San Francisco Chronicle - Monday November 13, 1989
Randy Shilts

At the end of the talk, when everyone else has left, they approach Osborn, grasp her hand and tell of a son or daughter who has died. Frequently, the exchange marks the first time the parent has ever told anyone, because he or she is ashamed and frightened of what other people might think.

"It strikes me there's so much pain out there all over the country -- and not just in New York and San Francisco -- but it's a quiet grief," says Osborn, dean of the University of Michigan School of Public Health.

"The idea of losing one of my children is hard enough to imagine," she says. "To lose one and not be able to talk about it is way beyond imagination."

To Osborn, this shame strikes at the heart of what is wrong with how America is dealing with AIDS. "This is an epidemic of sick people, not guilty people," she says. "That's the point we've got to get across."

During the next two years, Osborn will have ample opportunity to make this point in her new role as chairwoman of the National Commission on Acquired Immune Deficiency Syndrome.

A CENTRAL ROLE

As chief of the panel that is supposed to advise both Congress and the White House on federal AIDS policy, the 52-year-old pediatrician has assumed a central role in the debates over how America will grapple with the burgeoning epidemic.

Osborn and her 15-member commission, appointed jointly by President Bush and by Republican and Democratic congressional leaders, enter the fray at a particularly perilous time for AIDS policy.

On the one hand, consensus has been achieved on some of the critical social issues that split the government in earlier years, such as AIDS-related discrimination. Under Bush, White House pronouncements on AIDS are guided more by public health experts than by the ultraconservative ideologues who determined so much of the AIDS policy under President Reagan.

On the other hand, pressing issues remain largely unaddressed.

Hard-hit cities such as San Francisco and New York are in need of emergency funds to help them shoulder the skyrocketing costs of patient care. To stem the epidemic in the impoverished inner cities, recovery programs to treat drug addiction must be vastly expanded. Early intervention programs are desperately needed to deliver the medical breakthroughs in HIV management to the estimated 1.5 million Americans infected with the AIDS virus.

NEW PROGRAMS

What all these issues have in common is that they cost money. At a time when domestic programs are facing cuts, nobody knows where the money will come from. With neither Congress nor the president enthusiastic about adding to the federal budget, there will be few champions for expensive new programs, which means Osborn will be left with the task of prodding for the new expenditures.

President Bush's selection of Dr. Antonia Novello to succeed outspoken Surgeon General C. Everett Koop has made Osborn's new job even more crucial. An expert on pediatric AIDS, Novello is universally respected in AIDS circles around the country, but she is not expected to be the headline-grabbing media star that Koop was.

Given this, the role of leading advocate for AIDS programs will fall increasingly to Osborn. Because of Osborn's long record on a number of public health issues, her selection was enthusiastically acclaimed by AIDS experts and advocacy groups.

Still, it remains to be seen whether her lower-key, professorial style will be able to galvanize the broad coalitions that Koop and James Watkins, chairman of President Ronald Reagan's AIDS commission and now energy secretary, created around controversial AIDS issues.

For her part, Osborn hopes that the commission will use its influence to formulate long-term solutions for problems in America's health system that have been illuminated by AIDS but run far deeper than just one disease.

HEALTH-CARE SYSTEM'S CRACKS

"The only thing new about this epidemic is this one virus," she says. "It's shown the cracks in the health-care system, such as how unevenly available" medical attention is for the poor.

"We need to develop a sense of national urgency about the need to develop equity in the health-care system," she says.

By "putting a spotlight on areas that need attention," Osborn said, she hopes the commission can have a concrete effect on the epidemic and do more than issue reports that get widely applauded but roundly ignored.

Ultimately, however, Osborn believes that there is only one public health spokesman in the United States who carries the kind of credibility that is needed to mobilize a sense of national resolve to fight the AIDS epidemic.

"I'd like to ask President Bush to do something so cheap it would blow your mind," she says. "I'd ask him to talk to the American people, to convey the seriousness of the situation. He has the potential of making everybody's job easier by clearing the air of fear."

Only with such a resolute statement will the time come when June Osborn figures she will be able to give a speech and not see fearful, lonely figures in the back of the room, waiting to talk to someone about their secret pain.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1989. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .