The Miami Herald, Inc.; Tuesday, May 13, 1997
Herald Staff
The number of obituaries mentioning AIDS as a contributor to death is diminishing. AIDS deaths fell to 3,296 in 1996 from 4,381 in 1995, and new cases of HIV infection have been tapering off.
Education apparently has helped stem the infection rate, and a new array of potent, expensive drugs is cutting into the death rate of those infected. So well are those drugs working that scientists indicated last week that they may be able to eliminate the virus or nearly so within two or three years, particularly for those recently infected.
No one is saying the magical word "cure," but not to find the virus in the blood and lymph nodes of patients undergoing the treatment for six months was marvelous news indeed.
Should this news continue to be so good, it will -- or should -- open debate over public policy. The medicines are expensive; the disease has moved aggressively into poor populations. That raises issues of financing and of rationing. Only a fraction of the money needed to help the uninsured is available. Florida is channeling that to sicker patients, but the new studies' hopeful results were among patients with recent infection.
Further, if recent infection can be treated quite effectively, should states press to manage AIDS as they do other sexually transmitted diseases, by tracing sexual contacts? Or would that discourage early testing, as many AIDS activists continue to argue?
And how can states ensure that those who take the drugs are following a complex regime of specific medications at specific times? The state has trouble enough getting some people to take daily pills for tuberculosis.
The politics of AIDS has been volatile in the last two decades; as science moves toward resolving at least some of the medical issues, public policy will need to make that same progress.
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