Refocusing approaches to the problem of AIDS. More emphasis put on educating the public.
AFTER several years of trying to solve the AIDS problem through medical research, those who work on the issue in the United States now generally agree that it is time to focus more on educating the public about how to prevent the spread of the disease. Two years ago, federal officials believed that medical means of curing and preventing acquired immune deficiency syndrome would soon be available. But now, despite research progress, those predictions are considered overly optimistic.
As a result, the federal and many state governments are increasing funds for public education about the causes of AIDS infection in an attempt to curb its spread.
Meanwhile, as part of an effort to assist people already diagnosed as having AIDS, public and private groups are looking into affordable ways of caring for AIDS patients. Because of the rising costs of hospitalization, these groups are examining alternatives to hospital care for AIDS sufferers.
On another front, the world health community is starting to recognize that AIDS is far more of an international blight than was previously supposed. International health authorities report that the AIDS virus is known to have spread to at least half of the world's 200 or so nations.
Scientists and health officials from around the world are meeting in Paris this week for the Second International Congress on AIDS to consider next steps in coping with the international spread of the disease. And at a meeting this weekend in Geneva, the World Health Organization will ask its member nations to pledge $13 million to $17 million to launch AIDS education programs in 34 countries threatened by an AIDS crisis.
Earlier this month the US Public Health Service issued a report predicting that AIDS -- nearly unknown in the US five years ago -- could be one of the nation's 10 most serious disease problems by 1991.
With no medical antidote for AIDS yet in sight, renewed emphasis is being placed on preventing the spread of the virus through public awareness.
According to Dr. Mervyn Silverman, ``The only thing that is going to work today'' in arresting AIDS is the education of Americans, geared to prevention. ``We could stop the spread of the disease today'' if educational information were widely available and heeded, says Dr. Silverman, the president of the American Foundation for AIDS Research and president of the AIDS project of the Robert Woods Johnson Foundation, and formerly the health commissioner of San Francisco from 1977 to 1985.
AIDS is communicated principally through homosexual practices as well as the sharing of contaminated needles by intravenous drug users.
Federal and state funding related to AIDS has increased in recent years. Total federal expenditures on the problem have risen from $5.5 million in 1982 to $233 million in the current fiscal year. And New York, which (along with California) faces the most severe AIDS crisis, this year more than doubled its AIDS funding, to $9.5 million.
Even so, some experts complain that too little government funding is being directed toward public education. For example, only $8.6 million (less than 4 percent) of this year's federal expenditures on AIDS is going into education programs.
``The federal government is still practically invisible'' in the education and prevention effort, says Dr. Bruce Vladeck, president of the United Hospital Fund in New York City.
Some private organizations also are providing funds or programs in the effort to deal with AIDS. The health and life insurance industries, for instance, have provided $900,000 to the American Red Cross for its public education program regarding AIDS.
Meanwhile, there is a growing effort to find more humane and less expensive ways to assist AIDS patients than through hospitalization. Some hospital care can cost as much as $800 a day.
The effort being watched with the greatest interest around the US is in San Franciso, where a network of private organizations and homosexual rights groups have developed a sophisticated program of caring for AIDS patients at home. Experts elsewhere are trying to determine whether this approach will work in other communities, where there are fewer support groups for homosexuals, and where intravenous drug use is more of a problem.
The Robert Wood Johnson Foundation has offered $17 million, and the United States government $15 million, to finance new programs in 14 cities for alternative programs to hospital care for AIDS patients. The proposals now have come in, and the winning cities are expected to be selected by Nov. 1.
But expense is not the only reason some AIDS patients have experienced difficulty in obtaining health care. Continuing ignorance and fear about the communicability of the illness have prevented some patients from getting professional care in nursing facilities or even their homes.
``There are stories of [AIDS patients having] difficulty getting formal services, and getting into nursing homes,'' says Dr. William Scanlon of the Center for Health Policy Studies at Georgetown University. ``Families are becoming the care-givers,'' he says. ``People may have to leave jobs to care for their relatives.''
This problem demonstrates that increased public education about AIDS is needed not only to prevent people from contracting the disease, but also to guide others, both individuals and public officials, in their treatment of AIDS sufferers.
There is still too much of a tendency, health experts say, to isolate AIDS victims unnecessarily.
Little protection exists in state law for persons discriminated against because they are diagnosed as having AIDS. In only a handful of states does substantial protection exist, according to Richard E. Merritt, director of the Intergovernmental Health Policy Project at George Washington University.
Moreover, no trend toward providing additional protection or confidentiality to AIDS patients is apparent. Although proposals have been introduced in five or six states this year that would afford greater civil rights protections to people with AIDS, none has become law.
At the same time, Mr. Merritt and others take some comfort from the fact that state legislatures also have resisted enacting ``draconian'' measures included among the more than 100 AIDS-related bills introduced in state houses around the country this year.
Some of the bills would provide for strict isolation of AIDS patients from the general population.