epidemic, the CDC became the focal point for developing a strategy of prevention and public health response. As a result of significant increases in funding for AIDS since the early 1980s, AIDS-related programs constitute more than 40 percent of the current CDC budget. In addition, the highly visible role that CDC epidemiologists played in linking AIDS to particular life-styles and in engaging the discussion of how to prevent the spread of the epidemic by public health measures has significantly defined the public perception of the public health profession.
Public health practitioners have long been responsible for surveillance of the spread of communicable diseases and for population-based interventions to alter the course of epidemics. Over the course of the AIDS epidemic, public health providers increasingly have been drawn into supplying primary care services for HIV-infected individuals. Especially since therapies have become available to treat HIV disease before symptoms appear, public health providers are not only implementing programs to offer individual counseling and education, but also providing diagnostic services and medical care.
This chapter considers both the public health response to the needs for surveillance and prevention of HIV/AIDS and the role that public health departments play in delivering health services related to the epidemic. It begins with the debate that has raged around whether HIV and AIDS should be treated as a condition that is exceptional or as one subject to traditional public health measures to stem the spread of infection. This controversy centers around the question of whether the history of responses to lethal infectious disease provides relevant lessons for containing the spread of HIV infection and whether policies developed for the control of sexually transmitted disease (STDs) or other communicable conditions can and should be applied to AIDS, a disease of marginalized, already stigmatized, groups.
Public health policies and practices are determined and implemented at all levels of government—federal, state, and local. This chapter does not attempt to cover all of these; it focuses primarily on national issues and actions. Nor does it try to review all policy decisions and controversies; rather, it considers those concerning HIV antibody testing and screening, contact tracing of the sexual and needle-sharing partners of infected individuals, and the isolation and quarantining of infectious individuals. The chapter concludes by considering the role of public health departments in delivering medical care, planning for health services, and reacting to political controversy.