Primary care for patients with HIV.

AIDS will soon emerge as one of the top five causes of death in the United States. By 1995 it is going to be roughly equivalent to stroke in this regard: about 200,000 deaths annually. By that year between 400,000 and 500,000 AIDS cases will have been reported in this country. Right now our health care system, which is so sophisticated but which can be so inadequate, is effectively addressing AIDS in some areas of the country but is not effectively addressing the HIV epidemic. In order to identify HIV infection early, we all have to be involved. As internists we have to routinely offer screening. We have to make it easily accessible to our patients. There should be no more thought of ignoring the question of HIV infection than of ignoring smoking. There is no other answer to this major public health dilemma, and despite all the AIDS centers that are developing and the funding for in-patient and out-patient facilities, I think they are all going to be overwhelmed eventually, particularly in New York City, if we do not develop a more broad-based approach to the problem.