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The author's goal in this article, is not merely to propose public health strategies for the future, but also to examine why government has been so slow, so equivocal, in its public health response to the acquired immune deficiency syndrome (AIDS) epidemic. He argues that there has been a fundamental ambivalence in perceptions of the epidemic. For some, AIDS is perceived as a disease, with sympathy for sufferers. Once AIDS is viewed as a disease, like other catastrophic diseases, it follows that public policy will be based upon science and epidemiology--health education, research and treatment.

For others, AIDS is caused by willful, irresponsible behavior. Persons infected with human immunodeficiency virus (HIV) are seen as morally blameworthy and deserving of punishment. Once AIDS is seen to be caused by willful, immoral behavior, public policy will, at least in part, be punitive towards persons carrying the infection (e.g., criminal penalties and discriminatory treatment), and overly protective of the sensibilities and morals of the wider community (e.g., censorship of explicit public health messages directed at those groups who are blamed for spread of the epidemic).

In this article, the author sets out a number of constructive public health policies which have gained virtually unanimous support in the public health community. These should be the priorities for our public health agenda for the decade, and not the largely irrelevant moral and punitive concerns which have captured a large segment of media reports, public opinion and legislative initiative.

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5 Notre Dame J.L. Ethics & Pub. Pol'y 7-33 (1990)