8. Paper Prepared in the Department of State1


The Department of State, in May 1985, implemented a series of policies to deal with the AIDS problem.2 The major elements of the program are health education, a policy for management of infected individuals, a policy to assure safe blood transfusion services overseas, and a program to assess risk.

The Department is continually reviewing this program in light of the rapid progress being made. More systematic approaches to screening our population for the infection are currently being considered.

1. AIDS—Implications for the Foreign Service

A. Risks

Any large organization has members of its population at risk of infection from the Acquired Immune Deficiency Syndrome (AIDS) virus. According to the U.S. Centers for Disease Control, individuals who may be considered to be at increased risk of AIDS include sexually active homosexual and bisexual men, recipients of blood transfusions, present or past intravenous drug abusers and sexual partners of individuals at increased risk for AIDS, including prostitutes. A further risk factor of unknown significance is residence in areas where the disease [Page 28]is highly endemic. In Kinshasa, Zaire, for example, recent studies have shown 4–6% of the local population to be infected with this virus. This is the highest documented concentration of the infection in the world. A similar high prevalence of infection has been noted in other Central African countries as well as in Haiti. The implication for employees and their families residing in these areas has not yet been evaluated.

II. Management of the Problem—Policy and Programs Implemented by the Office of Medical Services in May 1985

A. Health Education

1. The most important and effective approach to the AIDS problem is health education. All employees of the Department and the 32 agencies who receive care from the Department’s medical program have been provided with authoritative information describing the cause and prevention of AIDS. (Attachment A)3 All health care providers working for the Department have been instructed to brief all new arrivals to posts abroad on AIDS, to incorporate information on AIDS into each post’s health handbook and to provide individual and group counseling to members of high risk groups. Special emphasis has been given to those serving in areas of the world where infection with the AIDS causing virus, Human T-Cell Lymphotropic Virus (HTLV III) is more common.

B. Medical Clearance and Treatment policies for those infected with the virus were established in May 1985 and revised in September 1985 (Attachment B)

a. All individuals with confirmed infection with the HTLV III virus will receive a limited medical clearance.

1) Those with evidence of immune deficiency will not be cleared for overseas assignments.

2) Those with no evidence of immune deficiency will be allowed overseas assignments, but only to posts with medical facilities and experience dealing with the complications of HTLV III infection.

C. Blood Transfusion Policy (Attachment C)

1. A medically sound policy for the use of blood products in emergency situations abroad was developed and distributed to all posts abroad.

D. Evaluation of the Risks of Foreign Service in Relation to HTLV III Infection

1. Cases of AIDS as they occur among employees and their dependents are being monitored for unusual patterns of spread.

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2. The Department, currently, provides HTLV III testing to any employee, who for any reason, requests it. If the test is positive, individuals whose problem was not related to service are referred to their family physician for confirmatory testing and counseling. Employees who became concerned in the course of service abroad are provided all indicated testing to confirm or rule out the HTLV III infection. Payment for care follows accepted Foreign Service Medical Program policies.

2[3]. In cooperation with the National Institutes of Health (NIH) and the Centers for Disease Control (CDC), the Department has initiated a voluntary research study which will evaluate the incidence of HTLV III infection amongst employees and families residing in an area of high prevalance.

III. Future Programs

A. Confidence in diagnostic testing has progressed since the introduction of the ELISA test for HTLV III infection in March 1985. The Office of Medical Services considers more systematic screening for this disease inevitable and is studying several options.

  1. Source: Reagan Library, Bledsoe, Ralph: Files, 320—AIDS Policy (4). No classification marking. Drafted by Goff, who forwarded the paper to Roper under an October 22 covering memorandum in which he wrote: “As requested, I am enclosing a copy of the Department of State Action Plan for Acquired Immune Deficiency Syndrome for the October 24 meeting of the Domestic Policy Council Working Group on Health Policy. Dr. Eben H. Dustin, Medical Director, will attend the meeting.”
  2. See Document 7.
  3. Attachments A–C are not attached.