National Commission on AIDS: Annual Report to the President and Congress

The Commission makes the following recommendations:

1. A comprehensive community-based primary health care system, supported by
adequate funding and reimbursement rates, is essential for the care and treatment
of all people, including people living with HIV infection and AIDS. The
Commission highlighted this need in its first report and continues to believe that lack
of access to primary care services provided by adequately trained primary care
providers is undermining current efforts in HIV/AIDS research, prevention and
treatment. The development of a comprehensive system with linkages to research
protocols, existing community-based services, hospitals, drug treatment programs,
local health departments, and longterm care facilities, based on a foundation of
adequate support, is long overdue and should be a top priority for the federal
government.
2. AIDS education and outreach services in rural communities should be expanded and
designed to provide clear and direct messages about how HIV is and is not
transmitted, and the kinds of behaviors that may place an individual at risk for HIV
and other sexually transmitted diseases. Expansion of programs, resources and
health care providers is also needed to respond to rural America's need for
prevention and treatment programs that address the three epidemics of HIV
infection, drug addiction and sexually transmitted diseases.
3. The NIH clinical trials program is in serious trouble. The limited number of
enrollees in trials and the lack of demographic and geographic diversity of the
participants threatens the success of the program and denies many people living with
HIV infection and AIDS the opportunity to participate in experimental drug
therapies. The academic health centers involved have not been as vigorous as one
would hope in advancing these trials, nor has the NIH been vigorous in monitoring
their performance. Aggressive efforts must be made to overcome the obstacles to
participation for many who are under-represented. Success in this area can only be
measured by increased participation in trials.
4. There is a desperate need for more research on the management of opportunistic
infections, usually the cause of death for people with AIDS. The NIH simply must
expand the level of research in this area. This expansion must not come at the
expense of other research efforts and should be an integral part of a comprehensive
AIDS research plan. This plan should outline the AIDS research priorities and goals
for the entire NIH, and the resources needed to achieve them. The plan
should be widely disseminated and should incorporate the views of persons living
with HIV infection and AIDS.
5. There is a shortage of crisis proportions of health care providers capable and willing
to care for people living with HIV infection and AIDS. This crisis will only get
worse as the HIV epidemic continues into the 1990's. Action must be taken now to
increase and improve the effectiveness of all programs designed to educate and
retain practicing health care professionals, and to create incentives for providers to
care for people in underserved areas. Existing programs such as the National Health
Service Corps should be expanded. New programs such as those outlined in the

167