Confronting AIDS -- Copyright -- Preface -- ACKNOWLEDGMENTS -- Contents -- Executive Summary -- INTRODUCTION -- HIV INFECTION AND ITS EPIDEMIOLOGY -- The Spectrum of HIV Infection -- Modes and Efficiencies of HIV Transmission -- Prevalence and Incidence of Infection in the United States -- UNDERSTANDING THE EPIDEMIC'S COURSE -- ALTERING THE EPIDEMIC'S COURSE -- Antidiscrimination Protections -- Education -- Screening and Testing for HIV Antibody -- Other Public Health Measures -- AIDS and IV Drug Abuse -- Resources for Public Health Measures -- CARE OF PERSONS INFECTED WITH HIV -- Care Needs of Special Patients -- Health Care Providers -- Costs of Health Care for Persons with AIDS -- Financing Health Care for Persons with AIDS and Other HIV-Infected Individuals -- Possible Financing Mechanisms -- THE BIOLOGY OF HIV AND BIOMEDICAL RESEARCH NEEDS -- HIV Biology -- Drug Development and Testing -- Vaccine Development and Testing -- Roundtable on Drugs and Vaccines -- Animal Models of AIDS -- Resources for the Campaign -- INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION -- A NATIONAL COMMISSION ON HIV INFECTION AND AIDS -- 1 Introduction -- REFERENCES -- 2 HIV Infection and Its Epidemiology -- HIV: THE ETIOLOGIC AGENT OF AIDS -- PROPORTION OF INFECTED INDIVIDUALS WHO WILL DEVELOP AIDS -- THE SPECTRUM OF HIV INFECTION -- MODES AND EFFICIENCIES OF HIV TRANSMISSION -- Heterosexual Transmission -- Efficiencies of Transmission -- Relative Efficiencies of HIV Transmission -- PREVALENCE AND INCIDENCE OF HIV INFECTION IN THE UNITED STATES -- HIV Prevalence in Groups at Recognized Risk -- HIV Prevalence Among Selected Segments of the General Population -- Incidence of New Infections -- National Estimates of HIV Infection -- The Program of HIV Surveys and Studies -- AIDS CASES IN THE UNITED STATES -- THE DEMOGRAPHIC IMPACT OF AIDS -- FUTURE RESEARCH NEEDS.

REFERENCES -- 3 Understanding the Course of the Epidemic -- THE USES OF MODELS -- DATA NEEDS -- REFERENCES -- 4 Altering the Course of the Epidemic -- FEATURES OF PUBLIC HEALTH PROGRAMS -- ANTIDISCRIMINATION PROTECTIONS -- EDUCATION -- Content of the Message -- School-Based Education -- Effect of Educational Programs -- Gay and Bisexual Men -- AIDS and Condoms -- HIV ANTIBODY SCREENING AND TESTING -- Technical Considerations -- Informed Consent and Confidentiality -- Voluntary Testing -- Mandatory Screening -- Blood, Tissue, and Organs -- Hospital-Based Screening -- Premarital Screening -- Female Prostitutes -- Home-Based Testing -- OTHER PUBLIC HEALTH MEASURES -- Duty to Warn -- Contact Notification -- Reporting of HIV-Seropositive Cases -- Personal Control Measures -- AIDS AND IV DRUG ABUSE -- Intervention Innovations -- Distribution of Sterile Needles and Syringes -- RESOURCES -- REFERENCES -- 5 Care of Persons Infected with HIV -- CARE NEEDS OF SPECIAL PATIENT GROUPS -- IV Drug Abusers -- Infants and Children -- Patients with Dementia or Other Neuropsychological Deficits -- HEALTH CARE PROVIDERS -- Ethical Aspects of Providing Care -- Occupational Risks -- Professional Obligations -- Health Care Worker Screening -- Health Care Provider Training -- The Psychological Burden of AIDS Patient Care -- HEALTH CARE COSTS FOR HIV-RELATED CONDITIONS -- Direct Costs of Care for AIDS Patients -- Indirect Costs of HIV-Related Conditions -- Cost Implications of Projected AIDS Cases -- Research on Health Care Costs -- FINANCING HEALTH CARE FOR HIV-RELATED CONDITIONS -- Sources of Financing -- Medicaid -- Medicare -- Private Health Insurance -- Alternative Financing Mechanisms to Improve Health Care Coverage -- Ensure Access to and Maintenance of Private Health Insurance Coverage -- Modify Existing Medicaid Programs -- Establish State Risk Pools.

Modify Medicare Eligibility Criteria -- Develop an AIDS Federal Grant Program -- Development of a Financing Strategy -- REFERENCES -- 6 The Biology of HIV and Biomedical Research Needs -- HIV BIOLOGY -- Viral Taxonomy and Disease -- Control of Viral Gene Expression -- Regulation and Production of HIV -- Interrupting Infection by HIV -- Natural History of HIV Infection -- The Importance of Basic Research -- DRUG DEVELOPMENT AND TESTING -- VACCINE DEVELOPMENT AND TESTING -- ROUNTABLE ON DRUGS AND VACCINES -- ANIMAL MODELS OF AIDS -- RESOURCES -- Facilities -- Reagent Distribution Center -- FUNDING FOR RESEARCH -- REFERENCES -- 7 International Aspects of AIDS and HIV Infection -- THE WHO GLOBAL PROGRAMME ON AIDS -- RATIONALE FOR U.S. INTERNATIONAL INVOLVEMENT -- THE U.S. CONTRIBUTION TO INTERNATIONAL EFFORTS -- REFERENCES -- 8 A National Commission on HIV Infection and AIDS -- A Summary and Recommendations from Confronting AIDS: Directions for Public Health, Health Care, and Research -- STATUS OF THE EPIDEMIC -- Infection and Transmission -- Clinical Manifestations of the Disease -- Statistical Dimensions of the Epidemic -- THE FUTURE COURSE OF THE EPIDEMIC -- OPPORTUNITIES FOR ALTERING THE COURSE OF THE EPIDEMIC -- Public Education -- Preventing HIV Infection Among IV Drug Users -- Public Health Measures -- Surveillance -- Mandatory Screening -- Voluntary Testing -- The Role of Coercive Measures in Public Health Efforts -- Funding for Education and Other Public Health Measures -- Discrimination and AIDS -- CARE OF PERSONS INFECTED WITH HIV -- Health Care Costs Resulting from HIV Infection -- The Financing of Health Care for HIV-Related Conditions -- FUTURE RESEARCH NEEDS -- Basic Research -- The Natural History of HIV Infection -- Epidemiologic Approaches -- Animal Models -- Antiviral Agents -- Vaccines -- Social Science Research Needs.

Funding for Research on AIDS and HIV -- INTERNATIONAL ASPECTS OF AIDS AND HIV INFECTION -- Rationale for U.S. International Involvement -- Risks of Infection Outside the United States -- International Research Opportunities -- GUIDANCE FOR THE NATION'S EFFORTS -- What Is Needed? -- Establishment of the Commission -- MAJOR RECOMMENDATIONS -- B CDC Classification System for HIV Infections and Revised Case Definition for AIDS -- CDC CLASSIFICATION SYSTEM FOR HIV INFECTIONS -- Introduction -- Goals and Objectives of the Classification System -- Definition of HTLV-III/LAV Infection -- Classification System -- REFERENCES -- REVISION OF THE CDC SURVEILLANCE CASE DEFINITION FOR AIDS -- Introduction -- 1987 Revision of Case Definition for AIDS for Surveillance Purposes -- Commentary -- References -- Appendix I -- Laboratory Evidence For or Against HIV Infection -- Appendix II -- Definitive Diagnostic Methods for Diseases Indicative of AIDS -- Appendix III -- Suggested Guidelines for Presumptive Diagnosis of Diseases Indicative of AIDS -- Appendix IV -- Equivalent Terms and International Classification of Disease (ICD) Codes for AIDS-Indicative Lymphomas -- C Correspondents -- D Biographical Notes on Committee Members -- Index.