America Living With AIDS

coordinating group to deal with HIV,
nor has a single agency been designated with the responsibility for AIDS
programs. One glaring example of the
absence of coordination serves to
illustrate the need for improved cabinet-level communication and cooperation-the longstanding impasse over
policy regarding restrictions on the
travel and immigration of HIV-infected individuals. This impasse arose
because of an infrequently used relationship between HHS and the
Department of Justice, and in particular, because of the unwillingness of the
Department of Justice to defer to HHS
officials on matters of public health.
The Commission is aware that
there are a number of federal HIV
coordinating groups at this time and
that PHS is currently finishing a
strategic plan for HIV policies and
programs. There is a leadership group
within PHS to resolve HIV-related
policy issues; there is a PHS Executive
Task Force on AIDS; and there is a
federal coordinating committee that
includes federal agency heads.
Unfortunately, the coordinating
groups as constituted do not have the
breadth or the authority needed to
meet the challenge of HIV disease.
When coordination does take place it
is most likely to occur among healthrelated agencies (especially within
PHS). Yet non-health-related HIV
issues arise with sufficient frequency
to warrant more inclusive coordinating bodies. Such issues include housing, immigration, criminal justice, and

corrections. Some mechanism is
needed that would support ongoing
consultations among all federal
departments, such as the Department
of Housing and Urban Development,
the Department of Justice, the Department of State, and other departments
and agencies that deal with AIDSrelated policy issues. This coordination must also take place at the highest
level of each department. Although it
is important for agency staff members
to meet regularly to cement working
relationships, it is also critical that
cabinet secretaries themselves forge
the broad policy outlines.
Technical Assistance
and Evaluation
State and local governments need a
much broader form of technical assistance from the federal government
than is currently envisioned or provided by any one agency. Usually, assistance does not extend through the life
of a program; it is narrowly confined
to the particular program and is primarily attuned to the needs of the
granting agency.
To some extent, a model for a
broader form of technical assistance or
capacity building existed during the
1970s in the CDC regional centers for
training and technical assistance in the
areas of sexually transmitted diseases
and tuberculosis. Although HIV technical assistance would have to span an
even broader range of programs and
agencies, the defining characteristics
of such centers could be usefully
applied. Staff at these centers were
permanently assigned to fostering

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.