America Living With AIDS

A M E R I C A Living With

that provide necessary research, prevention, and treatment programs, and
that protect those with HIV disease
from discrimination.
The social ferment occasioned by
AIDS has been great. It has risen to
the top of legislative agendas; nearly
one thousand bills related to AIDS
were proposed in state legislatures in
the first decade of the epidemic. It is
the most litigated disease in American
history. AIDS is also a persistent topic
of headline news, although often the
news centers on controversies on the
periphery of the crisis-Should gay
bathhouses be closed? Should children with HIV disease be excluded
from school? Should health care
workers be tested for HIV?-obscuring more central issues, such as the
lack of access to health care and the
lack of treatment opportunities for
substance users.
All of this is a predictable consequence of the absence of a strong
guiding voice. Committed and
informed leadership is necessary to
help the nation focus on the central
issues that must be addressed in order
to alter the course of the HIV epidemic. The waning national interest in
AIDS has, on occasion, been accompanied by a backlash against sustaining
levels of or commitment to funding
for AIDS prevention and education,
health care, and research. Some have
decried what they perceive to be the
privileged status of funding for AIDS
research and care. But in contrast to
many other diseases in society, the
upsurge in AIDS deaths and illnesses
is ongoing, uncontrolled, and in
urgent need of further attention. The

word "privileged" is especially and
poignantly misused in the context of
HIV disease. A diagnosis of AIDS
confers no privileges; it is a frightening occurrence that severely tests
physical, emotional, and economic
resources.
Leadership is also essential to keeping AIDS at the top of the list of
urgent national problems. The HIV
epidemic will expand, demanding ever
greater efforts in the years to come. It
should not be allowed to fall off the
list of national priorities because it
seems like old news. Nor can the
nation afford to indulge in exasperation or in a misapprehension that the
job of prevention, care, and research is
already done.
Leaders will surely have to take
unpopular stands to meet the challenges posed by HIV, at least until
their efforts begin to bear fruit in
enhanced public understanding. Irrational fears must be allayed in order to
prevent discrimination and to implement the advice of medical and public
health officials. Leaders must be willing to speak on behalf of those at
greatest risk of HIV disease, many of
whose voices cannot be heard because
they live on the margins of society.
It is important to acknowledge the
differences among state, county, and
municipal governments. In the case of
the HIV epidemic, variations in government structure and function are
complicated by major disparities in