AIDS Without End

Report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic

by James D. Watkins chairman. submitted to the President of the United States, June 24, 1988
US Government Printing Office, 201 pp., $11.00 (paper)

And the Band Played On: Politics, People, and the AIDS Epidemic

by Randy Shilts
St. Martin’s, 630 pp., $24.95

The first reactions of many doctors, researchers, and patients to the report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic by retired Admiral James D. Watkins, Chairman, were to admire, with some surprise, the humanity and acuity with which he addressed the AIDS epidemic. These qualities are unusual in bureaucratic governmental reports, and especially unexpected in view of the controversies surrounding this commission: its association with the Reagan administration, the lack of experience or the extreme ideology of some of its members, and the resignation of its first director and another early member. A close reading finds Watkins’s report to be even more coherent philosophically, and more critical of the management of the epidemic, than could be seen at first glance, and it finds the AIDS situation more grave than other recent views have held. It says that we are dealing with a serious and widening national and world health emergency, which is increasingly concentrated in disadvantaged groups—poor women, blacks and Hispanics and their infants, the homeless—whence it is bound to spread further. To contain it will require a nearly limitless budget to effect major social reforms.

The report deals with the incidence and prevalence of AIDS, legal and ethical issues the disease raises, “basic research, vaccine and drug development,” the public health system, an “overview of financing,” and more. Each category is discussed separately, followed by a series of recommendations, and perhaps even more interesting, by a list of “Obstacles to Progress.” Here Watkins indicts “lack of strong leadership,” “excessive concern about potential problems with testing programs and reporting systems,” a confusion about AIDS and HIV, “lack of uniform and strong antidiscrimination laws,” and hundreds of other impediments. The FDA is too slow and disorganized, and working conditions there are “below acceptable standards.” Communities may fail to incorporate HIV information in their classrooms because they “still do not believe the HIV epidemic…will ever affect them.” Admiral Watkins makes the useful point that to use the term AIDS at all is to perpetuate an arbitrary and untrue distinction between the currently ill and those who have tested positive to HIV who will become ill.

The report’s recommendations are specific and sometimes astute: increased funding for primate centers to hasten animal research: a requirement that sharing research data and materials be made a condition of receiving grants; even “assertiveness training” to help people avoid being pressured into unsafe sex. The report makes one conscious of the interconnection of all the remedies: testing and reporting procedures cannot be in place without legal protections against discrimination; without epidemiological data, programs cannot be targeted effectively; reasonable safeguards to privacy must be balanced by the real need of some people (sex partners, health workers, victims of sexual assault) to know who is infected.

That overwhelming revisions of deeply held views are needed is discouraging, in view of what we know about the slowness of social change; but the report is encouraging in that it represents a positive and …

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Letters

AIDS Without End’ December 8, 1988

AIDS Without End’ December 8, 1988