Table of Contents
The HIV/AIDS epidemic has effected many transient changes in the institutions that were studied and relatively few changes that were expected to be permanent. Among the more permanent, however, two were considered particularly noteworthy.
First, the institutions of public health, of health care delivery, and of scientific research have become more responsive to cooperation and collaboration with ‘outsiders.’ Policies and practices have been modified in these three institutions under pressure from and in collaboration with those who are affected by the epidemic and their advocates. Many of these changes are positive and will contribute to the efficiency and efficacy of the institutions. Similarly, volunteer organizations stimulated by the challenge of the epidemic have discovered ways not only of supplying help where extant institutions were lacking, they have also influenced the policies and practices of those institutions.
Second, even in institutions with very defined purposes and strong constraints—institutions as different as religious groups and correctional agencies—the response to the epidemic has reflected awareness of the scientific realities, as well as the social implications, of HIV/AIDS. Traditionally based doctrinal constraints in the case of religious groups and the stringent requirements of civil punishment in the case of correctional agencies are powerful forces that could and did dictate rigid and narrow response. Yet, powerful as those forces were, they did not negate more reflective responses that contributed to containment of the epidemic and respected the rights of individuals.
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Public Health
The public health systems of the countries absorbed the first shock of the AIDS epidemic and have remained at the forefront of research and policy development. Because of the increasing concentration of the epidemic in low-income and minority communities, the public health system at the local level has become the primary service provider for a large proportion of people with HIV disease or AIDS.
HIV/AIDS challenged the public health community to set aside many of its traditional policies and practices for the containment of infectious disease. Quarantine, mass mandatory testing, and contact tracing all had notable disadvantages in dealing with a disease with a long latency period, that was spread chiefly through sexual activity or intravenous drug use, and that largely affected already stigmatized groups. Spokesmen for the affected groups, particularly the gay community, advanced other methods of containment that relied on community education and voluntary anonymous testing
Overall, the impact of the epidemic on the public health system has been pervasive: it has prompted a critical examination of traditional responses to epidemics of infectious disease, challenged the public health community to devise more effective strategies for promoting behavioral change, and, because of the sheer size of the HIV/AIDS-related activities profoundly influenced the public’s perception of the public health systems. HIV/AIDS has also increased the range of clinical responsibilities of public health agencies and further strained already burdened resources. In many cities, this has resulted in the neglect of traditional areas of public health activities such as sexually transmitted disease and tuberculosis.
Health Care
AIDS has influenced health care providers in both direct and subtle ways. The specialty of infectious disease has enjoyed a renaissance and is now viewed as one of the few shortage medical specialties. Concern is growing, however, that the burden of the epidemic may further dissuade young physicians from entering specialties such as internal medicine or from practicing in a geographic location where the burden of caring for patients with HIV disease is perceived to be high. The care of AIDS patients in terminal stages of the disease falls very heavily on hospital-based nurses.
Like the practice of oncology nursing, it is an emotionally as well as professionally demanding experience. It is impossible to assess the extent to which the HIV/AIDS epidemic has exacerbated staffing problems in hospitals and other institutional settings that care for AIDS patients; however, a shortage of nurses has been identified as a major obstacle to improved care of AIDS patients.
