America Living With AIDS

AMERICA Li

APPENDIX B
RECOMMENDATIONS FROM PREVIOUS REPORTS
Report Number One:
Failure of U.S. Health Care System to Deal with HIV Epidemic
December 1989
What is Needed?
FIRST, frank recognition that a crisis situation exists in many cities that will require extraordinary measures to overcome. Significant changes must be made not only in our health care system
but in how we think about the system and the people it is designed to serve. As one witness told
the Commission, it can no longer be "business as usual."
SECOND, the creation of a flexible, patient-oriented, comprehensive system of care, closely
linking hospital, ambulatory, residential, and home care. Primary care physicians must be central
to such a system. But if primary care doctors are to care for patients with HIV infection and AIDS,
they need the financial, social and institutional support to assist them in managing complicated
patients.
THIRD, consideration of the creation of regional centers of networks of care, perhaps using the
already existing regionalized hemophilia treatment program as a model. These centers would not
serve as a replacement for the care provided by primary care physicians but would provide backup
and consultation to help strengthen community based primary care.
It is essential that everyone be afforded early intervention and access to care. In addition, the
availability of backup and consultation from appropriate specialists is required to provide the assistance and encouragement primary care doctors need to see more people with HIV infection and
AIDS. Regional centers should also provide the appropriate link with the hospital when hospital
services are needed.
FOURTH, create units which can treat patients who have both HIV infection and drug addiction. The availability of drug treatment on request is essential for responding to the combined HIV
and drug epidemic that imperils not only drug users but also their sexual partners and children.
Given the massive link between drug use and HIV infection, and the fact that there is an alarming increase in the number of new infections among intravenous drug users, the Commission wishes to go on record in expressing its surprise and disappointment that the White House National
Drug Control Strategy mentions AIDS only four times in its ninety pages of text and not at all in its
recommendations or discussions of how to allocate resources. The President's drug strategy simply
must acknowledge and include HIV infection and AIDS.
FIFTH, provide comprehensive health care services under one roof. Fragmented services create
additional barriers to needed health care. Often mothers will seek health care services needed for
their babies but are not able to then gain access to care for themselves. Health care services for
women and children need to be provided in one place. For the homeless, housing and health care
need to go hand-in-hand. This is true not only for those who are homeless today but for those who
will become homeless tomorrow because of the HIV epidemic.

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