Striving for a broad perspective on the mounting AIDS problem

Even as developments on the fast-moving AIDS front rush one after another, a growing number of experts are beginning to take the long view of the world's challenges in dealing with the disease. ``To me the whole issue,'' says Dr. David F. Musto, ``is one of boundary making,'' of establishing relationships between those who are afflicted with AIDS, and those who are not. He points out parallels to the world's dealing with past scourges that also were determined to be communicable: leprosy, yellow fever, tuberculosis - ``the whole notion of separating one group from another.

``We are in the process of a gradual evolution ... to a settled attitude toward AIDS,'' says Dr. Musto, who is a professor in three areas at Yale University: child study, psychiatry, and the history of medicine.

Harvard Prof. Mark H. Moore says he also thinks the United States, and the world, ought to understand the long perspective. History tells us that as a society ``the chances are,'' he says, ``that we'll start from a position of hostility and ostracism'' toward AIDS victims, ``and gradually modulate'' that view, in time integrating the afflicted in some way with society at large.

``The fundamental problem,'' he says, ``will be managing the rate at which that occurs. ... The fundamental task [for society] is to figure out how we can move to a decent set of relationships with people who have AIDS.'' Dr. Moore is Guggenheim professor of criminal justice, policy, and management at Harvard's Kennedy School of Government.

Even as some experts are trying to put the problem into long-term perspective, developments occur with increased speed at the state and national level in the US.

In Illinois a series of laws have just been approved that require premarital AIDS tests, provide limited power to the state to quarantine the afflicted, and permit the tracing of their sexual contacts. The measures also provide confidentiality to people tested or treated for the disease.

In Texas, mandatory testing for the AIDS virus has Begun of several categories of prisoners. Inmates who test positive may be housed separately. Three states require incoming prisoners to be tested for the presence of the virus. Three months ago federal prisons began mandatory testing of incoming and outgoing prisoners.

In Washington, Reagan administration officials and some Democrats in Congress are at odds over several AIDS proposals before Congress. The Democratic-introduced measures would forbid discrimination against people with the disease or virus, require that results of AIDS tests be kept confidential, and authorize $400 million for additional AIDS testing and counseling.

The Reagan administration says it is not a proper role for the federal government to require antidiscrimination and confidentiality, and that those actions should be left to the states to take, if they so choose.

Health and Human Services Secretary Otis Bowen says, however, that he is ``not ruling out a federal role in this.''

The sum of these and other actions to be taken across the US will produce society's eventual attitude toward the disease and those afflicted with it.

``The big philosophical question,'' Moore says, ``is whether we will see AIDS as a natural calamity that befell some people ... [or conclude that] `it's not my problem, it's theirs, and they brought it on themselves.'''

Settling that and related questions, Musto says, is a slow process. ``The adjustment that a whole society takes to come to a consensus on how to handle something like this is, I think, rather long'' - about 10 to 15 years.

Musto says society should examine the AIDS issue not in the perspective of ``the narrow, cramped quarantine'' used for victims of scarlet fever, but should more broadly consider it as ``a major boundary-making'' decision. By contrast, he notes, during the Middle Ages Europe segregated lepers from the public at large, but set up clearly defined ways, including religious rituals, that lepers still could participate in society.

At the same time Musto warns that diseases that plague the earth for protracted times may cause ``fundamental changes in our notions of privacy and control,'' as occurred during earlier scourges of leprosy, yellow fever, and tuberculosis.