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Ronald Bayer, PhD

Arch Intern Med. 1999;159:1042-1048.

In the 18 years since the first cases of the acquired immunodeficiency syndrome (AIDS) were reported by the Centers for Disease Control and Prevention (CDC), the epidemic has undergone profound transformations, and so, too, has the sociomedical context within which public health policy is fashioned and implemented. The early years of neglect and panic were also characterized by relative therapeutic impotence and deep uncertainty about the epidemiological course the new threat would take. In the United States and in other economically advanced nations, the threat of contracting the human immunodeficiency virus (HIV) has abated. The incidence of infection has declined, and the prevalence of infection has stabilized and, in some instances, begun to fall. The pattern of HIV spread, where it has continued, has been dramatically circumscribed to marginalized populations.¹ The panic of the mid-1980s has passed, and in many nations, AIDS has lost its salience as a public issue. A sense of therapeutic impotence no longer prevails, and a new mood of triumphalism has taken hold. How have these crucial changes affected AIDS policies in America?

From the Division of Sociomedical Sciences, Columbia University School of Public Health, New York, NY.

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