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For the Public Good: Highlights from the Institute of Medicine, 1970–1995
fronting AIDS: Directions for Public Health, Health Care, and Research, played a key role in the difficult process of mobilizing and guiding a national response, as did its successor report, Confronting AIDS: Update 1988. As Ms. Hardy accurately describes, the documentation and recommendations provided independent, respected benchmarks against which hasty, sometimes unhelpful policy responses could be measured, and they proved useful to conscientious legislators and administrators at many levels of governmental leadership.
Perhaps the most striking features of those reports were their breadth and balance, with emphasis given to health care and public health aspects of the epidemic as well as to research needs. Thus, recommendations concerning intricate and sophisticated biomedical scientific issues were paralleled by the call for such “low-tech” but fundamental measures as ensuring drug treatment on demand for addicted users and the ready availability of condoms, for greater attention to social science research including the need for well-designed studies of sexual behaviors, and for the derivation and evaluation of strategies of health education for prevention of HIV. They called for initiation of public discussion about sexuality and about realistic approaches to substance abuse, topics that had rarely surfaced in national discourse before and that would have been difficult for the political leadership to introduce without the unassailable, independent backing provided by the IOM.
Epidemiologic investigations during the first years of the AIDS epidemic had quickly yielded the finding that AIDS was primarily a blood-borne or sexually transmitted disease and that it was difficult to transmit (once the blood supply was secured in 1985) except through certain risky behaviors, but those insights were not effectively mobilized in prevention programs until after 1986. It is noteworthy that then-Surgeon General C. Everett Koop's staff had worked closely with the IOM/NAS committee in 1986, and that Dr. Koop's own report was issued on the same day as the 1986 Confronting AIDS report, which almost surely enhanced the impact of both important contributions to public awareness and reinforced the public's willingness to face the difficult issues raised by the epidemic. Among other effects, the strongly stated recommendations provided a basis and rationale for the news media to begin to grapple with coverage of topics concerning risk behaviors and AIDS prevention that had been virtually taboo until that time.
My own involvement in the AIDS epidemic, which had begun officially in early 1984 when I was asked to chair a National Institutes of Health (NIH) advisory committee, intensified greatly through my participation in the 1985 annual meeting of the IOM and subsequent membership on the Confronting AIDS committee. Yet those substantial involvements were dwarfed by the demands of my later role as chairwoman of the U.S. National Commission