Strong Medicine
At last the nation has a plan of action commensurate to the threat posed by AIDS. It is the extraordinarily helpful and instructive recommendations for the final report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic.
Adm. James D. Watkins has presented the draft as his recommendations as commission chairman. They must receive the final approval of the commission in the weeks ahead before they go to the President. His proposals are the fruit of almost a year of exhaustive hearings and research, however. And their wisdom is so apparent that final approval seems a foregone conclusion.
The report will pose problems for the White House because it calls for anti-discrimination legislation, urgent public-health measures and vastly increased federal spending that President Reagan until now has resisted.
Central to the report and its plan of action are the proposals to protect those infected with the AIDS virus from discrimination. The President is asked to act immediately with an executive order on discrimination, to be followed by federal legislation. The reasons are clear. “HIV-related discrimination is impairing this nation’s ability to limit the spread of the epidemic,” the report correctly says. “As long as discrimination occurs, and no strong national policy with rapid and effective remedies against discrimination is established, individuals who are infected with the HIV will be reluctant to come forward for testing, counseling and care.”
Watkins, in a proposal that has not yet been reviewed by the full commission, wants the President to show his recognition of the problem with an immediate declaration that the AIDS epidemic is “a public-health emergency” and to direct Surgeon General C. Everett Koop “to implement the public-health emergency response.” That seems to us to be most appropriate.
The report offers useful proposals for protecting the confidentiality of AIDS tests and diagnoses while at the same time making exceptions to confidentiality rules to protect health-care providers and sexual partners who may be at risk from infected people. Again, federal legislation would be required. “Rigorous maintenance of confidentiality is considered critical to the success of the public-health endeavor to prevent the transmission and spread of HIV infection,” according to the report. The report suggests state laws to establish the criminalization of those who deliberately expose others to AIDS. But it is respectful of due process. In dealing with testing of persons involved in sex crimes, for example, it mandates HIV testing only after conviction, in contrast with a proposal that will be on the ballot in California in November that would allow testing before conviction.
The validity of the commission findings was reinforced a day earlier with the release of a report from the National Academy of Sciences that cited many of the same priorities, including the need for better coordination and direction.
Within the 269 pages of the presidential commission’s draft recommendations is perhaps the most complete exposition ever assembled on the disease and the current knowledge of how it may be contained. There is a risk that in offering so many recommendations on so many aspects of the disease, the force of the recommendations could be lost. But in identifying some immediate challenges for the President and Congress, the report leaves no excuse for inaction.
The intentions of the President will be tested promptly by Watkins’ call for an executive order barring discrimination against those infected with the AIDS virus, and for an immediate declaration of a health emergency. With those actions the President can reassure the nation that the federal government is moving with new vigor and commitment to contain the spread of the disease.
