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Aids: 1991

August 10, 1986|NEIL R. SCHRAM | Neil R. Schram is a physician and chairman of the Los Angeles City / County AIDS Task Force.

The following fictional scenario is based on what is known about acquired immune deficiency syndrome, AIDS. It is meant to summarize the latest information on the disease and to describe choices that could confront society if the virus continues to spread unchecked. The author has been a persistent advocate of increased government spending on education and prevention to help stop the spread of AIDS.

It is Sept. 17, 1991, and the White House has just announced that the vice president's daughter and her 5-month-old son have AIDS. Shocked and declaring that "this brutal, uncontrolled epidemic must be stopped-- and stopped now," the President appoints a blue-ribbon commission to find ways to quickly halt the spread of the disease in American society.

By any measure, it is an awesome task. Since June, 1986, when the U.S. Public Health Service predicted that the number of AIDS cases would jump tenfold in five years, to almost 270,000, millions more have become infected with the AIDS virus. Estimates now put the total at 3 million to 4 million--about one in every 70 Americans--and each is considered capable of spreading the disease to his or her sexual partners.

Researchers have a far better understanding of the AIDS virus than they did in 1986 and can blunt its attack on the immune system, the body's natural defenses against disease. But five years later, there still is no vaccine to prevent new infections, no cure for the disease itself. Today, as in 1986, more than 80% of the patients diagnosed as having full-blown AIDS will die within two years as their weakened immune systems are overwhelmed by diseases healthy bodies can easily repel.

As federal health officials projected in 1986, more than 54,000 Americans will die from the disease this year--almost as many people who died in the entire 40 years of the polio epidemic. There are so many AIDS patients that acute-care services at many hospitals have been in chronically short supply for years now. Insurance companies have been bankrupted. Every American is paying higher medical bills and insurance premiums.

The signs of trouble have been apparent for years, even before actor Rock Hudson died of AIDS in 1985 and the press erupted with reports about the disease. "Not since syphilis among the Spanish, plague among the French, tuberculosis among the Eskimos and smallpox among the American Indians has there been the threat of such a scourge," the prestigious Journal of the American Medical Assn. had warned that year.

But only this year, as the vice president's daughter and grandson fall victim, and as the AIDS toll exceeds the annual slaughter on the nation's highways, does the nation finally recognize that a health crisis of historic proportions is at hand.

The President's Commission, headed by a retired Supreme Court justice, quickly gets down to business. It just as quickly discovers that its choices of recommendations are amazingly few. Despite years of increasingly dire warnings from public health officials, little has been accomplished to check the spread of the disease. The greatest efforts--and almost all of the money--have been aimed at producing a vaccine and drugs to treat the disease. Nothing suggests that the general public, after years of denying that this "gay plague" could affect them, knows enough to take the protective measures that would help to contain it.

Faced with this grim reality, the commission produces a set of drastic recommendations. The AIDS virus, the panel notes, is spread in three major ways: by sexual contact, by intravenous drug use, and from mother to child (during pregnancy or through breast feeding). Any approaches that don't block these routes of transmission can't be effective, and AIDS could be expected to spread indefinitely.

Nonetheless, the recommendations create a firestorm of controversy.

The report calls for mandatory AIDS virus testing of every U.S. resident. Everybody will have to carry a photo identification card describing his or her test results. Those who are infected will be barred by law from having sex with uninfected people. Anyone found to have spread the infection will be jailed. Sex outside of marriage will be outlawed. Sodomy laws will be reinstated. If an infected woman becomes pregnant, she will be forced to have an abortion. Everyone entering the country--businessmen, tourists and Americans living abroad--will be quarantined for two weeks and then tested for the virus. All Americans will be tested for intravenous drugs, and drug users will be forced into treatment programs or jailed.

To many, it seems that George Orwell's dark vision of a pervasively monitored society has arrived seven years later than he predicted. It appears that the nation is quickly becoming a society at the mercy of AIDS, divided between those who are infected and those fearing infection. The whole world is beginning to consider the United States a diseased country.

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