America Living With AIDS

Report Number Three:
Research, the Workforce and the HIV Epidemic in Rural America
August 1990
1. A comprehensive community-based primary health care system, supported by adequate funding and reimbursement rates, is essential for the care and treatment of all people, including people living with HIV infection and AIDS. The Commission highlighted this need in its first
report and continues to believe that lack of access to primary care services provided by adequately trained primary care providers is undermining current efforts in HIV/AIDS research,
prevention and treatment. The development of a comprehensive system with linkages to
research protocols, existing community-based services, hospitals, drug treatment programs,
local health departments, and long-term care facilities, based on a foundation of adequate support, is long overdue and should be a top priority for the federal government.
2. AIDS education and outreach services in rural communities should be expanded and designed
to provide clear and direct messages about how HIV is and is not transmitted, and the kinds of
behaviors that may place an individual at risk for HIV and other sexually transmitted diseases.
Expansion of programs, resources and health care providers is also needed to respond to rural
America's need for prevention and treatment programs that address the three epidemics of HIV
infection, drug addiction and sexually transmitted diseases.
3. The NIH clinical trials program is in serious trouble. The limited number of enrollees in trials
and the lack of demographic and geographic diversity of the participants threatens the success
of the program and denies many people living with HIV infection and AIDS the opportunity to
participate in experimental drug therapies. The academic health centers involved have not been
as vigorous as one would hope in advancing these trials, nor has the NIH been vigorous in
monitoring their performance. Aggressive efforts must be made to overcome the obstacles to
participation of many who are under-represented. Success in this area can only be measured by
increased participation in trials.
4. There is a desperate need for more research on the management of opportunistic infections,
usually the cause of death for people with AIDS. The NIH simply must expand the level of
research in this area. This expansion must not come at the expense of other research efforts and
should be an integral part of a comprehensive AIDS research plan. This plan should outline the
AIDS research priorities and goals for the entire NIH, and the resources needed to achieve
them. The plan should be widely disseminated and should incorporate the views of persons living with HIV infection and AIDS.
5. There is a shortage of crisis proportions of health care providers capable and willing to care for
people living with HIV infection and AIDS. This crisis will only get worse as the HIV epidemic
continues into the 1990's. Action must be taken now to increase and improve the effectiveness
of all programs designed to educate and retain practicing health care professionals, and to create
incentives for providers to care for people in underserved areas. Existing programs such as the
National Health Service Corps should be expanded. New programs such as those outlined in
the Disadvantaged Minority Health Improvement Act (H.R. 3240) should be created. And, specific HIV/AIDS fellowships and training programs should be established and supported to prevent a crisis of greater magnitude.
6. Volunteers should be publicly recognized not only for the invaluable contribution they have
made to people living with HIV infection and AIDS, but also for the way in which they fight
fear and bigotry by fostering compassion and caring. The cost effective dollars needed to
recruit, train, support and manage volunteers must be provided by the government and the private sector, and recognized as essential to our national response to the HIV epidemic.

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