t i o n a r e a s o f e d u c a t i o n , t e s t i n g , and c o u n s e l i n g , and on a l a c k o f c o o r d i n a t i o n of F e d e r a l and S t a t e programs and f u n d i n g . H e a l t h p o l i c y r e s e a r c h e r s c i t e d i n t h e CAO r e p o r t h a v e c o n c l u d e d t h a t t h e F e d e r a l r e s p o n s e t o AIDS a p p e a r s u n c o o r d i n a t e d and i n s u f f i c i e n t because o f systemic f a c t o r s i n our h e a l t h c a r e system. These i n c l u d e ( 1 ) m u l t i p l e l e v e l s of government; ( 2 ) t h e r e l a t i o n s h i p o f government t o t h e p r i v a t e s e c t o r ; ( 3 ) t h e d i f f u s i o n of a u t h o r i t y w i t h i n t h e F e d e r a l Government; ( 4 ) t h e a b s e n c e of mechanisms t o d e a l w i t h e m e r g e n c i e s ; and ( 5 ) t h e t e n d e n c y t o f u n d AIDS by r e a l l o c a t i n g f u n d s a l r e a d y a p p r o p r i a t e d t o o t h e r e x i s t i n g h e a l t h programs. ( P h i l i p R. Lee and P e t e r Arno, The F e d e r a l Response t o t h e AIDS Epidemic, H e a l t h P o l i c y , v. 6 , 1986, p. 259-267.) Congressional Actions B e f o r e 1987, c o n g r e s s i o n a l a c t i v i t y on AIDS f o c u s e d p r i m a r i l y on s u p p o r t of t h e P u b l i c H e a l t h S e r v i c e ' s r e s e a r c h and e d u c a t i o n programs t h r o u g h t h e a p p r o p r i a t i o n s p r o c e s s . T o t a l PHs s p e n d i n g f o r AIDS was $61.5 m i l l i o n i n FY84, $108.6 m i l l i o n i n FY85, and $233.8 m i l l i o n i n FY86, and $502.9 m i l l i o n i n FY87. F o r FY88, t h e c o n t i n u i n g r e s o l u t i o n a p p r o p r i a t e s Previous $951.0 m i l l i o n f o r AIDS a c t i v i t i e s , a n 89% i n c r e a s e o v e r FY87. C o n g r e s s e s a l s o h e l d numerous h e a r i n g s on AIDS i s s u e s , and Members i n t r o d u c e d a v a r i e t y of b i l l s , b u t no c o m p r e h e n s i v e l e g i s l a t i o n was considered. I n t h e 1 0 0 t h C o n g r e s s , o v e r 65 b i l l s on AIDS h a v e been i n t r o d u c e d , and s e v e r a l a r e u n d e r a c t i v e c o n s i d e r a t i o n . The r a n g e of t o p i c s c o v e r e d i n c l u d e s t e s t i n g v a r i o u s g r o u p s of p e o p l e f o r AIDS v i r u s i n f e c t i o n s , o f t e n accompanied by r e p o r t i n g a n d / o r c o n t a c t t r a c i n g ; c o n t r o l o f i n f e c t e d p e r s o n s ; c o n t r o l s on i m n i g r a n t s ; p r o t e c t i o n of h e a l t h c a r e w o r k e r s ; p u b l i c e d u c a t i o n ; c o n f i d e n t i a l i t y of m e d i c a l r e c o r d s ; e x t e n s i o n o f M e d i c a r e b e n e f i t s ; e s t a b l i s h m e n t o f c e n t e r s f o r p e d i a t r i c AIDS; and o u t r e a c h eo The House h a s p a s s e d H.R. m i n o r i t y p o p u l a t i o n s and t o I V d r u g a b u s e r s . 2881 e s t a b l i s h i n g a n a t i o n a l a d v i s o r y commission on AIDS, and t h e S e n a t e h a s p a s s e d S. 945 c o n c e r n i n g i n f a n t s abandoned i n h o s p i t a l s b e c a u s e of AIDS o r d r u g e x p o s u r e . Comprehensive l e g i s l a t i o n a u t h o r i z i n g $635 m i l l i o n f o r programs i n AIDS e d u c a t i o n , p r e v e n t i o n , t r e a t m e n t , c a r e , and r e s e a r c h h a s been r e p o r t e d i n t h e S e n a t e and i n t r o d u c e d i n t h e House (S. 1220 and H.R. 2626). Companion b i l l s c a l l e d t h e AIDS F e d e r a l P o l i c y Act of 1987 (H.R. 3071 and S. 1575) a d d r e s s i s s u e s c o n c e r n i n g AIDS a n t i b o d y t e s t i n g and c o u n s e l i n g and t h e p r o t e c t i o n o f p e o p l e i n f e c t e d w i t h t h e AIDS v i r u s from d i s c r i m i n a t i o n . LEG1 SLATION P.L. 100-71, H.R. 1827 S u p p l e m e n t a l A p p r o p r i a t i o n s , 1987. A p p r o p r i a t e s $78.5 m i l l i o n f o r AIDS: $20 m i l l i o n f o r a mass m a i l i n g of i n f o r m a t i o n t o e v e r y h o u s e h o l d , $27 m i l l i o n f o r t e s t i n g , c o u n s e l i n g , and m i n o r i t y e d u c a t i o n a c t i v i t i e s , $30 m i l l i o n t o pay f o r AIDS d r u g s , and $1.5 m i l l i o n f o r e v a l u a t i o n and a n a l y s i s o f d r u g s , v a c c i n e s , and t e s t s f o r t r e a t m e n t o f AIDS. R e p o r t e d by 100-28) Mar. 25, 1987. Passed C o r n i t t e e on A p p r o p r i a t i o n s (H.Rept. House, amended, Apr. 23. R e p o r t e d , w i t h amendments, by S e n a t e Committee on A p p r o p r i a t i o n s (S.Rept. 100-48) May 1. P a s s e d S e n a t e , amended, J u n e 2. C o n f e r e n c e r e p o r t (H.Rept. 100-195) f i l e d J u n e 27. Conference r e p o r t a g r e e d t o by House J u n e 3 0 , and S e n a t e J u l y 1. S i g n e d - i n t o l a w J u l y 1 1 , 1987. P.L. 100-202, H.J.Rea. 395 C o n t i n u i n g ~ p p r o p r i a t i o n s Act, 1988. Includes p r o v i s i o n s of t h e c o n f e r e n c e agreement f o r Labor-HHS-Education a p p r o p r i a t i o n s ( s e e H.R. 3058). R e p o r t e d by C o m n i t t e e on A p p r o p r i a t i o n s (H.Rept. 100-4151 Oct. 2 9 , 1987. P a s s e d House, amended, Dec. 3. R e p o r t e d w i t h amendments by S e n a t e Passed Senate, C o r n l t t e e on A p p r o p r i a t i o n s (S.Rept. 100-238) Dec. 8. amended, Dec. 11. C o n f e r e n c e r e p o r t (H.Rept. 100-498) f i l e d and a g r e e d t o Dec. 21. S i g n e d i n t o law Dec. 2 2 , 1987. H.R. 2626 (Rangel) A c q u i r e d Immunodeficiency Syndrome E d u c a t i o n , I n f o r m a t i o n , Risk R e d u c t i o n , T r a i n i n g , P r e v e n t i o n , T r e a t m e n t , C a r e , and R e s e a r c h Act of 1987. Amends t h e P u b l i c H e a l t h S e r v i c e Act t o p r o v i d e f o r a c o m p r e h e n s i v e program on AIDS. I n t r o d u c e d J u n e 8 , 1987; r e f e r r e d t o Committee on Energy and Comnerce. H.R. 2881 ( R o w l a n d of Ga.) N a t i o n a l Comnission on Acquired Inunune D e f i c i e n c y Syndrome Act. E s t a b l i s h e s a 2-year, 15-member c o m n i s s i o n c h a r g e d w i t h s t u d y i n g and making r e c o r n e n d a t i o n s f o r n a t i o n a l p o l i c y on AIDS r e s e a r c h , t e s t i n g , t r e a tmen t , and prevention. I n t r o d u c e d J u l y 1, 1987; r e f e r r e d t o C o m n i t t e e s on Energy and Commerce, and on V e t e r a n s A f f a i r s . Reported, w i t h amendments, by Comnit t e e on V e t e r a n s A f f a i r s (H .Rept. 100-245, P a r t 1) J u l y 28. C o n s i d e r e d and o r d e r e d r e p o r t e d by C o m n i t t e e on Energy and Passed House, amended, Aug. 4. Referred t o Senate Comnerce Aug. 4 . C o m n i t t e e on Labor and Human R e s o u r c e s Aug. 5 , 1987. H.R. 3058 ( M a t c h e r ) D e p a r t m e n t s of L a b o r , H e a l t h and Human S e r v i c e s , and E d u c a t i o n , and R e l a t e d A g e n c i e s ~ ~ p r o p r i a t i o n Act, s 1988. R e p o r t e d by Committee on P a s s e d House, amended, A p p r o p r i a t i o n s (H.Rept. 100-2561 J u l y 30, 1987. Aug. 5. R e p o r t e d w i t h amendments by S e n a t e C o m n i t t e e o n A p p r o p r i a t i o n s Passed S e n a t e , amended, O c t . 14. House and (S.Rept. 100-1891 O c t . 1. S e n a t e c o n f e r e e s a g r e e d Dec. 16 t o f u n d i n g l e v e l s which were t h e n i n c o r p o r a t e d i n t o t h e FY88 C o n t i n u i n g R e s o l u t i o n ( s e e H.J.Res. 3 9 5 ) . H.R. 3071 (Waxman) AIDS F e d e r a l P o l i c y Act o f 1987. Amends t h e P u b l i c H e a l t h S e r v i c e Act t o e s t a b l i s h a g r a n t program ( a u t h o r i z e d a t $400 m i l l i o n f o r e a c h of 3 y e a r s ) t o p r o v i d e f o r c o u n s e l i n g and t e s t i n g s e r v i c e s r e l a t i n g t o AIDS and t o e s t a b l i s h c e r t a i n p r o h i b i t i o n s t o p r o t e c t i n d i v i d u a l s w i t h AIDS. I n t r o d u c e d J u l y 30, 1987; r e f e r r e d t o C o m n i t t e e s on Energy and Commerce, on t h e J u d i c i a r y , and on E d u c a t i o n and Labor. H e a r i n g s h e l d by Subcommittee on H e a l t h and t h e Environment Aug. 6-7, 1987. H.R. 3825 (Waxman) AIDS R e s e a r c h Act o f 1987. Amends t h e P u b l i c H e a l t h S e r v i c e Act w i t h r e s p e c t t o r e s e a r c h programs on AIDS. I n t r o d u c e d Dec. 20, 1987; r e f e r r e d t o Committee on Energy and Commerce. S. 557 (Kennedy) C i v i l R i g h t s R e s t o r a t i o n Act. Amends f o u r c i v i l r i g h t s s t a t u t e s , i n c l u d i n g S e c t i o n 504 o f t h e R e h a b i l i t a t i o n A c t , t o p r o v i d e f o r a d e f i n i t i o n o f program o r a c t i v i ' t y t h a t would d e f i n e t h e term i n a b r o a d e r manner t h a n done by t h e Supreme Court i n Grove C i t y C o l l e g e v. .&B Also c o n t a i n s a n amendment c o n c e r n i n g c o n t a g i o u s d i s e a s e s which c o u l d imply S e c t i o n 504 c o v e r a g e o f p e r s o n s who a r e H I V i n f e c t e d b u t m a n i f e s t no p h y s i c a l symptoms o f t h e i r d i s e a s e . Passed S e n a t e J a n 28, 1988; p a s s e d House Mar. 2. Vetoed by P r e s i d e n t Reagan Mar. 16. Veto o v e r r i d e v o t e s s c h e d u l e d i n House and S e n a t e f o r Mar. 22, 1988. S, 945 (Metzenbaum) Abandoned I n f a n t s A s s i s t a n c e Act of 1987. A u t h o r i z e s g r a n t s t o l o c a l g o v e r n m e n t s f o r d e m o n s t r a t i o n p r o j e c t s t o p r o v i d e r e s p i t e home and o t h e r a s s i s t a n c e f o r i n f a n c s abandoned i n h o s p i t a l s , i n c l u d i n g i n f a n t s w i t h AIDS. I n t r o d u c e d Apr. 8 , 1987; r e f e r r e d t o C o m n i t t e e on Labor and Human Resources. R e p o r t e d w i t h an amendment i n t h e n a t u r e o f a s u b s t i t u t e , P a s s e d S e n a t e , amended, Aug. 5. w i t h o u t w r i t t e n r e p o r t , Aug. 4. R e f e r r e d t o House Committees on Energy and Conmerce and on E d u c a t i o n and L a b o r Aug. 7 , 1987. S. 1220 (Kennedy) A c q u i r e d Immunodeficiency Syndrome R e s e a r c h and I n f o r m a t i o n Act o f 1987. Amends t h e P u b l i c H e a l t h S e r v i c e Act t o p r o v i d e f o r a c o m p r e h e n s i v e program f o r AIDS i n f o r m a t i o n , p r e v e n t i o n , c a r e , t r e a t m e n t , and r e s e a r c h . I n t r o d u c e d May 1 5 , 1987; r e f e r r e d t o C o m n i t t e e on Labor and Human Resources. R e p o r t e d w i t h a n amendment i n t h e n a t u r e of a s u b s t i t u t e (S.Rept. 100-133) and p l a c e d on l e g i s l a t i v e c a l e n d a r J u l y 29, 1987. S. 1575 (Kennedy) AIDS F e d e r a l P o l i c y Act of 1987. Amends t h e P u b l i c H e a l t h S e r v i c e Act t o e s t a b l i s h a g r a n t program ( a u t h o r i z e d a t $400 m i l l i o n f o r e a c h of 3 y e a r s ) t o p r o v i d e f o r c o u n s e l i n g and t e s t i n g s e r v i c e s r e l a t i n g t o AIDS and t o e s t a b l i s h c e r t a i n p r o h i b i t i o n s t o p r o t e c t i n d i v i d u a l s w i t h AIDS. I n t r o d u c e d J u l y 3 1 , 1987; r e f e r r e d t o C o m n i t t e e on Labor and Human Resources. FOR ADDZTlONAL READING U.S. Congress. technology. ----- O f f i c e o f Technology Assessment. Blood p o l i c y Washington, U.S. Govt. P r i n t . O f f . , 1985. 240 p. Do i n s e c t s t r a n s m i t AIDS? by Lawrence Miike. Covt. P r i n t . O f f . , 1987. 4 3 p. Washington, ----- Review o f t h e P u b l i c H e a l t h S e r v i c e ' s response Washington, U.S. Govt. P r i n t . O f f . , 1985. 158 p. to and U.S. AIDS. U.S. G e n e r a l A c c o u n t i n g O f f i c e . AIDS: i n f o r m a t i o n on g l o b a l d i m e n s i o n s and p o s s i b l e i m p a c t s ; f a c t s h e e t t o t h e Honorable J e s s e Helms, U.S. S e n a t e . Oct. 1 8 , 1987. [Washington] 1987. 19 p. ----- views on t h e a d m i n i s t r a t i o n ' s b u d g e t p r o p o s a l s . AIDS p r e v e n t i o n : B r i e f i n g r e p o r t t o t h e Chairman, S u b c s m n i t t e e on Labor, H e a l t h and Human S e r v i c e s , E d u c a t i o n and R e l a t e d A g e n c i e s , Comnit tee on A p p r o p r i a t i o n s , - U . S . S e n a t e . HRD-126BR, Aug. 1 2 , 1987. 33 p. U.S. L i b r a r y o f Congress. Congressional Research Service. Acquired imnune d e f i c i e n c y syndrome (AIDS): a b r i e f o v e r v i e w o f t h e m a j o r l e g a l i s s u e s , by Nancy Lee J o n e s . [Washington] Feb. 10, 1987. 4 2 p. CRS R e p o r t 87-236 A ----- Acquired immune d e f i c i e n c y syndrome (AIDS): health care financing and s e r v i c e s , by Mark M e r l i s . [Washington] 1987. (Updated r e g u l a r l y ) CRS I s s u e b r i e f 87219 ----- Acquired immune d e f i c i e n c y syndrome: overviews; newspaper e d i t o r i a l s and p u b l i c o p i n i o n p o l l s , by S h e i l a S h a v e r a n d Mark Eddy. [ W a s h i n g t o n ] J u l y 1987. 105 p. CRS R e p o r t 87-714 L ----- Acquired imnune d e f i c i e n c y syndrome and m i l i t a r y manpower p o l i c y , by David F. B u r r e l l i . [ W a s h i n g t o n ) 1987. (Updated r e g u l a r l y ) CRS I s s u e B r i e f 87202 ---- - AIDS: a c q u i r e d immune d e f i c i e n c y syndrome, by Pamela W. [ W a s h i n g t o n ] J u l y 1 7 , 1987. 17 p. J u d i t h A. J o h n s o n . CRS I s s u e B r i e f 83162 ----- S m i t h and AIDS: a c q u i r e d immune d e f i c i e n c y syndrome; s e l e c t e d r e f e r e n c e s , Bonnie Mangan. [ W a s h i n g t o n ] November 1987. 52 p. CRS Report 87-924 L by --------- AIDS: bibliography-in-brief, 1986. 4 p. CRS Report LO739 L 1986, by Bonnie Mangan. -- AIDS health care costs: bibliography-in-brief, Bonnie Mangan. [Washington] J a n u a r y . 1 9 8 7 . 4 p. CRS Report 87-032 L ----- AIDS i n A f r i c a : b a c k g r o u n d / i s s u e s f o r U.S. p o l i c y , Copson. S e p t . 1 5 , 1987. [Washington] 1987. 1 7 . p . CRS Report 87-768 F ----- AIDS i n t h e workplace: employee v. employer McCallion. [Washington] J u n e 3 , 1987. 11 p. CRS Report 87-510 E ----- A 1 DS : i n t e r n a t i o n a l problems and i s s u e s , [ W a s h i n g t o n ] 1987. (Updated r e g u l a r l y ) CRS I s s u e B r i e f 87214 ----- by [Washington] 1985-1986, by by Raymond W. interest, Lois B. by Gail McHugh. Blood t e s t i n g f o r a n t i b o d i e s t o t h e AIDS v i r u s ; the legal issues, Shampansky. by C h a r l e s D a l e , Nancy L e e J o n e s , a n d J a y R. [ W a s h i n g t o n ] Aug. 25, 1987. 67 p. CRS Report 87-738 A ----- F e d e r a l f u n d i n g f o r AIDS r e s e a r c h and e d u c a t i o n [ b y ] Pamela U. Smith and J u d i t h A. Johnson. [Washington] 1987. (Updated r e g u l a r l y ) CRS I s s u e B r i e f 87028 ----- F i f t y s t a t e s u r v e y of s t a t e s t a t u t e s c o n c e r n i n g v e n e r e a l d i s e a s e a s i t may r e l a t e t o AIDS, by M. Ann Wolfe. [Washington) Mar. 4 , 1987. 1 3 p. CRS Report 87-240 A ----- L e g a l a n a l y s i s o f Dept. of J u s t i c e , O f f i c e of Legal C o u n s e l , memorandum on t h e a p p l i c a t i o n of S e c t i o n 504 of t h e R e h a b i l i t a t i o n Act of 1973 t o p e r s o n s w i t h AIDS, by Nancy Lee J o n e s . [Washington] Aug. 25, 1986. 32 p. CRS Report 86-877 A ----- L e g a l imp1 i c a t i o n s o f t h e C o n t a g i o u s D i s e a s e o r I n f e c t i o n s Amendments t o t h e C i v i l R i g h t s R e s t o r a t i o n A c t , S. 557, by Nancy Lee Jones. [Washington] Mar. 1 4 , 1988. 27 p. CRS Report 88-214 A ----- School board of Nassau County v. A r l i n e : a person w i t h t h e c o n t a g i o u s d i s e a s e o f t u b e r c u l o s i s may be c o v e r e d under S e c t i o n 504 o f t h e R e h a b i l i t a t i o n Act of 1973, by Nancy Lee J o n e s . [Washington] Mar. 4 , 1987. 6 p. CRS R e p o r t 87-238 A ----- S u m a r y o f s t a t e s t a t u t e s which s p e c i f i c a l l y m e n t i o n a c q u i r e d i m u n e d e f i c i e n c y syndrome (AIDS), by H. Ann Wolfe. [Washington] Feb, 7, 1987. 16 p. CRS R e p o r t 87-239 A ---- - Survey o f t h e f i f t y S t a t e s and t h e D i s e r i c t of Columbia s t a t u t e s g e n e r a l l y c o n c e r n i n g t h e q u a r a n t i n e and i s o l a t i o n o f p e r s o n s h a v i n g a c o n t a g i o u s o r i n f e c t i o u s d i s e a s e , by Ann M. Wolfe. S e p t . 8, 1987. [ W a s h i n g t o n ] 1987. 6 p. CRS Report 87-765 A