America Living With AIDS

The second chapter deals with
issues of prevention and education. It
points out that prevention is currently
our only hope of altering the course of
the HIV epidemic and that efforts in
this sector have been grossly underutilized-further, that prevention strategies will remain key even after the
development of effective drugs or vaccines. It develops the theme that frank
communication is our best defense for
our children against the twin epidemics of HIV and drugs. Elements
common to successful programs are
highlighted, including the importance
of cultural sensitivity, cultural competence, and community involvement.
Effective progress in the prevention of
HIV disease associated with illicit drug
use is noted. Finally, a call is made for
a comprehensive national HIV prevention initiative that would integrate
federal, state, county, and municipal
governments, community-based organizations, and affected populations to
achieve a common goal of HIV prevention.
The third chapter discusses how
health care for people with HIV disease can be improved. It takes note of
the substantial progress that has been
made in enhancing the quality and
extending the duration of lives of people with HIV. It describes who should
be involved in the delivery of health
care and social services to those with
HIV disease, the sites where care
should be available, and how those
care services can best be organized.
Ideally, such care involves an interdisciplinary group in a continuum of ser
vices delivered in the least restrictive,
least institutional settings at the lowest
possible costs. Common elements
link counseling and testing with primary care in out-of-hospital settings,
coordination of that care with the hospital, access to investigational drugs
and integration of illicit drug use
treatment with HIV care. The point is
made that existing health care
providers must be better trained to
manage the care of people with HIV
disease and that future needs for more
health care professionals must be
anticipated. Finally, continued efforts
must be devoted to improving communication strategies so that minimal
delay occurs between development of
new therapies and their availability.
The fourth chapter deals directly
with the difficult issues of health care
financing in the context of HIV. The
Commission came to the conclusion
that systemic reform will be necessary
to achieve genuinely appropriate
access to health care for all Americans.
Only in this way will those with HIV
disease be assured of needed care.
Thus we have not confined our discussion to the arena of HIV disease alone,
but have instead discussed solutions to
problems of financing that are consistent with the broader initiatives of
health system reform currently under
discussion. However, our recommendations are specific to problems of
HIV, and thus we offer a series of
options that could improve the lot of
HIV infected people and we cost out
their implications. We remain firm in
our conviction that these short-term
measures should give way as quickly as
possible to nationwide reform of the