Subject: Bigger Battle Against AIDS Severely Hampered By Fights Date: Published: 12/28/87 147 lines Source: WALL STREET JOURNAL. Copyright Dow Jones & Co. Inc. Bigger Battle Against AIDS Severely Hampered By Smaller Fights in Congress, Administration --- By John E. Yang Staff Reporter of The Wall Street Journal WASHINGTON -- In trying to set a consistent policy on the deadly AIDS epidemic, Congress and the Reagan administration have worked themselves into a state of near paralysis. As death tolls and medical warnings continue to mount, official Washington remains riven by the emotionally volatile issue. The very nature of the disease raises the kinds of issues of personal morality -- such as sexual preference and drug use -- that Washington seems least capable of coming to grips with. The result is that the battle against AIDS, or acquired immune deficiency syndrome, has lagged badly. While lawmakers have increased research funds, liberals and conservatives sharply disagree on such critical, and unresolved, topics as who should be tested and how explicit education should be. Meanwhile, the administration itself is split between public-health officials and more ideological conservatives, while President Reagan's commission on AIDS has been wracked by bitter infighting, resignations and complaints that it lacks experts on the disease. The situation, says Ronald Bayer of the Hastings Center, a bioethical think tank, shows how "moralism can twist the appropriate federal response to a disease like this." Certainly, there appears to be precious little middle ground between warring factions. Liberal Democrats such as Rep. Henry Waxman (D., Calif.) , chairman of the House subcommittee on health, and Sen. Edward Kennedy (D., Mass.) , chairman of the Senate Labor and Health Resources Committee, have taken the lead in pushing legislation that would establish voluntary federal AIDS testing. They also want safeguards to maintain the confidentiality of test results and protect those found to have the AIDS virus from discrimination, and support informational programs explicitly describing the activities that researchers believe transmit the infection to try to stop its spread. But conservative Republicans, led by Rep. William Dannemeyer (R., Calif.) and Sen. Jesse Helms (R., N. C.) , have opposed them nearly every step of the way. These lawmakers argue that mandatory, routine testing of large groups in the population is needed and that the names of those found to be carrying the virus should be reported to public-health officials. Currently, most states require reporting only the names of those who are actually ill with the disease. The conservatives see attempts to protect the confidentiality of AIDS test results as an endorsement of the goals of homosexual-rights groups. Sen. Helms calls AIDS "the first politically protected plague in all history" and says that for gay groups, "public safety takes a back seat to their civil rights to engage in unnatural and immoral sexual behavior." And he argues that explicit educational efforts only perpetuate the AIDS problem by promoting drug use and homosexuality. Many public-health experts bridle at the conservatives' objections. Sanitizing AIDS education materials is "unbelievably retrograde," says Mr. Bayer of the Hastings Center, where he is co-director of a project on AIDS and the ethics of public health. "It really represents public-health malpractice." But while Messrs. Helms and Dannemeyer haven't been able to move their own AIDS legislation through Congress, they have tried with some success to attach various parts of their proposals to other legislation. The $600 billion omnibus spending bill Congress approved last week, for example, includes a provision pushed by Sen. Helms that would bar the government from funding AIDS education or prevention programs that "actively promote" homosexual activities. The fight in Congress mirrors continuing battles within the Reagan administration itself -- battles that have seriously eroded its ability to provide leadership on the AIDS issue. The administration's public-health officers, including Health and Human Services Secretary Otis Bowen and Surgeon General C. Everett Koop, oppose mandatory testing for the AIDS virus in favor of a voluntary program and education. But others in the administration, notably Education Secretary William Bennett and Gary Bauer, assistant to the president for policy development, call for mandatory testing, arguing that the need to stem the spread of AIDS outweighs individuals' rights to privacy. Their arguments are bolstered by political support from the conservatives who make up the heart of Mr. Reagan's political constituency. So far, the administration's public-health officials have been losing out. In April, for instance, the Centers for Disease Control urged that the federal government take the lead in establishing guidelines regarding the confidentiality of AIDS tests results and the protection of those infected with the AIDS virus. But the administration has said it believes that matter is best left to the states. Similarly, the CDC last year recommended testing only those immigrants who show symptoms of having AIDS, but this summer President Reagan backed mandatory testing of all immigrants. Some people concerned about the problem had hoped that the president's commission to study AIDS, which he appointed in July, would be able to bring some order to the chaos of federal policy disputes. Instead, however, the commission found itself in the same political situation, pressured on the one side by the demands of public-health experts and on the other by the conservatives. As a result, the commission is only now getting down to serious work after an extended period of disarray. Internal discord resulted in the firing of its executive director in September and the resignations of its chairman and vice chairman in October. In an interim report issued earlier this month, the panel said it now hopes to report to Mr. Reagan by February on the prevalence of the disease, drugs to combat it, its spread among drug abusers and care for those with AIDS. The net result of the disarray, complains Rep. Waxman, one of the liberal leaders on the issue, has been a vacuum in Washington policy-making -- a vacuum that he charges has been filled by "yelping on the sidelines from the right wing." He adds, "The clearest counter to them would be clear leadership from the administration." --- 'What would you say is the most urgent health problem facing this country at the present time? ' AIDS ........................................ 68% Cancer ...................................... 14 Heart disease ................................ 7 Obesity ...................................... 4 Drug abuse ................................... 3 Malnutrition/hunger .......................... 2 Smoking ...................................... 2 Health care costs ........................... 1 Pollution .................................... 1 Alcohol abuse ................................ 1 Other ........................................ 6 No opinion ................................... 3 Source: Gallup poll of 1,569 adults nationwide, conducted Oct. 23-26, 1987; total is more than 100% because of multiple responses. [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]