Lessons from the Past: Responding to the AIDS Crisis

Prologue: As the acquired immunodeficiency syndrome (AIDS) insinuates its way into American culture, the nation approaches the dubious milestone of 100,000 reported AIDS cases—over half the reported cases worldwide. Increasingly, those affected most harshly by AIDS and human immunodeficiency virus (HIV) infection are poor, members of minority groups, and children. These Americans typically live in communities that lack the social supports and cohesiveness undergirding successful community-based responses to AIDS in the gay communities of San Francisco and other cities. “The disease distribution of AIDS increasingly reflects the social stratification of American society,” David Mechanic and Linda Aiken write. “The changing configuration of AIDS…, if not approached carefully, could overwhelm our mental health capacities, social services, and public hospitals, and destroy the fragile structures we have been working so hard to develop.” In this article, Mechanic and Aiken propose a series of lessons to apply to AIDS from long-term care for the severely mentally ill, long-term care for the elderly, and terminal care for people with cancer. “These issues may come together differently in AIDS,” the authors write, “but it would be a grave error to neglect previous lessons of relevance” Mechanic, who received his doctorate in sociology from Stanford University, has been director of Rutgers University's Institute for Health, Health Care Policy, and Aging Research since 1981. He is also Rene Dubos Professor of Behavioral Sciences at Rutgers. Aiken, a nurse, holds a doctorate in sociology and demography from the University of Texas at Austin. She is Trustee Professor of Nursing and Sociology at the University of Pennsylvania and is associate director of the Leonard Davis Institute of Health Economics there. She was formerly a vice-president of The Robert Wood Johnson Foundation. Both Mechanic and Aiken have done extensive research in approaches to care for the population groups from which the lessons in this article are taken—pursuits from which their current work on AIDS has evolved.