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To Improve Human Health: A History of the Institute of Medicine
from diverse backgrounds "cope with the reality of having family members who are infected with HIV." It also suggested that they develop new programs "to encourage and facilitate innovative, collaborative, and cross-disciplinary proposals." To make sure AIDS received the proper emphasis at these institutes, the committee recommended that each establish "a full-time AIDS coordinator.'' Each institute should also "develop initiatives to support research on the role of social, cultural, and structural factors in HIV/AIDS transmission, prevention, and intervention.''66
Of necessity, AIDS and Behavior was a diffuse document, in part because of the original congressional mandate and in part because the subject did not lend itself to an overarching theme. Unlike the 1986 report and its 1988 update, the behavior study did not represent a general call to arms as much as a fine-tuning of bureaucratic priorities. The presence of such a study showed how the IOM addressed two substantively different audiences on the subject of AIDS. On the one hand, it sought to address the general public and the top levels of political leadership through studies such as Confronting AIDS. On the other hand, it attempted to reach the professional research community and the inner levels of the federal bureaucracy through studies such as AIDS and Behavior . Both groups listened.
The Institute and AIDS
In the decade between 1985 and 1995, AIDS became one of the IOM's signature activities, as Samuel Thier had hoped it would. The Institute could take credit for urging federal action to combat the epidemic at a time when the top levels of government preferred to ignore it. The 1986 and 1988 reports set the stage for the nation's response to AIDS and made the Institute of Medicine visible to the public for the first time. Many of the recommendations in these reports were written into law by Congress or put into operation by the federal bureaucracy. In August 1990, for example, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act, which established a federal grant program to cities that were affected by the epidemic. Congress patterned the program after the one that Stuart Altman had devised and the Oversight Committee on AIDS had recommended in 1988. The very existence of the congressionally mandated National Commission on AIDS, which served from 1989 to 1993, could be traced to recommendations in the 1986 report. In 1991, the Office of AIDS Research in the National Institutes of Health