AIDS and institutions: institutions are failing to meet the challenge of the AIDS epidemic.

Institutions are failing to meet the challenge of the AIDS epidemic

Despite the toll that the HIV/ AIDS epidemic has taken on the people of the United States, institutions such as the public-health system and correctional facilities have made few if any changes in response, according

With over 1 million people infected and over 130,000 dead from the disease as of the end of 1991, "AIDS has . . . had little effect on American society as a whole or its way of doing business," says Albert R. Jonsen, co-editor of the report.

In analyzing the impact of AIDS on health care, public health, the correctional system, volunteer organizations, and religious groups, the report concluded that neither structure nor behavior of these institutions has changed significantly, with many approaches simply done in an ad hoc fashion.

Despite the costs of medical care for AIDS patients, the report found that there have been few major changes to the health-care-financing system. Some 200,000 patients have been sent into the system over the last decade alone, and many either have no health insurance or have restricted benefits. What few changes there have been have taken place in areas with a high concentration of cases. In these areas, institutions such as hospitals are coming under serious financial strain. Questions of reimbursement have caused many hospitals to resist taking on such cases.

In terms of public-health organizations, the report recommends that the more traditional methods for dealing with infectious diseases, such as quarantine and mass mandatory testing, must be forgone in favor of education and outreach programs. As the disease spreads, techniques such as partner notification and HIV screening for pregnant women and newborn babies will have to be used more widely.

At least 1 million inmates populate the correctional system in the United States, and issues such as screening for HIV/AIDS and segregating infected individuals are still being debated. The biggest effect of the disease has been to worsen the existing problems of providing adequate health-care facilities. The report found that most institutions currently treat the infected inmates no differently from others, except for a few initial precautions.

Due to the HIV/AIDS epidemic's early association with drug users and homosexuals, the government was initially slow to react to it, while many volunteer organizations have engaged in a variety of efforts. However, financial constraints, individual burnout, and endless amounts of bureaucratic red tape are impeding the effectiveness of many efforts. Also, the report found that, since poverty and unemployment make volunteering difficult for most people in poorer areas, these resources will be lacking as the disease spreads in those areas.

The report also found that many religious groups seem to have been unaffected by HIV/AIDS. While some factions have seized upon the belief that the disease is a "divine punishment," others simply admonish certain behaviors or criticize the frankness advocated in "safe sex" education.

Health care and research experts have become more cooperative with activist and volunteer groups, but the report recommends that such efforts be expanded so that policies and practices can be shaped to reflect what is actually going on.

"HIV is concentrating in pools of people who are also caught in the synergism of plagues'--poverty, poor health and lack of health care, [and] inadequate education," according to the report. In New York City, HIV is spreading more quickly through poor and minority communities where such factors come into play, and this pattern will likely occur throughout the country.

Source: The Social impact of AIDS in the United States, edited by Albert R. Jonsen and Jeff Stryker. National Academy Press, 2101 Constitution Avenue, N.W., Washington, D.C. 20418. 1993. 322 pages. $34.95.