And the Band Played on

Abstract

I 1 3 population the epidemic has become the leading cause of death, hitting its victims unexpectedly, killing young c c A people-especially young men-without warning or hope of a cure. And yet, because the victims are concentrated in subgroups of the population and, more important, in subgroups outside the mainstream, politically-dominant population, the epidemic was largely ignored. It was something that happened to "others." Moreover, because the high risk groups were looked down upon -substance abusers, discriminated-against minority group members, "different," "undeserving," "deviant" -the common perception was that a strong element of victim fault was involved. The former Director of the Centers for Disease Control warned that this was "the principal public health problem in America today"; but little was done and the epidemic was allowed to spread. Much could be done. The experts made it clear that an organized response was possible: prevention, not cure, was the best way to fight this epidemic. But any effective response costs money: money for preventive approaches. Unfortunately the money was slow to arrive and inadequate to the task. The epidemic has grown to become the fourth leading cause of death in the nation and the first cause of death in terms of productive years of life lost -but spending has been inconsequential. The federal government has spent less than two percent of its health research funding on the problem (while spending much more on health problems of lesser consequence). Advocates have sought without success to persuade the public (a) that everyone, not just certain subgroups, is potentially at risk, and (b) that intervention to fight and defeat the