A I D S T his is a report from the Surgeon General of the U.S. Public Health Service to the people of the United States on AIDS. Acquired Immune Deficiency Syndrome is an epidemic that has already killed thousands of people, mostly young, productive Americans. In addition to illness, disability, and death, AIDS has brought fear to the hearts of most Americans- fear of disease and fear of the unknown. Initial reporting ofAIDS occurred in the United States, but AIDS and the spread of the AIDS virus is an international problem. This report focuses on prevention that could be applied in all countries. My report will inform you about AIDS, how it is transmitted, the relative risks of infection and how to prevent it. It will help you understand your fears. Fear can be useful when it helps people avoid behav- ior that puts them at risk tbr AIDS. On the other hand, unreasonable fear can be as crippling as the disease itself, If you are participating in activities that could expose you to the AIDS virus, this report could save your life. A I D s IL preparing this report, I consulted with the best medical and scientific experts this countty can offer. I met with leaders of organizations concerned with health, education, and other aspects of our society to gain their views of the problems associated with AIDS. The information in this report is current and timely. This report was written personally by me to provide the necessary understanding ofAIDS. The vast majority ofAmericans are against illicit drugs. As a health officer I am opposed to the use of illicit drugs. As a practicing physician for more than forty years, I have seen the devastation that follows the use of illicit drugs - addiction, poor health, fam- ily disruption, emotional disturbances and death. I applaud the President's initiative to rid this nation of the curse of illicit drug use and addiction. The success of his initiative is critical to the health of the American people and will also help reduce the number of persons exposed to the AIDS virus. Some Americans have difficulties in dealing with the subjects of sex, sexual practices, and alternate lifestyles. Many Americans are opposed to homo- sexuality, promiscuity of any kind, and prostitution. This report must deal with all of these issues, but does so with the intent that information and educa- tion can change individual behavior, since this is the primary way to stop the epidemic ofAIDS. This report deals with the positive and negative conse- quences of activities and behaviors from a health and medical point of view. Adolescents and pre-adolescents are those whose behavior we wish to especially influence because of their vulnerablity when they are exploring their` own sexuality (heterosexual and homosexual) and perhaps experimenting with drugs. Teenagers often consider themselves immortal, and these young people may be putting themselves at great risk. A I D `S Education about AIDS should start in early ele- mentary school and at home so that children can grow up knowing the behavior to avoid to protect themselves Ii-am exposure to the AIDS virus. The threat ofAIDS can provide an opportunity for par- ents to instill in their children their own moral and ethical standards. Those of & who are parents, educators and com- munity leaders, indeed all adults, cannot disregard this responsibility to educate our young. The need is critical and the price of neglect is high. The lives of our young people depend on our fulfXng our responsibility. AIDS is an infectious disease. It is contagious, but it cannot be spread in the same manner as a common cold or measles or chicken pox. It is con- tagious in the same way that sexually transmitted diseases, such as syphilis and gonorrhea, are conta- gious. AIDS can also be spread through the sharing of intravenous drug needles and syringes used for injecting illicit drugs. AIDS is not spread by common everyday contact but by sexual contact (penis-vagina, penis-rectum, mouth-rectum, mouth-vagina, mouth-penis). Yet there is great misunderstanding resulting in unfounded feat that AIDS can be spread by casual non-sexual contact. The first cases ofAIDS were reported in this country in 1981. We would know by now ifAIDS were passed by casual, non-sexual contact. Today those practicing hish risk behavior who become infected with the AIDS virus are bund mainly among homosexual and bisexual men and male and female intravenous drug users. Heterosexual tmns- mission is expected to account fbr an increasing proportion of those who become infected with the AIDS virus in the future. 4 5 A I D s At the beginning of the AIDS epidemic many Americans had little sympathy for people with AIDS. The feeling was that somehow people from certain groups "deserved" their illness. Let us put those feelings behind us. We are fighting a disease, not people. Those who are already a&ted are sick people and need our care as do all sick patients. The country must face this epidemic as a unified society. We must prevent the spread ofAIDS while at the same time preserving our humanity and intimacy. AIDS is a life-threatening disease and a major pub- lic health issue. Its impact on our society is and will continue to be devastating. By the end of 1991, an estimated 270,000 cases of&DS will have occurred with 179,000 deaths within the decade since the disease was lit-s recognized. In the year 1991, an estimated 145,000 patients with AIDS will need health and supportive setices at a total cost of between $8 and $16 billion. However, AIDS is preventable. It can be controlled by changes in personal behavior. It is the responsibility of every citizen to be informed about AIDS and to exercise the appropriate preven- tive measures. This report will tell you how. The spread ofAIDS can and must be stopped. C. Everett Koop, M.D., Sc.D. Smgeon Gem?& 6 A I D s AIDS AIDS Caused by Virus T he letters A-I-D-S stand for Acquired Immune Deficiency Syndrome. When a person is sick with AIDS, he/she is in the I&I stages of a series of health prob- lems caused by a virus (germ) that can be passed born one person to another chiefly during sexual contact or through the sharing of intravenous drug needles and syringes used for "shooting" drugs. Scientists have named the AIDS virus "HIV or HTIV-III or LAW. These abbreviations stand for information denoting a virus that attacks white blood cells (T-Lymphocytes) in the human blood. Throughout this publication, we will calI the virus the `AIDS virus." The `These are different names given to AIDS virus by the scientific community: HIV - Human ImmuncdeficiencyVirs HTLWIII - Human TLymphotropic Virus T$pe III LA!! - Lymphadenopathy AssociatedVirus 9 A I D S AIDS virus attacks a person's immune system and damages his/ her ability to fight other disease. Without a functioning immune system to ward off other germs, he/she now becomes vulnerable to becoming infected by bacteria, protozoa, fungi, and other viruses and malignancies, which may cause life-threatening illness, such as pneumonia, meningitis, and cancer. No A-vlollm Cllre There is presently no cure for AIDS. There is presently no vaccine to prevent AIDS. A I D S Virus Invades Blood Stream ARC SignsandSymptoms No Signs Some people remain apparently well after infection with the AIDS virus. They may have no physically apparent symp- toms of Illness. However, ifptoper precautions are not used with sexual contacts and/or intravenous drug use, these infected individuals can spread the virus to others. Anyone who thinks he or she is infected or Involved in high risk behaviors should not donate his/her blood, organs, tissues, or sperm because they may now contain the AIDS virus. when the AIDS virus enten the blood stream, it begins to attack certain white blood cells (T-Lymphocytes). Sub- stances called antibodies are produced by the body These antibodies can be detected in the blood by a simple test, usually two weeks to three months after Infection. Even before the antibody test is posifive, the victim can pass the virus to others by methods that will be explained. Once an individual is infected, there are several possi- bilities. Some people may remain well but even so the-y are able to infect others. Others may develop a disease that is less serious than AIDS referred to as AIDS Related Complex (ARC). In some people the protective immune system may be destroyed by the virus and then other germs (bacteria, protozoa, fungi and other viruses) and cancers that ordi- narily would never get a foothold cause "opportunistic diseases.. ." using the opportunity of lowered resistance to infect and destroy. Some of the most common are Pneumocyst& carinii pneumonia and tuberculosis. Indi- viduals infected with the AIDS virus may also develop certain types of cancers such as Kaposi's sarcoma. These infected people have classic AIDS. Evidence shows that the AIDS virus may also attack the nervous system, causing damage to the brain. AIDS-Related Complex (ARC) is a condition caused by the AIDS virus In which the patient tests positive for AIDS infection and has a specific set of clinical symptoms. How- ever, ARC patients' symptoms are often less severe than those with the disease we call classic AIDS. Signs and symptoms of ARC may Include loss of appetite, weight loss, fever, night sweats, skin t-ashes, diarrhea, tiredness, lack of resistance to Infection, or swollen lymph nodes. These are aLso signs and symptoms of many other diseases and a physician should be consulted. AIDS Only a qualified health professional can diagnose AIDS, which is the result of a natural progress of infection by the AIDS virus. AIDS destroys the body's immune (defense) system and allows otherwise controllable infzctions to invade the body and cause additional diseases. These opportunistic diseases would not otherwise gain a l&A-told in the body. These opportunistic diseases may eventually cause death. Some symptoms and signs ofAIDS and the "opportunistic infections" may Include a persistent cough and fever asso- ciated with shortness ofbreath or difficult breathing and 10 11 A I D s may be the symptoms of Pneumoc~~& carinii pneumonia Multiple purplish blotches and bumps on the skin may be a sign of Kaposi's sarcoma. The AIDS virus in all infected people is essentially the same; the reactions of individuals may differ. Long Tam The AIDS virus may also attack the nervous system and cause delayed damage to the brain. This damage may take years to develop and the symptoms may show up as memory loss, indifference, loss ofcoordination, partial paralysis, or mental disorder. These symptoms may occur alone, or with other , `50 of these health workers reported possible additional exposure b!, direct 12 13 A A I D S contact with a patient's body fluid through spills or being accidentally stuck with a needle. Upon testing these 750, only 3 who had accidentally stuck themselves with a needle had a positive antibody test %)r exposure to the AIDS virus. Because health workers had much more contact with patients and their body tluids than would be expected horn common everyday contact, it is clear that the AIDS virus is not transmitted by casual contact. Control of Certain Behaviors Can Stop Further Spread of AIDS Knowing the facts about AIDS can prevent the spread of the disease. Education of those who risk infecting them- selves or infecting other people is the only wy we can stop the spread of AIDS. People must be responsible about their sexual behavior and must avoid the use of illicit intrave- nous drugs and needle sharing. We will describe the types of behavior that lead to infection by the AIDS virus and the personal measures that must be taken for effective protec- tion. Ifwe are to stop the AIDS epidemic, we all must under- stand the disease-its cause, its nature, and its prmention. Precautions must be taken. The AIDS virus infects persons who expose themselves to known risk behavior, such as certain t)ipes of homosexual and heterosexual activities or sharing intravenous drug equipment. Risks Although the initial discovety was in the homosexual com- munity, AIDS is not a disease only of homosexuals. AIDS is found in heterosexual people as well. AIDS is not a black or white disease. AIDS is not just a male disease. AIDS is found in women; it is found in children. In the future AIDS will probably increase and spread among people who are not homosexual or intravenous drug abusers in the same manner as other sexuak transmitted diseases like syphilis and gonorrhea. Sex Betureen Men Men who have sexual relations with other men are espe- cially at risk. About 70 percent ofAIDS victims throughout the country are male homosexuals and bisexuals. This percentage probahh; will decline as heterosexual transmis- sion increases. Infection wsultsfknn a sexual relationship with an infected person. The risk of infection increases according to the number of sexual partners one has, male orfemale. The more partners yu have, the greater the risk of becoming infected with the AIDS virus. 14 A I D s A I D s Although the AIDS virus is found in several body fluids, a person acquires the virus during sexual contact with an infected person's blood or semen and possibly vaginal secretions. The virus then enters a person's blood stream through their rectum, vagina or penis. Small (unseen by the naked eye) tears in the surface lining of the vagina or rectum may occur during insertion of the penis, fingers, or other objects, thus opening an avenue for entrance of the virus directb into the blood stream; therefore, the AIDS virus can be passed from penis to rectum and vagina and vice versa without a visible tear in the tissue or the presence of blood. Couples who maintain mutually tithful monogamous rela- tionships (only one continuing sexual partner) are pro- tected from AIDS through sexual transmission. If you have been faithful for at least five years and your partner has been faithful too, neither of you is at risk. Ifyou have not been faithful, then you and your partner are at risk. If your partner has not been faithful, then your partner is at risk which also puts you at risk. This is true for both hetero- sexual and homosexual couples. Unless it is possible to know-with absolute certainty that neither you nor your sexual partner is not carrying the virus of AIDS, you must use protective behavior. Absolute certainty means not on$ that you and your partner have maintained a mutually faith- ful monogamous sexual relationship, but it means that neither you nor your partner has used illegal intravenous drugs. AIDS: you can protect yourself from infection s ome personal measures are adequate to safely protect yourself and others from infection by the AIDS \.irus and its complications. Among these are: . If you have been invohred in any of the high risk sexual activities described above or hnre iniected illicit intra- venous drugs into your body. you should have a blood test to see if you have been infected with the AIDS virus. . Ifyour test is positive or ifyou engage in high risk activ- ities and choose not to have a test, \T)LI should tell your sexual partner. If you jointb decide to have sex, you must protect your partner by ahqs using a rubber (condom) during (start to finish) sexual intercourse (vagina or rectum). . Ifyour partner has a positive blood test showing that he/ she has been infected with the AIDS virus or you suspect that he,jshe has been exposed by previous heterosexual or homoseA1 behavior or use of intm~enous drugs n-ith shared needles and syringes. a rubber (condom ) sl~oulci alnx~s bc uw.1 during ( st:lrt to fini5li ) sczu,ll intercourse (~lginn or rectum ). 16 I- A I 1) s . IF you or your panner is at high risk, avoid mouth contact with the penis, vagina, or rectum. . Avoid all sexual activities which could cause cuts or tears in the linings of the rectum, vagina, or penis. . Single teen-age girls have been warned that pregnancy and contracting sexually transmitted diseases can be the result of only one act of sexual intercourse. They have been taught to say NO to sex! They have been taught to say NO to drugs! By saying NO to sex and drugs, tht? can avoid AIDS which can kill them! The same is true for teenage boys who should also not have rectal intercourse with other males. It may result in AIDS. . Do not have sex with prostitutes. Infected male and female prostitutes are frequently also intravenous drug abusers; thereFore, they may infect clients by sexual inter course and other intravenous drug abusers by sharing their intravenous drug equipment. Female prostitutes also can infect their unborn babies. A I 11 s Drug abusers who inject drugs into their veins are another population group at high risk and with high rates of infec- tion by the AIDS virus. LJsers of intravenous drugs make up 25 percent of the cases ofAIDS throughout the country. The AIDS virus is carried in contaminated blood left in the needle, syringe, or other drug related implements and the virus is injected into the new Lictim by reusing dirty .syringes and needles. Even the smallest amount of infected blood left in a used needle or syringe can contain live AIDS virus to be passed on to the next user of those dirty implements. No one should shoot up drugs because of addiction, poor health, family: disruption, emotional disturbances and death that follow. However. many drug users are addicted to drugs and for one reason or another have not changed their behavior. For these people. the only way not to get AIDS is to use a clean, pra'iotid~~ unusedneedle, syringe or an)- other implement necessary for the injection of the drug solution. Some persons with hemophilia (a blood clotting disorder that makes them subject to bleeding) have been infected with the AIDS virus either through blood transfusion or the use of blood products that help their blood clot. Now that we know how to prepare safe blood products to aid clotting, this is unlikely to happen. This group represents a very small percentage of the cases of AIDS throughout the country Currentl>' all blood donors are initially screened and blood is not accepted from high risk individuals. IUoocl that has been collected for use is tested for the presence of antibod), to the AIDS virus. I lowever, some people ma>* ha1.e had a blood transfusion prior to March 1985 before \\.e knew bon to screen blood for safe transfilsion and ma)- have become 18 19 A I D P infected with the AIDS virus. Fortunately there are not now a large number of these cases. With routine testing ofblood products, the blood supply fbr transf&ion is now safer than it has ever been with regard to AIDS. Persons who have engaged in homosexual activities or have shot street drugs within the last 10 years should neuer donate blood. Mother Can Infect Newborn If a woman is infected with the AIDS virus and becomes pregnant, she is more likely to develop ARC or classic AIDS, and she can pass the AIDS virus to her unborn child. Approximately one third of the babies born to AIDS-infected mothers will also be infected with the AIDS virus. Most of the infected babies will eventually develop the disease and die. Several of these babies have been born to wives of hemophiliac men infected with the AIDS virus by way of contaminated blood products. Some babies have also been born to women who became infected with the AIDS virus I~!. bisexual partners who had the virus. Almost all babies with AIDS have been born to women who were intravenous A I 11 s drug users or the sexual partners of intravenous drug users who were infected with the AIDS virus. More such babies can be expected. Think carefully ifyou plan on becoming pregnant. If there is any chance that you may be in any high risk group or that you have had sex nith someone in a high risk group, such as homosexual and bi-sexual males, drug abusers and +eir sexual partners. see your doctor. AIDS a@cts certain groups of the population. Homosexual and bisexual males u60 IJaw bad sexual corztact with other homosexual or bisexual males as well as those uho "slwot"street drugs are atgreatest tisk of e-lposure, infec- tion and ewntual death Sexualpartnevs sf these h@ risk individuaLFare at t-i& as well as aqj children born to uomen who cany the ~M.ts. Hete?vsexrtalpersolzc are increasii@y at r&k AIDS: what is safe Everyd? living does not present any risk of infection. You cannotget AIDS f?om casual social contact. Casual social contact should not be confused with casual seazalcontact which is a major cause of the spread of the AIDS virus. Casual social contact such as shaking hands, hugging, social kissing, qing, coughing or sneezing, will not transmit the AIDS virus. Nor has AIDS been contracted l?om sn,imming in pools or hot tubs or from eating in restaurants (even if a restaurant worker has AIDS or carries the AIDS virus.) AIDS is not contracted from sharing bed linens, towels, CUPS, straws, dishes, or any other eating utensik. \ixr cannot get AIDS l?om toilets, doorknobs, telephones. office machiner?; or household furniture. You cannot get AIDS from hod> massages. masturbation or any non-sexual hod!. ColltXt. 20 21 A I D s In the I'.S. ever). blood donor is screened to es&& high risk persons and e~w?. Ihod donation is now tested for the presence of :untihoclics to the AIDS Lirus. Blood that sho~vs esposure to the AIDS \,irus I,!, the presence of antibodies is not iisecl either for transfiision or for the manufacture of tAoocl products. I\lood b:inks are as safe as current tcch- nolog!- can make them. Because antibodies do not form imniedi:itel!~ atier exposure to the virus, a newly infected person mai!' imknoningly donate bk)od afier becoming infected but before his her antibody test becomes posi- ti1.e. It is estim:ited that this might occur less than once in 100.000 transfilsions. There is no danger of AIDS virus infection thorn visiting a doctor. dentist. hospital, hairdresser or beautician. AIDS cannot be transmitted non-sexually fiorn an infected per- son through a health or senice provider to another person. Ordinary methods of disinfection for urine, stool and vomitus which are LISA for non-infected people are ade- quate for people who have AIDS or are carving the AIDS virus. You may have wondered why your dentist Wears gloves and perhaps a mask when treating you. This does not mean that he has AIDS or that he thinks you do. He is protecting you and himself from hepatitis, common colds or flu. There is no danger in visiting a patient with AIDS or caring for him or her. Normal hygienic practices, like wip- ing of body fluid spills with a solution of water and house- hold bleach ( 1 part household bleach to 10 parts water), will provide full protection. Children in School None of the identified cases of AIDS in the United States are known or are suspected to have been transmitted fi-om one child to another in school, day care, or foster care settings. Transmission would necessitate exposure of open 22 23 A I D 3 cuts to the blood or other body Buids of the infected child. a highly unlikely occurrence. Even then routine safety pro- cedures for hmding blood or other body fluids (n-hich sho~~ld be standard for all children in the school or da!. care setting) rould be effective in preventing transmission fi-om children nith AIDS to orher children in school. Children nirh AIDS are highly susceptible to infections, such as chicken pox, ~!?om other children. Each child with AIDS sho~~ld be examined by a doctor before attending school or before returning ro school, day care or foster care settings after an illness. No blanket rules can be made for all school boards to cover :111 possible cases of children mith AIDS and each case should be considered separately and individualized to tile child and the setting, as would be done with any child with a special problem, such as cere- bral palsy or asthma. A good team to make such decisions with the school board would be the child's parents, physi- cian and a public health ol%cal. Casual social contact hem-een children and persons infected nith the AlDS virus is not dangerous. Insects There are no known cases of AIDS transmission by insects, such as mosquitoes. Pets Dogs, cats and domestic animals are not a source of infec- tion Tom AIDS virus. Tears and Saliva Although the AIDS virus has been found in tears and saliva, no instance of transmission born these body fluids has been reported. ADS comesfrom sexual contacfS with infectedpersons andfiom the sburing of syringes and needles i%ere is no danger of infection with ADS virus by casualsocial contact. Testing of Military Personnel You may wonder why the Department of Defense is cur- rently testing its uniformed services personnel for presence of the AIDS virus antibody. The military feel this procedure is necessary because the uniformed seMces act as their own blood bank in a time of national emergency. They also need to protect new recruits (who unknowingly may be AIDS virus carriers) kom receiving live virus vaccines. These vaccines could activate disease and be potentially life-threatening to the recruits. 24 25 A S AIDS: what 3s currently understood A lthough AIDS is still a mysterious disease in many ways, our scientists have learned a great deal about it. In five years we know more about AIDS than many diseases that we have studied for even longer periods. While there is no vaccine or cure, the results Tom the health and behavioral research community can only add to our knowl- edge and increase our understanding of the disease and ways to prevent and treat it In spite of all that is known about transmission of the AIDS virus, scientists will learn more. One possibility is the I. Virus enters \ white blood cells. 4. Immune svstem weakened. 5. Bad! susceptible to unusual "ouoortunistic L I diseases " potential discovety of factors that may better explain the mechanism of AIDS infection. Wy are the antibodiesproduced @ the boa$ toJight the AIDS k-us not able to destroy that 1 -ims? The antibodies detected in the blood of carriers of the AIDS virus are ineffective, at least when classic AIDS is actually triggered. They cannot check the damage caused by the virus, which is by then present in large numbers in the body. Researchers cannot explain this important observation. We still do not know why the AIDS virus is not destroyed by man's immune qstem. S- AIDS no longer is the concern of any one segment of sociew it is the concern of us alI. No American's life is in danger if heishe or their sexual partners do not engage in high risk sexual behavior or use shared needles or syringes to inject illicit drugs into the body. People who engage in high risk sexual behar-ior or who shoot drugs are risking infection with the AIDS virus and are risking their lives and the lives of others, including their unborn children. We cannot yet know the full impact of AIDS on our society. From a clinical point of lien; there rnq. be new manifestations of AIDS- for example, mental distrubances due to the infection of the brain by the AIDS virus in carriers of the virus. From a social point of vim, it may bring to an end the tiee-wheeling sexual lifesvle which has been called the sexual rmolution. Economicah the care of AIDS patients will put a tremendous strain on our alread) overburdened and costb health care deliveT s!%em. The most certain way to avoid getting the AIDS ~.irus and to control the AIDS epidemic in the United States is for individuals to avoid promiscuous sexual practices, to main- tain mutuab faithful monogamous sexual relationships and to avoid injecting illicit drugs. A I D S A I D S Look to the Future The Cbaiknge of the Future A n enormous challenge to public health lies ahead of us and we would do well to take a look at the future. We must be prepared to manage those things we can pre- dict, as well as those we cannot. At the present time there is no vaccine to prevent AIDS. There is no cure. AIDS, which can be transmitted sexually and by sharing needles and syringes among illicit intrave- nous drug users, is bound to produce profound changes in our society, changes that will affect us all. Information and Education Oniy Weapons Agaimt AIDS It is estimated that in 191 54,000 people will die Ii-om AIDS. At this moment, many of them are not infected with the AIDS virus. W%h proper information and education, as many as 12,000 to 14,000 people could be saved in 1!9!91 fkom death by AIDS. ALDS will Impact All The changes in our society will be economic and political and will affect our social institutions, our educational prac- tices, and our health care. Although AIDS may never touch you personally,the societal impact certainly will. Concern About @read of AIDS While the concentration of AIDS cases is in the larger urban areas today, it has been found in eve? state and with the mobility of our society, it is likely that cases of AIDS will appear far and n+de. Specki Educaiioncrl concerns There are a number of people, primarib adolescents, that do not yet know they will be homosexual or become drug abusers and will not heed this message: there are others who are illiterate and cannot heed this message. They must be reached and taught the risk behaviors that expose them to infection with the AIDS virus. High Risk Get Blood Test The greatest public health problem lies in the Large num- ber of individuab with a history of high risk behavior who have been infected with and may be spreading the AIDS virus. Those with high risk behavior must be encouraged to protect others by adopting safe sexual practices and b> the use of clean equipment for intmrenous drug use. If a blood test for antibodies to the AIDS virus is necessary to get these individuals to use safe sexual prxtices, the! should get a blood test. Call your local health department for information on where to get the test. Be Educated - Be Prepared Be prepared. Learn as much about AIDS as you can. Learn to separate scientific infbrmation from rumor and myth. The Public Health Service, your local public health officiab and family physician will be able to help you. Some people aacted nith AIDS will feel :I sense of anger and others a sense of guilt. In spite of these understand- able reactions, eveTone must join the effort to control the epidemic, to provide for the care of those nith .%IDS, and to do all n-e can to inform :~nd educate others about AIDS. and ho-3~ to pre\.ent iI. 28 A I D S A I D S Confidentiality Because of the stigma that has been associated with AIDS, many afaicted with the disease or who are infected with the AIDS virus are reluctant to be identified with AIDS. Because there is no vaccine to prevent AIDS and no cure, many feel there is nothing to be gained by revealing sexual contacts that might also be infected with the AIDS virus. When a community or a state requires reporting of those infected with the AIDS virus to public health authorities in order to trace sexual and intravenous drug contacts-as is the practice with other sexually transmitted diseases-those infected with the AIDS virus have gone underground out of the mainstream of health care and education. For this reason current public health practice is to protect the privacy of the individual infected with the AIDS virus and to maintain the strictest confidentiality concerning his/her health records. State and Local AIDS Tmk FWces Many state and local jurisdictions where AIDS has been seen in the greatest numbers have AIDS task forces with heavy representation born the field of public health joined by others who can speak broadly to issues of access to care, provision of care and the availability of community and psychiatric support setices. Such a task force is needed in every community with the power to develop plans and policies, to speak, and to act for the good of the public health at every level. State and local task forces should plan ahead and work collaboratively with other jurisdictions to reduce transmis- sion of AIDS by far-reaching informational and educational programs. As AIDS impacts more strongly on society, they should be charged with making recommendations to pro- vide for the needs of those afllicted with AIDS. They also will be in the best position to answer the concerns and direct the activities of those who are not infected with the AIDS virus. The responsibility of State and local task forces should be far reaching and might include the following areas: . Insure enforcement of public health regulation of such practices as ear piercing and tattooing to prevent trans- mission of the AIDS virus. . Conduct AIDS education programs for police, firemen, correctional institution workers and emergency medical personnel for dealing with $IDS victims and the public. . Insure that institutions catering to children or adults who soil themselves or their surroundings with urine, stool, and vomitus have adequate equipment for cleanup and disposal, and have policies to insure the practice of good hygiene. School Schools will have special problems in the future. In addition to the guidelines already mentioned in this pamphlet, there are other things that should be considered such as sex education and education of the handicapped. Sex Education Education concerning AIDS must start at the lowest grade possible as part of any health and hygiene program. The appearance of AIDS could bring together diverse groups of parents and educators with opposing views on inclu- sion of sex education in the curricula. There is now no doubt that we need sex education in schools and that it include information on heterosexual and homosexual rela tionships. The threat of AIDS should be sufficient to per- mit a sex education curriculum with a heavy emphasis on prevention of AIDS and other sexually transmitted diseases. Children with AIDS or ARC will he attending school along with others who carry the AIDS virus. Some children wiU dn.elop brain disease which will product changes in men~l 30 31 A I II s A I I> s behavior. Because of the right to special education of the handicapped and the mentally retarded, school boards and higher authorities will have to provide guidelines for the management of such children on a case-by-case basis. The strain on the health system can be lessened by family, social, and psychological support mechanisms in the community. Programs are needed to train chaplains, clergy, social workers, and volunteers to deal n-ith AIDS. Such support is critical to the minority communities. Labor and management can do much to prepare for AIDS so that misinformation is kept to a minimum. Unions should issue preventive health messages because many employees will listen more carefuliy to a union message than they will to one from public health authorities. AI15 Education at the NW-k .Site Offices, factories, and other work sites should have a plan in operation for education of the work force and accom- modation of AIDS or ARC patients before the first such case appears at the work site. Employees with AIDS or ARC should be dealt with as are any workers with a chronic illness. In-house video programs provide an excellent source of education and can be individualized to the needs of a specific work group. Strain on the Health Caw De& evy System The health care system in many places will be over bur- dened as it is now in urban areas with large numbers of AIDS patients. It is predicted that during 1991 there will be 145,000 patients requiring hospitalization at least once and 54,000 patients who will die of AIDS. Mental disease (dementia) will occur in some patients who have the AIDS virus before they have any other manifestation such a5 ARC or classic AIDS. State and local task forces will have to plan for these patients by utilizing conventional and time honored sys- terns but will also have to investigate alternate methods of treatment and alternate sites for care including homecare. Our sociev will also face an additional burden as we bet- ter understand the mental health implications of infection by the AIDS virus. LJpon being inf?)rmcd of infection with the AIDS virus, a young, active, vigorous person faces anxi- ety and depression brought on I>>- fears associated with social isolation, illness, and dying. Dealing with these illdi- vidual and family concerns will require the best ei%orts of mental health professionals. A number of controversial AIDS issues have arisen and will continue to be debated largely because of lack of knowledge about AIDS, how it is spread, and how it can be prevented. Among these are the issues of compuboq blood testing, quarantine, and identification of AIDS carriers by some visible sign. Compulsory blood testing of individuals is not necessar): The procedure could be unmanageable and cost prohib- itive. It can be expected that many who test negati\,ely might actually be positive due to recent exposure to the AIDS virus and give a fabe sense of security to the individual and his/her sexual partners concerning necessary protec- tive behavior. The prevention behavior described in this report, if adopted, will protect the American public and contain the AIDS epidemic. Voluntary testing will be avails able to those who have been involved in high risk behavior. 32 33 A I D s Quarantine has no role in the management of AIDS hccaustr AIDS is not spread by casual contact. The on1~. time that some form of quarantine might be indicated is in a situa- tion where an individual carg,ing the UDS \-irus kntmingl) and n-illin&, continues to espose others through sexual contact or sharing drug equipment. Such circumstances should be managed on a case-by-case ba.sis by iocal authorities. Iden tificntion of AIDS Curriers by Some Esible Sign Those who suggest the marking of carriers of the AIDS virus by some visible sign have not thought the matter through thoroughly. It would require testing of the entire population which is unneces.~, unmanageable and costly. It would miss those recently infected individuals who would test negatively, but be infected. The entire procedure would give a false sense of security AIDS must and will be treated as a disease that can infect anyone. AIDS should not be used as an excuse to discriminate against any group or individual. Updating Information As the Surgeon General, I aill continually monitor the most current and accurate health, medical, and scientific information and make it available to you, the American people. Armed with this information !-ou can join in the discussion and resolution of AIDS-related issues that are critical to )`our health, your children's health, and the health of the nation. A I D s Additional Information Telephone Hotlines (Toil Free) PHS AIDS Hotline 800.342.AIDS 800-342-2437 Nationally Sexually Ti-ans- mitted Diseases Hotline/ American Social Health Association 800-227-8922 Information Sources i.!S Public Health Sewice Public Affairs Ofice Hubert H. Humphrey Building, Room 721-H 200 Independence Avenue, SW. Washington, D.C. 20201 Phone: (202) 245-6867 National Gay Task Force AIDS Information Hotline 800-221-7044 (212) 807-6016 (NY State) Local Red Ctvss OY American Red Cross AIDS Education Ofice 1730 D Street, N.W. Washington, D.C. 20006 Phone: (202) 737-8300 American Association of Physicians fbr Human Rights PO. Box 14366 San Francisco, C4 94114 Phone: (415) 558-9353 AILlSAction Council 729 Eighth Street, S.E., Suite 200 Washington, D.C 20003 Phone: (202) 547-3101 Gay Men's Health G-is& PO. Box 274 132 West 24th Street NewYork, NY 10011 Phone: (212) 807-6655 Hispanic AIDS Forum c/o APRED 853 Broadwy, Suite 2007 New York, NY 10003 Phone: (212) 870-1902 or 870-1864 Los Angeles AIDS Pmject 1362 Santa Monica E3oulevard Los Angeles, CaIibmia !90046 (213) 871ADS 34 35 A I D S Minority Tmk Force on AIDS c/o NewYork City Council of Churches 475 Riverside Drive, Room 456 NewYork, NY 10115 Phone: (212) 749-1214 Mothers of AIDS Patients (MAP) c/o Barbara Peabody 3403 E Street San Diego, CA 92102 (619) 234-3432 National AIDS Network 729 Eighth Street, S.E., Suite 300 Washington D.C. 20003 (202) 546-2424 NationalAssociation of People with ALDS PO. Box 65472 Washington, D.C. 20035 (202) 483-7979 National Coalition of Gay Sexually Transmitted Disease SewiLes c/o Mark Behar P.O. Box 239 MiIwaukee, WI 53201 Phone: (414) 277-7671 National Council of Cburches/luDS Tak Force 475 Riverside Drive, Room 572 NewYork, NY 10115 Phone: (212) 870-2421 San Fran&coAIDS Found&ion 333 Valencia Street, 4th Floor San Francisco, CA 94103 Phone: (415) 863-2437