America Living With AIDS

RI CA Living

American health care system, reform
that ensures financial access to care for
all of our citizens.
The fifth chapter focuses on clinical
trials and treatment-related research.
To date, our deliberations have not
focused on the nation's vitally important biomedical research enterprise.
Further, we have paused only briefly to
underscore the manifest importance
of social and behavioral research in
achieving ultimate control of the HIV
epidemic. In this chapter, the discussion is directed to currently dynamic
issues of clinical trials and the search
for new therapeutic agents for people
with HIV disease. Problems of assuring access to drug trials for diverse
populations with HIV disease while
maintaining orderly studies that will
permit sound scientific assessment of
therapies are considered. Issues of
delivery of care in the context of
experimental therapy and the use of
new drugs in expanded access programs are also covered.
In the sixth and final chapter, the
responsibilities and opportunities for
government to intervene and interact
with other components of society are
examined. It is noted that at all levels
of government greater leadership is
needed. At the federal level, we note
that within the U.S. Public Health Service there has been a real effort to
coordinate responses, but that there is
a need for much greater cooperation
and coordination across many departments at the cabinet level. State and
local governmental roles are critical
and distinctive. Of particular concern

is the current fiscal crisis occurring in
many of the states with the highest
incidence of AIDS. The need to fully
fund the Ryan White CARE Act is
underscored, and the importance of
providing the funding to evaluate programs is stressed.
After each chapter the Commission
has offered a short series of recommendations for action. They have
been purposely kept few with the hope
that they will all receive careful consideration. They overlap. Prevention of
HIV infection, care and treatment of
those with HIV disease, the financing
of that care, and the research necessary
to improve treatment are all intimately
interwoven and inseparable.
To transform what now obtains
into effective action requires simultaneous attention to all facets of this epidemic which is now causing such pain
and loss of life.