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Ides

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Mdex A Acquired immune deficiency syndrome (AIDS) age trends, 4-5, 36 animal models of, 18, 124; see also Animal models/experiments budget for, 22, 88 cases by risk group, 34, 51-52 clinical manifestations, 3, 36, 203-206, 214-216 definition/defining, 2-3, 36-37, 81, 105, 173, 207-217 demographic impact, 52, 109 diagnosis, 71, 214-216 disease presentation, 106 economic costs in U.S., 16, 104-105, 108 etiologic agent, 2, 33-35; see also Human immunodeficiency virus geographic differences in clinical manifestations, 106 incidence, 36 incubation period, 29, 61, 66, 83 infectiousness, 5, 29' 61 international scope of, 22-23, 159-160, 195 mortality, 29, 52 parallels and contrasts with past epidemics, 1, 27-28 227 patterns of spread, 23, 33, 40, 70, 159-160 progression from HIV infection to, 2, 34, 35-36, 37-38, 52, 127, 159, 173 projected cases and deaths, 57, 108, 171 reporting of cases, 159 social response to, 2, 29; see also . _. . . . . Jlscrlmlnatlon as a special case, 1, 29-30 worldwide cases, 22-23, 159 see also Cofactors in AIDS; HIV infection; Human immunodeficiency virus; Pediatric AIDS Africa AIDS cofactors in, 40 blood supply contamination, 40 heterosexual transmission of HIV in, 3, 40 parenteral transmission in, 40 seroprevalence in, 174 AIDS-associated retrovirus, see Human immunodeficiency virus AIDS Federal Policy Bill, 11, 81 AIDS patients costs of care for, 104-106 health care needs of specific populations, 13-14, 94-96, 106 life expectancy, 108 minorities, 15, 27, 98-99

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228 INDEX obligation of health care providers to treat, 8, 51, 52, 67-68 wage and productivity losses, 16, 106, 107 AIDS-related complex, 3, 37; see also Human immunodeficiency virus American Medical Association guidelines on physicians' duty to warn, 11, 80 policy statement on obligation to treat AIDS patients, 15, 99 recommendations on drug abuse treatment program enrollments, 85 American Nurses' Association, position on obligation to treat AIDS patients, 15, 99 Animal models/experiments baboons, 147 chimpanzees, 20, 21, 124, 142, 147-148, 191 development of, 147-149 facilities for, 149-150 genetically immunodeficient mice, 148 non-HIV-related retroviruses, 147 recommendations, 21, 145, 148, 149 rhesus macaques, 20, 21, 147, 148 simian, bovine, and feline lentiviruses, 18, 21, 124, 147 small animals, 21-22, 149 superinfection experiments, 142, 147 supplies of animals, 21, 148-149, 191 transgenic mouse, 149 vaccine development, 20-21, 142, 144, 145 Antibodies to HIV antienvelope, 134 neutralizing, 134, 142-143 Antibody tests for HIV availability of, 71 confidentiality of results, 10, 72-74, 79, 181 false results, 9, 35, 71 funding for, 88 home test kits, 10-11, 79-80 sensitivity and specificity, 9, 10, 71, 76, California 79 techniques, 71, 79, 190 Antiviral agents 2',3'-dideoxycytidine, 132, 137 ideal characteristics, 191 soluble CD4 preparation, 131 AZT, see Zidovudine Behavioral change B in IV drug abusers, 30 in prostitutes, 10, 79 ways for inducing, 9, 10, 30, 70, 74 see also Public education about AIDS Bisexual men, see Homosexual men Blacks AIDS prevalence among, 8, 51, 52, 67-68 education on AIDS, 8, 13, 68, 89 pediatric AIDS cases in, 95 seroprevalence among, 41, 47, 48, 52, 78, 84 Blood donations lack of risk in, 67 self-screening, 76, 180 Blood donors confidentiality of, 73 screening of, 34, 183 seroprevalence among, 39, 47-48 Blood products heat treatment of factor concentrate, 49 screening, 71, 75-76 World Health Organization safety initiative, 161 Blood transfusion recipients AIDS cases in U.S., 34, 51-52 incidence of new infections in, 4, 49 progression from HIV infection to AIDS, 36, 52 risk of infection, 3, 45, 76, 172 Blood transfusions, HIV transmission through, 34, 39, 42 Bovine immunodeficiency virus, 124 Brown University Center for Health Care Research, 110 Bubonic plague, 1, 27 C confidentiality of HIV test results in, 73 expenditures for AIDS prevention, 184 health care financing, 112 Prostitutes Education Program, 79 syphilis increases, 41 Candidiasis, oral, 36, 214, 215

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INDEX 229 Casual contact, evidence against transmission by, 6, 29, 39, 67, 80, 96, 172 CD4 cells, 130, 133 Centers for Disease Control Costs, see Health care costs classification system for HIV infections, 38, 202-206 definition of AIDS, 2-3, 105, 203-205, 207-217 effectiveness of surveillance efforts, 167 HIV surveys and studies, 50 paid advertising for AIDS education, 7, 65 review of explicitness of educational materials, 66 universal precautions for health care Discrimination personnel, 10, 76, 98 Central nervous system, HIV detection in, 133-134 Children, see Infants and children Cofactors in AIDS in Africa, 40 chronically activated immune systems, 40 data needs on, 59 history of sexually transmitted diseases, 40 host immunoregulatory and infectious pathogens, 135 Colorado, HIV reporting requirements, 73 Condoms commercial advertising, 8, 69 education about, 8, 67, 69, 176 effectiveness, 68-69 prostitute use of, 78 regulation and quality control, 69 virucidal agents used with, 69 Confidentiality about cause of death, 73 exceptions to, 11, 73 health records and medical charts, 72-74 and physicians' duty to warn, 11, 80-81 recommended protections, 9, 72, 74, 101, 181 record of public health officials in preserving, 81 Consolidated Omnibus Budget Reconciliation Act, 114 Contact tracing and notification, 11, 43, 80-82, 179 D Deaths age and gender trends, 4-5, 29 of celebrities, 67 in New York City, 5, 52 projections, 57, 108, 162, 171 publication of cause of, 73 in San Francisco, 5, 52 Dementia care of AIDS patients with, 14, 96, 108 as part of Centers for Disease Control definition, 3, 36, 215 by health insurance companies, 113 protections against, 6, 62-63, 72, 113 public health responses complicated by, 6, 29, 63 range and scope, 63 Drug abuse education for adolescents, 13, 87 by former drug abusers, 13, 87 recommendations, 12, 13, 65, 87 Drug abuse treatment programs ADAPT, 87 counselors for, 12, 13, 85 coupon program, 86 expansion of slots in, 12, 84-85, 86 funding, 13, 84, 85, 88 importance in preventing AIDS, 5, 62 methadone maintenance, 84-85, 87 serologic testing in, 12-13, 87 third-party coverage for, 88 waiting lists for entry into, 12, 13, 84-85, 86, 88 Drugs AZT, see Zidovudine clinical trials, 19, 131, 132, 138-139, 192 development and testing, 18-20, 136-140 FDA approval process, 19, 137-140 HIV targets for design of, 131, 136 investigational new drug (IND) status, 17, 19, 117, 137, 139 liability issues, 139 "magic bullet," 28 Medicaid coverage for, 114-115 roundtable on, 146-147

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230 INDEX scarcity, 138 screening of compounds for, 136-137 for syphilis treatment, 28 treatment IND, 17, 19, 117, 137, 139, 144 trimetrexate, 19, 138 see also Antiviral agents E Education, see Public education about AIDS Employee Retirement Income Security Act, 115 Enzyme-linked immunoassay (ELISA) tests, 71 Epidemic AIDS as a series of overlapping epidemics, 49 future course, 29-30, 41, 174, 175 in heterosexual population, 41 historical parallels to AIDS, 1, 27-28 Epidemiological research case-control studies, 40 health care worker infection with HIV 44 on heterosexual transmission, 40, 44 partners of infected hemophiliacs, 44 prospective cohort studies, 34, 35-36, 37, 44, 49, 181, 190 recommendations, 5, 53 for seroprevalence determinations, 82 Epidemiological surveillance blinded surveys, 51 case definition for AIDS, 207-217 Centers for Disease Control program 50 difficulties in, 43 at drug abuse treatment centers, 47 effectiveness, 30 of health care workers, 44 populations selected for, 50-51, 190 self-selection bias in, 4, 48, 51 at sexually transmitted disease clinics, 47 Ethical issues access to health care, 16, 63, 98-99, 110-111 clinical trials of drugs and vaccines, 19-20, 139-140, 145 employment of infected individuals, 6, 63-64, 100-101 in health care financing, 113 historical parallels, 1, 27 marketing of unproven therapies, 20, 142 obligation to care for HIV-infected persons, 15, 27, 98-99, 186 obligations of at-risk individuals, 9, 74, 186 physicians' duty to warn, 11, 80-81 terminal care decisions, 186-187 F Fear of AIDS effects of, 63, 178 in health care providers, 98-100 Federal Rehabilitation Act, applicability to seropositive individuals, 63-64 Feline immunodeficiency virus, 124 Financing, see Funding; Health care ~ . nnanclng Findings and recommendations access to health care, 16-17, 111, 117, 118 AIDS as a special case among diseases, 1, 29 AIDS-related complex, 3, 37 animal models/experiments, 21, 145, 148, 149 antidiscrimination measures, 6, 63, 64, 185 barriers to public health measures, 6, 62 biomedical research, 18, 135-136 budget for research, 22, 151 cause of AIDS, 2, 33 clinical trials, 19-20, 140, 145 condom use, 8, 69 confidentiality protections, 9, 72, 74, 101, 181 contact notification programs, 11, 82 counseling and psychiatric/psychosocial support, 9, 10, 12-13, 16, 74, 87, 103-104 drug abuse treatment programs, 12, 13, 84, 85, 87, 178 drug development and testing, 19, 20, 117, 139, 140, 146-147 education of seropositive children, 182 educational programs, 7, 8, 13, 65-69, 87, 175-178, 199

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INDEX 23 1 epidemiological research, 5, 53 facilities for research, 22, 150 funding, 13, 88, 135-136, 184 health care facilities, 14, 95, 96, 185-186, 188 health care financing, 16-17, 111, 117, 118, 188 health care personnel, 15-16, 79, 101-103 international research, 164, 197 models and modeling, 5, 60, 174-175 National Commission on AIDS/HIV infection, 25-26, 167, 198, 199 needle distribution to drug abusers, 86, Health care 179 occupational risks of HIV infection, 15, 100 paid advertising by Centers for Disease Control, 7, 65 precautions by health care workers, 10, 76-77 prevention and control measures, 5, 11-12, 82-87, 174-175, 184 reagents for research, 22, 151 reporting of test results, 11, 82, 180 restrictive measures for HIV carriers, 11-12, 83, 182 screening, 10, 75-79, 101, 196 social science research, 9, 67, 75, 79, 104 test standards and quality assurance, 9, 71 Florida testing, 9, 10-11, 12-13, 15, 74-75, 79, 87, 101, 196 training of health care providers, 15, 102 U.S. international responsibilities, 23, 163, 197 vaccine development and testing, 20, 21, 145, 146-147, 193 mandatory screening for HIV infection, 78-79 pediatric AIDS cases, 95 syphilis increases, 41 Funding animal models, 148 biomedical research, 18, 135-136, 194 diversion from other research and treatment strategies, 6, 30, 62, 194 drug abuse treatment programs, 84, 85 educational programs, 7, 13, 88, 177, 181-185 facilities for research, 150, 194 health care cost research, 110 primate research, 149-150, 194 see also Health care financing G Genital ulcers, 40 H access to, 16-17, 19, 63, 98-99, 110-111, 117, 118, 139-140 basic approach, 93 community-based, 14, 95, 96, 105, 109, 110, 186 day care, 95 decline in high-prevalence areas, 29 deficiencies, 13, 30 demonstration projects, 110, 183 discharge planning, 13-14, 94 ethical issues in, 1, 11, 15, 27, 80-81, 97-101 foster care, 14, 96 geographic burdens, 29, 111, 117 home hospice care, 14, 95, 105 hospital, 29, 105, 106, 185, 187-188 incentive payments for, 14 infection control precautions, 10, 14-15, 76, 97, 98 long-term, 95 nursing homes, 14, 95, 96, 115 recommendations, 16-17, 95, 96, 99-102, 103-104, 111, 117, 118, 185-186 residential care, 14, 95, 96 respite care, 95 sexually transmitted disease clinics,47, 62 special-patient needs, 13-14, 94-96, 186 specialized AIDS clinics, 93, 96 see also Psychiatric/psychosocial support Health care costs average lifetime cost per AIDS case, 16, 104, 178 direct, for AIDS patients, 104-106, 187 estimation, 105 geographic variations in, 105-107, 109

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232 INDEX hospital, 105, 106, 109 indirect, of HIV-related conditions, 16, 106-107, 186-187 for long-term care, 96 Medicaid, 111 national expenditures, 107-108 projections, 16, 108 reimbursement for, 96, 109, 114-115 research on, 16, 109-110, 188 type-of-patient factor in, 106, 109 zivoduvine (AZT) treatments, 108 Health care financing deficiencies, 16, 30, 94, 110-111, 113 eligibility for, 111-112, 114-115, 116 Employee Retirement Income Security Act and, 115 for experimental therapies, 17, 114, 117-118 federalgrant program, 17, 116-117 Medicaid, 17, 111-112, 114-115, 188 Medi-Cal, 112 Medicare, 112, 109, 116, 188 recommendations, 117-118, 188-189, 200 sources, 111-113 strategies, 17, 113-118 waiting period, 17, 112, 116 see also Health insurance Health care personnel AIDS units/teams, 13-14, 93-94 collaborative surveillance study, 44 education and training, 15, 101-102, 186 emergency care personnel and surgeons, 15, 98 funding for, 88 HIV exposure through accidental needle sticks, 39, 44 private physicians, 62 psychological stress in, 15-16, 103-104, 185, 187-188 right to know serologic status of patients, 73 risks to, 14, 97-98 screening for HIV infection, 15, 76-77, 100-101 seropositivity in, 15, 100-101 universal precautions, 10, 14-15, 76, Hispanics 97, 98 volunteers, 105, 186 Health care planning data needs for, 70 problems, 30 Health insurance antidiscrimination laws governing, 113 drug abuse treatment coverage, 88 early-stage coverage, 38 ethical issues, 113 extension of coverage period, 114 inadequate coverage, 17, 111, 188 incentives and subsidies for AIDS patient coverage, 17, 113-114, 116 limitations on coverage, 17, 112-113 state risk pools, 17, 115-116 Health Resources and Services Administration, 102, 110 Helper/inducer cells, see CD4 cells Hemophiliacs AIDS cases in U.S., 51 incidence of new infections in, 4, 49 progression from HIV infection to AIDS, 36 risk of transmission for sexual partners of, 43 seroprevalence among, 4, 47 Hepatitis B virus occupational risks to health care personnel, 97 similarities between HIV spread and, 33, 97 Heterosexual contacts AIDS cases in U.S., 51 seroprevalence among, 39, 41, 42, 47 Heterosexual transmission in Africa, 3, 40, 196 chain of, 12, 41, 78, 84 efficiency of, 39, 43 from men to women, 39, 41-42 study design, 39 from women to men, 39, 41-42 Heterosexuals, prevalence of HIV infection in, 39, 41, 42 High-risk groups case distribution, 51-52 contact tracing among, 82 disease trends by, 46-47, 51-52, 160 education of adolescents in, 87 social stigma and prejudice toward, 6, 61 AIDS prevalence among, 8, 51, 52, 68 educational programs on AIDS, 8, 13, 68, 89 pediatric AIDS cases in, 95 seroprevalence among, 41, 47, 48, 78, 84

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INDEX 233 HIV infection Hospital patients activation, 134 screening for HIV infection, 48-49 age and, 43, 112 seroprevalence among, 48-49 asymptomatic period, 37, 172, 173, 181, Human immunodeficiency virus (HIV-1) 204 antibodies, 134 cells susceptible to, 131 antibody testing of, see Antibody tests classification system for, 38 definition, 203-206 as a disease or continuum of conditions, 3, 37-38 diagnosis, 37-38 diversity of isolates, 133 geographical differences in epidemiology, 46 incidence, 4, 5, 34, 49, 58 interruption of, 130-132 laboratory evidence of, 212-213 macrophage role in, 18, 133, 143, 145 modeling transmission dynamics, 58 national estimates, 4, 49-50 natural history of, 132-135, 189-190 pathogenesis, 35, 133, 135, 171-172 persistence, 133-134 prevalence, see Seroprevalence progression to AIDS, 2, 34, 35-36, 37-38, 52, 127, 159, 173 spread of, 39, 52, 196 susceptibility to, 40, 133 symptoms and stages, 3, 37-38, 133 treatment, 37-38, 174; see also Drugs; Treatment strategies Homosexual men adolescents, 68, 75 AIDS cases in U.S., 51, 52 attitudes about testing, 74 costs of treating, 106 discrimination against, 63 disease progression in, 2, 34, 35-36 education of, about AIDS, 8, 68, 89, 176-177 epidemiological studies of, 2, 34, 35-36, 43, 49 high-risk behavior, 40, 41, 43 incidence of new infections in, 4, 49 population size estimates, 59 presenting diagnosis for AIDS patients, 106 risk of HIV transmission, 3, 43 seroprevalence among, 2, 4, 34, 35-36, 39, 46, 68, 173 wage losses, 107 for HIV antigenic drift in, 143 biology of, 18, 123-136 cell-mediated immune response to, 134-135, 143, 144 control of viral gene expression, 127 cytopathic particle generation, 128 detection, see Testing/tests for HIV entry into cell, 131, 141 envelope glycoprotein, 18, 125, 128, 130, 131, 134, 141 fragility and lethality, 65 gene products, 124-125, 129 genes involved in replication, 125, 129-130 genome structure/characteristics, 18, 124-127 host tissues, 132-133 infectiousness, 5, 43-44, 59, 61, 133 in vitro production, 127 lentivirus analogy, 124, 133, 134 long terminal repeats, 125 nucleotide sequences, 125, 126, 129 production-inhibiting gene, 130 protein immunoregulatory activity, 145 reading frames, 125, 128 regulatory genes, 128, 129 replication of, 18, 124-125, 127-128, 129, 130, 132 syncytia formation, 131, 135 target cells, 18, 130-131, 133 tat-III and artitrs genes, 125, 129-130 taxonomic assignment, 124 transactivation response element, 129 transcription and translation of RNA, 128, 131-132 transmission, see Parenteral transmission; Transmission of HIV Human immunodeficiency virus (HIV-2) detection, 124 genome structure, 127 prevalence, 18, 123 regulatory genes, 130 taxonomic assignment, 124 transmission and pathogenesis, 123

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234 INDEX Idaho, HIV reporting requirements, 73 Illinois, mandatory screening for HIV infection, 77-79 Immune system cell-mediated immune response to HIV, 134-135 chronic activation and susceptibility to HIV infection, 40 Infants and children AIDS cases in U.S., 51-52 care needs of AIDS patients, 14, 95-96, 109 progression from HIV infection to AIDS, 52 schooling of infected individuals, 182 seroprevalence among, 48 Infection, see HIV infection Insect vectors, evidence against exposure by, 39, 67, 172 Institutionalized populations, mandatory testing of, 10, 70 International AIDS efforts U.S. contributions to, 23, 162-164, 196-197, 201 U.S. responsibilities, 30 see also World Health Organization International issues prevalence of AIDS/HIV infection, 159-160, 174, 194-195 rationale for U.S. involvement in international efforts, 161-162, 195 reporting of AIDS cases to World Health Organization, 159 International resources for fighting AIDS organizations, 195-197, 201 U.S. contribution to, 30 Intravenous (IV) drug abusers AIDS cases in U.S., 51 bleach distribution to, 12, 86-87 care needs of, 14, 94-95, 106 costs of treating, 106, 109 counseling for HIV infection, 12-13, 87 data needs on, 59 distribution of sterile needles and syringes to, 12, 86-87, 179, 200 efficiency of HIV transmission among, 3, 42-43, 45 former, as counselors, 12, 85, 87 heterosexual transmission of HIV infection through, 12, 41, 8 high-risk behaviors, 41, 42-43, 196 incidence of new infections in, 49 presenting diagnosis for AIDS patients, 106 seroprevalence among, 4, 34, 41, 46-47, 84, 87 testing of, 12, 87 women, 84 see also Drug abuse treatment programs J Job Corps entrants, seroprevalence among, 48 K Kaposi's sarcoma, 106, 205, 214, 216 L Legal issues confidentiality of test results, 9, 72, 81 criminal penalties or civil liability for intentional transmission, 83 discrimination, 63-64, 72, 81 distribution of sterile needles and syringes, 86 education about AIDS, 66 informed consent for testing, 71-72 new drug/vaccine therapies, 139-140, 145 personal liberty restrictions, 12, 83-84 reporting of HIV infection, 180 third-party warnings, 11, 80-81 Lentiviruses disorders caused by, 124 similarity to HIV-1, 124, 133 Life insurance, distinction among applicants, 64 Louisiana, mandatory screening for HIV infection, 77 Lymphadenopathy, see Persistent generalized lymphadenopathy M Macrophages, role in HIV infection, 18, 133, 143, 145

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INDEX 235 Massachusetts confidentiality of HIV test results in, 73 HIV prevalence among women giving birth, 48-49 Maternal-infant transmission IV drug abuse and, 95 risk, 3, 35, 42, 45 Miami, seroprevalence among prostitutes, 78 Military personnel, seroprevalence among, 39, 48 Minnesota, insurance risk pools, 116 Models/modeling data needs for, 5, 58-60 difficulties, 58, 174-175 IOM/NAS workshops on, 60 prevalence and incidence of AIDS/HIV infection, 5, 36 of progression from seropositivity to AIDS, 2, 36 research recommendations, 5, 60 transmission dynamics of HIV infection, 58 types, 58 uses, 57, 60 Monitoring, see Epidemiological surveillance N National Cancer Institute, drug screening program, 136-137 National Center for Health Services Research and Health Care Technology Assessment, 109 National Center for Health Statistics, HIV surveys and studies, 50-51 National Commission on HIV Infection and AIDS, 14-26, 165-167, 198-199 National Institute of Allergy and Infectious Diseases AIDS clinical trial units, 20, 140 AIDS Research and Reference Reagent Program, 22, 150-151 National Cooperative Drug Discovery Groups, 18-19, 136 National Institutes of Health grants for health care training, 102 Office of AIDS Research, 166 National Research Council Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences, 59, 67 Needle sticks, accidental, HIV transmission through, 4, 44, 45, 97-98, 196 Needles and other unsterile implements, HIV infection from, 40 Neurologic complications care needs of patients with, 14, 96 prevalence and severity, 135 types, 205 Nevada mandatory testing of prostitutes for HIV, 78 seroprevalence among prostitutes, 78 New Jersey burden on health care system in, 111 drug abuse treatment programs, 86 mandatory testing for HIV, 79 pediatric AIDS cases, 95 posthospital residential care program, 95 seroprevalence among IV drug abusers, 4, 47 seroprevalence among prostitutes, 78 New York City burden on health care system in, 107-108, 111, 187-188 Covenant House, 79 deaths from AIDS, 5, 52 drug abuse treatment programs, 84-85 educational programs in, 8, 68 pediatric AIDS cases, 77, 95, 109 seroprevalence among homosexuals in, 34 seroprevalence among infants, 86 seroprevalence among IV drug abusers in, 4, 34, 42, 47, 49, 109 seroprevalence among women delivering babies, 49, 52 syphilis increases, 41 o Opportunistic infections in AIDS, 205 Oregon, insurance risk pools, 116 p Palo Alto Medical Foundation Research Institute, 109-110 Parenteral transmission accidental needle sticks, 4, 44, 45

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236 INDEX in Africa, 40 blood transfusions, 34-35, 36; see also Blood transfusions; Hemophiliacs through needles and other unsterile implements, 88 see also Intravenous (IV) drug abusers Pediatric AIDS care needs for patients, 14, 95-96, 109 cases in U.S., 51-52, 77, 95 family disruption, 95, 14 transmission routes, 35, 51 Perinatal transmission, see Maternal-infant transmission Persistent generalized lymphadenopathy, 36, 37, 204 Pneumocystis carinii pneumonia, 106, 138, 173, 205, 214, 216 Polio epidemics, 28 Presidential Commission on the Human Immunodeficiency Virus Epidemic, 24, 165-166 Prevention strategies for blood products, 49, 88 budget for, 88, 183 contact tracing and notification, 70 criminal penalties or civil liability for intentional transmission, 83 importance of, 60 isolation and quarantine, 11-12, 28, 83 for IV drug abusers, 30, 62, 85-87, 178-179; see also Drug abuse treatment programs from programs for other sexually transmitted diseases, 62 resources for, 13, 87-89 see also Behavioral change; Condoms; Public education about AIDS; Public health measures; Vaccines against HIV Projections accuracy, 108 AIDS cases and deaths, 57, 108, 162, 171 data needs for, 5, 58-60 economic costs of AIDS, 16, 108 progression from HIV infection to AIDS, 36, 57 see also Models/modeling Prostitutes case-control studies in Africa, 40 IV drug abuse by, 10, 41, 78 mandatory screening of, 10, 78 - 79 prevention strategies, 10, 79 seroprevalence among, 40, 41, 47, 78 Psychiatric/psychosocial support for AIDS patients, 186 with antibody testing, 9, 70, 72, 74, 78, 79, 88-89, 101 for health care workers, 15-16, 103-104 recommendations, 9, 10, 12-13, 16, 74, 87, 103-104 Public education about AIDS for adolescents, 66-67, 68, 87 all-household mailing, 24, 167 at colleges, 7, 66-67, 88 content of, 7, 65-66, 176 culturally specific programs, 8, 68 "dirty words" issue, 66 funding for, 7, 13, 88, 177, 181-185 gaps in, 67 historical parallels to syphilis epidemic, 28 moral issues, 7, 65 obstacles, 7, 64, 65, 69 paid advertising, 7, 64-65, 69 public service announcements, 65 recommendations, 7, 8, 65-69, 87, 175-178, 199 resources for, 13, 87-89 school-based, 7, 66-67, 88, 177 statutes allowing or mandating, 66 success of, 67-68 Public health measures classification of programs, 61-62 complication by discrimination, 2, 29, 63 contact tracing and notification, 11, 80-82 criminal penalties, 83 historical parallels to syphilis epidemic, 28 isolation or quarantine, 11-12, 28, 83 recommendations, 5, 11-12, 82-87, 174-175, 184 Q Quarantine, 11-12, 28, 83 R Recommendations, see Findings and recommendations

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INDEX 237 Research basic biomedical, importance of, 18, 135-136 budget, 22, 151 HIV "starter kit," 22, 151 international opportunities, 196-197 see also Epidemiological research; Social science research Research needs diversion of resources from other important conditions, 6, 30 on educational campaigns, 8 epidemiological studies, 5, 52-53 facilities, 22, 149-150 international data base on activities, 24, 164 reagent distribution center, 22, 150-151 see also specific subject areas Reverse transcriptase, inhibition of, 18, 131-132, 137 Robert Wood Johnson Foundation AIDS Health Services Program, 110 Roundtable on Development of Drugs and Vaccines Against AIDS, 146-147 S San Francisco AIDS case trends, 34, 107 burden of AIDS patients on health care system in, 107-108 community care resources, 105 contact tracing program in, 82 deaths from AIDS, 5, 52 educational programs, 8, 68 Men's Health Study, 34 seroprevalence among homosexual men in, 34, 46 seroprevalence among IV drug abusers in, 4, 49 Screening for HIV of blood and blood products, 34-35, 71, 75-76, 179 of blood and plasma donors, 49 at drug abuse treatment centers, 47 health care workers, 76-77, 100-101 historical parallels to syphilis epidemic, 28 hospital patients, 10, 48, 70, 77 institutionalized populations, 70 mandatory, 10, 75-79, 180-181 newborns, 50 organs and tissues for transplantation, 76 premarital, 10, 77-78 prenatal, 77 of prostitutes, 10, 78-79 public health objectives achieved through, 8-9, 70 recommendations, 10, 75-79, 101, 196 semen for banking, 76 sites for, 47, 50, 89, 183 Serologic testing, see Antibody tests for HIV; Screening for HIV; Testing/tests for HIV Seropositive individuals age trends, 48 asymptomatic, 64, 70 discrimination against, 63-64 employment of, 6, 63-64, 100-101 health care workers, 76-77, 100-101 insurability, 113 progression to AIDS, 35-36 reporting of, 11, 80 students and teachers, 6, 63-64 Seroprevalence in Africa, 174 age and, 48 among blacks, 41, 47, 48, 52, 84 among blood donors, 39, 47-48 data needs on, 59 among hemophiliacs, 4, 47 among heterosexual partners, 39, 41, 42, 47 among Hispanics, 41, 47, 48, 52, 84 among homosexual men, 4, 34, 35-36, 39, 46, 52, 68 among hospital patients, 48-49 among infants, 48, 52, 86 among IV drug abusers, 4, 34, 41, 46-47, 49, 52, 84, 87 among Job Corps entrants, 48 among military inductees and personnel, 39, 48 modeling, 5, 58 national estimates, 4, 49-50 among prostitutes, 40, 41, 47 studies for determining, 82 among women, 40, 47, 48-49, 52 Sexual behavior data needs on, 59 see also Behavioral change

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238 INDEX Sexual transmission of HIV efficiency of routes, 3-4, 45 men to women, 39, 41-42, 44 multiple partners and, 40, 43 partner tracing, 11, 43, 80-82, 179 prevention, see Behavioral change; Condoms receptive anal intercourse, 40, 42, 43, 45, 80, 172 vaginal intercourse, 39, 40, 41-42, 45, 80, 172 women to men, 39, 41-42, 44 see also Heterosexual transmission Sexually transmitted disease clinics AIDS prevention role, 6, 62 HIV screening through, 47, 50, 89 Shooting galleries, 42-43 Simian immunodeficiency virus (SIV), 21, 124, 130, 147, 148 Smallpox epidemics and eradication effort, 28 Social science research needs, 5, 59-60, 67, 193, 200 recommendations for, 5, 67, 193, 200 Social stigma complication of public health measures by, 2, 29 see also Discrimination Surveillance, see Epidemiological surveillance Syphilis epidemiological parallels to AIDS epidemic, 1, 27-28 increase in, correlated with HIV United States infection rates, 41, 89 premarital screening for, 77 T T lymphocytes historical parallels to syphilis epidemic, 28 home-based, 10-11, 79-80 infants, for maternal infection, 48 informed consent for, 71-72, 101, 181 opponents of, 74 patient care and, 70 psychological effects of, 9, 70 purposes, 70 sites, 47, 50, 89, 183 standards and quality assurance, 9, 71 voluntary, 9, 72, 181 Texas, mandatory screening for HIV infection, 77 Transmission of HIV biological factors in, 43 determinants other than route, 45 efficiencies, 3-4, 39, 41-45, 172 intentional, criminal penalties or civil liability for, 83 international patterns, 159-160 misunderstandings about, 8, 67 modes, 3-4, 8, 38-42, 65, 133, 172 see also Casual contact; Cofactors in AIDS; Maternal-infant transmission; Parenteral transmission; Sexual transmission Treatment strategies, see Antiviral agents; Drugs; Vaccines against HIV U CD4 receptor on, 130-131 cytotoxic, 134, 141 as predictor of HIV transmission, 44 reduction in AIDS patients, 35 Testing/tests for HIV anonymous, 48, 51 behavioral impacts, 9, 74-75 budget for, 88 confidentiality of results, 9, 10, 71-74, 79, 101 counseling with, 9, 10, 13, 70, 72, 74, 78, 79, 88-89, 101, 181, 193 AIDS cases by risk group, 51-52 contributions to international efforts! 23, 162-164, 196-197 economic costs of AIDS, 104-105; see also Health care costs patterns of disease spread in, 3, 40 payments to World Health Organization, 163 rationale for international involvement, 161-162 U.S. Department of Health and Human Services joint infection control guidelines with U.S. Department of Labor, 98 paid advertising for AIDS education, 7, 65 U.S. Food and Drug Administration budget for AIDS research, 151

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INDEX 239 drug approval process, 19, 137-140 expedition of review, 19, 138 resources for drug approval process, 139 treatment IND, 17, 19, 117, 137, 139, 144 vaccine approval process, 20-21, 144-145 U.S. Public Health Service Executive Task Force on AIDS, 24, 166 Intragovernmental Task Force on AIDS Health Care Delivery, 117 National AIDS Program Office, 24, 166 projections of AIDS cases and deaths, 57 see also Public health measures Utah, ban on marriage of antibody-positive individuals, 77 V Vaccines against HIV animal trials, 20, 142, 144, 145 baculo-derived gpl60, 142 development approaches, 141-144, 189, 192-193 difficulties in developing, 20, 142-143 FDA approval process, 20-21, 144-145 HIV structural characteristics important to development of, 125 human trials, 144, 145 immunogenic carriers, 143 inhibition of gpl20-CD4 interaction, 131, 141, 143 injury and compensation schedules, 146 legal liability issues, 145-146 passive immunization, 142 purified gpl20, 142 whole killed virus, 144 W Western blot analysis, 71 Wisconsin HIV reporting requirements, 73 insurance subsidy program, 116 World Health Organization, AIDS-related activities, 23, 145, 160-161 z Zidovudine (AZT) action, 132 approval process, 138 in combination with biological response modifier, 19, 137 comparison of other drugs with, 139 effectiveness, 37, 108, 132 Medicaid coverage for treatment, 114 side effects, 132 treatment costs, 108 trials in asymptomatic individuals, 70,

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