Medicine: Frank Talk About the AIDS Crisis &

Admiral James Watkins is a man determined to speak bluntly, and damn the torpedoes! As chairman of the 13-member presidential AIDS commission, he began his study of the AIDS crisis eight months ago by warning that his findings would not be swayed by political considerations. Last week, before a packed Washington press conference, he ended the study with the same forthrightness. In issuing a 269-page draft of the commission’s final report, he managed both to show a fine disregard for prevailing prejudices about AIDS and to issue a sharp challenge to the Reagan Administration. Going beyond a National Academy of Sciences report also released last week that criticized the White House for an “absence of strong leadership” in the AIDS fight, Watkins declared, “The system has failed. It is not working well, and we had better get with it.”

The chairman’s 579 recommendations add up to a bold plan for action that could cost $3 billion. In a preliminary report released last February, the commission called for hundreds of new treatment centers for intravenous drug users, home care for AIDS patients and a streamlined federal approval process to speed up the delivery of experimental AIDS drugs. In the latest document, Watkins went further and emphasized two measures that the Reagan Administration has stiffly opposed: new federal antidiscrimination laws to protect those infected with the AIDS virus from loss of jobs, insurance and housing, and new confidentiality statutes to ensure accurate testing for and reporting of the disease. The draft report, which must be approved by the full commission before it goes to the President, is already being hailed by health professionals and AIDS activists as a courageous national strategy. Says Mathilde Krim, co-founder of the American Foundation for AIDS Research: “It is a comprehensive report. It is a human report. And it is an intelligent report.”

Watkins called discrimination the “foremost obstacle to progress” in combatting AIDS. “People simply will not come forward to be tested or will not supply names of sexual contacts for notification,” he said, “if they feel they will lose their jobs and homes based on an HIV-positive test.” The chairman’s recommendation: that the President issue an Executive Order extending federal antidiscrimination laws already on the books to include those infected with the AIDS virus. In Congress, conservative lawmakers, who vigorously oppose steps that would confer special rights on homosexuals, the group most directly affected by AIDS, promptly voiced their objections.

Watkins homed in on another Administration bugaboo: guaranteed confidentiality. Since the AIDS crisis began, programs to determine the focus and spread of the disease have been stymied because people at high risk have feared being stigmatized by showing up for tests. “An effective guarantee of confidentiality is the major bulwark against that fear,” the report asserts. However, it also establishes clear exceptions to the rule: namely, when there is a need to protect those “who may unknowingly be in immediate danger of being exposed” to the AIDS virus. Among them are victims of sexual assaults, health-care workers who are accidentally exposed and those who may be treating infected individuals.

Watkins proposed education initiatives that “are of such vital importance . . . that they must be implemented immediately,” including comprehensive health courses in the schools and a program tailored to minority communities that have been hardest hit by AIDS. The chairman also suggested that the Surgeon General act as the Government’s principal spokesman in health-care emergencies, with the authority to forge effective public policy speedily. As if to underscore the urgent tone of Watkins’ draft report, the San Francisco department of public health and the federal Centers for Disease Control predicted last week, for the first time, that infection with the AIDS virus will almost certainly result in death unless effective treatments are found.