from the gay community. Only after the voluntary effort had failed did the state compel the closure of commercial bathhouses. The health commissioners had less success with needle exchange programs. Although sequential New York City Health Commissioners David Sencer and Stephen Joseph both endorsed needle exchange programs, and New York State Health Commissioner David Axelrod was also willing—albeit reluctantly—to experiment with such approaches, the proposed programs generated too much political opposition. It was not until 1989 that a limited needle exchange demonstration was approved for New York City. The lessons reinforced by these two issues were clear: individual rights matter and politics matter. To craft strategic programs, public health officials had to appease civil libertarians and advocacy groups at one end of the political spectrum and political conservatives at the other end.

The HIV antibody test developed in 1985 as a means of safeguarding the blood supply raised the greatest specter of government intrusion into an individual's private domain. Although public health officials did not universally endorse a voluntary HIV testing program initially (it was, in fact, opposed initially by the city health commissioner), by the end of 1985 most health officials acknowledged the test's utility for preventing transmission of the virus. The HIV test, however, was regarded by its opponents as the linchpin for a number of potentially intrusive measures—registries of HIV -infected individuals (which could both stigmatize and lead to discrimination if the names were ever revealed), mandatory partner notification programs, impingement of women's reproductive choices, and potential deportation of infected immigrants. In response to these concerns, public health officials and policy makers reinforced the exceptionalist nature of AIDS policy—rather than using the traditional reporting requirements and contact tracing associated with sexually transmitted and other communicable diseases, New York health officials carved out explicit informed consent requirements and voluntary HIV testing and notification policies. Behind such policies was an implicit quid pro quo. In return for relying upon various risk groups' voluntary compliance with these prevention strategies, public health officials would withhold a compulsory approach. Given the absence of any reliable treatment in the mid- 1980s, public health officials' reliance upon voluntary prevention efforts seemed the most prudent course of action.

New York's innovative administration of its AIDS programs further reflected its awareness that this disease required a different approach than others. The AIDS Institute was established as an independent center within the state health department in 1982, at first reporting to the director of the Center for Community Health (an umbrella unit for all community-based public health activities) and later reporting directly to the commissioner of health. The broad mandate of the AIDS Institute included strategic planning, the oversight of community and clinical programs, the synthesis of epidemiological and evaluation data for planning purposes, and policy development. The Bureau of HIV/AIDS Surveillance operated separately from the AIDS Institute and worked as a component



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