It is true that AIDS primarily strikes homosexuals and intravenous drug abusers, yet the rapid spread of this fatal disease is alarming a wide spectrum of the population not only in the United States but around the world. What accounts for such fear? Is it justified? Why should the general population and world health officials be so concerned about AIDS?
THE WORLD & I asked prominent scientists in the field and U.S. policymakers to give their views on how AIDS may affect the U.S. presidential race in 1988, who should be tested, what effects AIDS may have on impoverished Third World nations, and what the future holds in terms of scientific breakthroughs and social policy.
Donald Lambro, national editor of the Washington Times and a syndicated columnist, cites political experts who believe AIDS is important to the American electorate, but it is not a "decision issue," one on which they will base their vote for a candidate. Lambro notes that candidates have to walk a fine line between not alienating special interest groups yet not appearing to succumb to pressure from such groups. He also discerns some trends in how Democrats and Republicans view the issues of testing and education. While all the candidates support more federal funding for AIDS research and education, "finding a way to pay for all of this education and research will be a cold, hard reality for the next president to face."
Gary L. Bauer, President Reagan's assistant for policy development, argues that the United States should take basic health measures, including routine or even in some cases mandatory testing, to control the epidemic. "The main problem with voluntary testing," Bauer says, "is that it subjects the safety of the general population entirely to the discretion of high-risk groups."
On the other hand, the statistically large percentage of false positives still appearing in AIDS test results makes such a policy of widespread testing inadvisable, say Harvey V. Fineberg and Mary E. Wilson. Fineberg is dean of the Harvard School of Public Health, and Wilson is chief of the Division of Infectious Diseases at Mount Auburn Hospital in Cambridge, Massachusetts. Testing for AIDS, they say, "should be based on scientifically selected samples of the pertinent age, gender, ethnic, and geographic populations."
Evans Johnson, a journalist who has written widely on the possible strategic consequences of the AIDS epidemic, writes that less developed nations, particularly in Africa, "are in danger of losing a generation of leaders" because of AIDS. The disease is spreading rapidly among the young, educated elite - those most able, for example, to pay for health care at hospitals and thus more likely to get injections and transfusions. The effects of AIDS are also economic: By 1995, in the opinion of one expert, "many African nations will be losing more money each year to the ravages of AIDS than the amounts they will be given for development by Western nations."
In perhaps the most optimistic assessment, Edward N. Brandt, Jr., chancellor of the University of Maryland at Baltimore, points out that this epidemic has been characterized by the greatest scientific advances in the shortest period of time in history. He predicts there will be a satisfactory vaccine, and drugs capable of controlling the disease, in the early 1990s, although other
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