Int J Health Serv
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The influence of health-related political action committees (PACs) continued to grow during the 1990 election campaign. During the first 18 months of the election cycle, contributions from medical and health care PACs to congressional candidates reached a total of $7.7 million. Among the leading PACs were the American Medical Association, American Dental Association, and American Hospital Association, which contributed a total of $3.3 million to congressional races through September 1990. ⋯ In all, 16 senators and representatives received more than $30,000 each from health care PACs. Senator John D. Rockefeller IV (Democrat, West Virginia) and Representative Thomas Tauke (Republican, Iowa) led the Senate and House, respectively, in total PAC receipts.
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This article describes Cuba's effort to develop a comprehensive program for control of its human immunodeficiency virus (HIV) epidemic. The program consists of multiple interventions, including blood donor screening, a ban on imported blood and blood products, widespread semicompulsory screening of defined and general populations, research and clinical trials on treatment and diagnostic methods, and health education in the press, radio, television, workplace, and schools. The most controversial of the program's measures has been the treatment of HIV antibody-positive persons (both asymptomatic and clinically ill) through what Cubans term a "sanatorial regimen," consisting of admission into an institutional setting where both preventive and curative treatment is offered, and where residents have limited contact with their families, neighborhoods, friends, and the rest of society. The Cuban HIV control program merits studying because of the comprehensiveness of the measures in a poor country; the special experience of screening large, mostly healthy populations; its potential contribution to understanding the natural history of the disease due to the early identification and follow-up of HIV antibody-positive individuals; and the cultural, political, and socioeconomic conditions that give rise to a different epidemiologic profile of the disease and to an apparent societal consensus on the controversial issue of institutional semiconfinement.
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The National Action Plan for Primary Health Care, a planning document of the Sierra Leonean Ministry of Health for the restructuring of the country's rural health services, is analyzed in its social, economic, and historical context. It appears to be an attempt of the national government to gain control over the highly devolved health care delivery system, but the state has neither the political will nor the power to achieve this goal. The utility of the document is therefore in doubt, which raises two important questions: Whose interests does this plan serve, and at whose cost?
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The World Health Organization estimates that almost half a million women in developing countries die in pregnancy and childbirth every year. Unsafe induced abortion is responsible for perhaps one-quarter of these deaths. ⋯ United States international policy on funding abortion-related activities in maternal health and family planning programs is especially restrictive. A new policy approach is clearly needed if unacceptably high rates of maternal morbidity and mortality in many countries are to be reduced.