America Living With AIDS

APPENDIX C
IMPLEMENTATION OF PRESIDENTIAL COMMISSION
RECOMMENDATIONS
In its enabling legislation, the National Commission on AIDS was called upon to
"[m]onitor the implementation of the recommendations of the Presidential Commission
on the HIV Epidemic, modifying those recommendations as the Commission considers
appropriate."1 Monitoring the implementation of those recommendations has been a
useful task for the National Commission, providing the National Commission with a
number of insights into the federal response to the epidemic.
First, the recommendations were never used as the basis for a "national strategy" as
was originally intended by the Presidential Commission. As Chairman Watkins
expressed in his letter of transmittal to the President, "It is our hope, Mr. President, that
you will... use our report as your national strategy...."2 Our failure as a nation to
adopt the recommendations and to mobilize the necessary resources to respond to the
recommendations indicates a glaring need for a national plan to coordinate the federal
response to the HIV epidemic.
Second, the process of monitoring the recommendations highlighted how fragmented
and decentralized the response to the epidemic has been on the part of the federal government. While some federal agencies have incorporated Presidential Commission recommendations into initiatives, these actions have taken place separate from other agencies within their Department and separate from other federal Departments.
Third, there is a need for evaluation of initiatives on the federal level. No clear evaluation tool was developed to gather useful information to monitor the response to the Presidential Commission recommendations.
Historical Overview
In 1987 President Reagan established the Presidential Commission on the HIV Epidemic. After one year of hearings, the Presidential Commission produced a comprehensive report, which included 597 recommendations, and presented it to the President on
June 27, 1988. The Institute of Medicine Committee for the Oversight of AIDS Activities, in a 1988 update of its book Confronting AIDS, stated that "... the commission has
made major contributions to the public's understanding of HIV infection and AIDS and
to the development of a compassionate and informed response to the epidemic. Guided
by Admiral James D. Watkins' strong leadership and open-minded approach, the commission's focused attention has been effective in bringing diverse public and private
resources to bear on a national problem."3
Within the 597 recommendations, the Presidential Commission identified a number
of recommendations for immediate consideration by the federal government. Among
these were: (1) passage of federal, state, and local antidiscrimination laws dealing with
HIV as a disability in both the public and private sectors, (2) substance use treatment on
demand, (3) federal protections for confidentiality, (4) health care worker recruitment
and retention initiatives, (5) HIV education and prevention targeted to distinct populations as well as to the general public, (6) expansion of experimental drug trials, (7) health
care financing reform, (8) ensuring the safety of the blood supply, and (9) support for
international education and prevention efforts.
The Presidential Commission presented the recommendations to President Reagan,
who then submitted them to his staff for evaluation.4 In July of 1988 four staff members
from the Department of Health and Human Services (HHS) were detailed to the White

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