18. Paper Prepared in the Department of State1

[Omitted here is a title page.]

[Omitted here is a table of contents.]

Executive Summary

The Problem

Acquired Immune Deficiency Syndrome (AIDS) has rapidly emerged as a worldwide public health threat since its identification in 1981. Its recognition as a new disease was delayed by the absence of unique symptoms, and also by the long period between infection (by the HTLV–III/LAV virus) and the appearance of symptoms. As of April 7, 1986, over 19,100 cases and 9500 deaths have occurred in the United States alone, and limited evidence suggests that upwards of ten million individuals are now infected, worldwide. Infected individuals are thought to carry the virus, and therefore be potentially infectious to others, for life. There is no known cure or vaccine for AIDS at present: it is invariably fatal.

U.S. Foreign Policy Interests

The AIDS epidemic raises significant international public health, scientific, social and political issues that collectively require close attention and responses by the State Department and other U.S. foreign affairs agencies.

Thousands of Americans live and travel abroad—including official personnel and their families—where they could be exposed to the AIDS virus under conditions where medical capabilities for advising on, diagnosing or treating the disease are inadequate or nonexistent. The United States is also the world leader in its ability to help shape and support a successful attack on the problem, based on its medical expertise, institutional capacity and research investment. Consequently, U.S. assistance is in demand, and there is need to target and apply it efficiently and effectively.

This country also has the highest number of diagnosed cases of AIDS in the world. Given the worldwide distribution of blood products of U.S. origin, and the great frequency of travel abroad by private citizens and military personnel, the United States is sometimes per [Page 48] ceived and portrayed by others as the principal source of the AIDS-causing virus.

Numerous offices of the State Department have been involved in AIDS-related issues over the past two years, including Medical Services, Consular Affairs, geographic bureaus (especially AF), and OES. In November 1985, a Departmental Working Group on AIDS was established—under the chairmanship of OES, and with participation by USAID and HHS. Its principal objectives were to: identify and evaluate the key foreign policy issues associated with AIDS; recommend and pursue appropriate responses by the State Department and other U.S. foreign affairs agencies; and ensure proper coordination of the Department’s policy and program responses, both in-house and at the interagency level.

The Departmental Working Group identified at the outset three classes of foreign policy objectives which required early attention:

1) protection of U.S. citizens abroad,

2) prevention and mitigation of political problems,

3) assisting governments and the international health community in efforts to address the medical, public health and social problems created by the AIDS epidemic.

The Working Group then evaluated the extent and quality of the Department’s responses to date in each of these areas, and identified additional measures that should be carried out to strengthen these responses and to fill gaps.

The analysis and recommendations discussed in detail below can be summarized in the following categories:

—promotion of international medical research on cause, prevention and cure of the disease,

—expansion of epidemiological studies to learn more about cause and prevalence,

—stronger public information and education campaigns to prevent panic, exaggerated responses, and spread of the disease,

—promotion of measures to ensure that the world’s blood supply is protected from contamination by the HTLV–III/LAV virus,

—ensuring the adequacy of the medical capabilities of U.S. diplomatic posts as well as those of host governments,

—engagement of host governments in open dialogues to prevent AIDS from becoming a divisive foreign relations problem and to facilitate the work of the health community.

Protection of U.S. Citizens Abroad

State/MED cares for the health of Americans employed overseas by the State Department, USAID, and some 30 other U.S. Government [Page 49] agencies. To date, State/MED has initiated a comprehensive program on AIDS which encompasses health education, safety of blood and blood products, screening of employees, counseling and management of individuals who may become infected by the AIDS-causing virus, and the review of host country medical and dental facilities. Guidance has also been prepared for official contractors and other temporary duty personnel. This has been distributed to Embassy medical units as well as to other USG agencies which assign individuals to overseas duty.

Private citizens travel abroad with great frequency. The evidence indicating AIDS is spread by heterosexual contact, and the fact that most foreign blood supplies are not screened for AIDS-virus antibodies, suggest that some form of guidance for the traveling public should be prepared.

Working Group recommendations focus on the need for:

—expanded efforts to provide educational materials for all U.S. travelers,

—continuing guidance on the matter of blood transfusions, and measures to safeguard blood supplies,

—an early (positive) decision on MED’s proposal for mandatory employee screening, and

—closer coordination with the Department of Defense and the Peace Corps on common problems of health care, screening and public affairs.

Prevention and Mitigation of Political Problems

AIDS is an extremely sensitive topic in many nations (particularly in the Middle East) due to its association with homosexuality and drug use. Some Central African countries believe they are being unjustly blamed for ‘originating’ the disease, and other nations fear a decline in tourism if AIDS is diagnosed in their populations.

In addition, those who are already predisposed against the United States find AIDS to be an attractive new focus for anti-U.S. feelings, particularly where it can be tied to the presence of U.S. military personnel.

To prevent or counter the politicization of the AIDS problem, the Working Group recommends:

—provision, by the Department to U.S. overseas posts, of accurate, objective information on the state of the AIDS problem and U.S. policy thereto, on a continuing basis,

—efforts to maintain open communications with other governments to minimize misunderstandings and emotional reactions, while instilling a sense of realism as to what can be done,

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—support for public education through the World Health Organization program,

—close coordination with the Department of Defense, and

—preparation and distribution of contingency guidelines and talking points to U.S. posts abroad.

U.S. Assistance

In the worldwide fight against AIDS, U.S. assistance—both technical and financial—will be important in two areas: (1) support to other nations, particularly developing countries, to either stimulate or assist them in addressing the problem; and (2) assistance to the international health community to acquire data as well as to design and mount effective responses. Provision of such assistance will require judicious use of both multilateral and bilateral channels.

Working Group recommendations center on:

multilateral assistance through the World Health Organization. Emphasis needs to be placed on: ensuring that the emerging WHO program is consistent with U.S. views of needs and priorities; determining the type and level of U.S. technical and financial support that can be provided; evaluating the capabilities of WHO’s regional offices; and developing international support for the WHO program,

bilateral assistance, with emphasis on close USG interagency coordination. A centerpiece should be USAID’s proposed multi-faceted AIDS policy and program intended to support: expanded surveillance activities in Africa, technical assistance in health education, travel for developing country health experts to international meetings and support for WHO’s Global Program. In addition, channels for the distribution of health education/risk reduction information to the general public of a given country should be developed.

[Omitted here are sections of the paper that are not part of the Executive Summary.]

  1. Source: Department of State, AIDS, 1984–1987, Lot 89D137, AIDS Policy. Confidential. Drafted by the AIDS Working Group.