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Stephen Joseph was commissioner of health in New York City from 1986 to 1990 during the administration of Mayor Edward Koch. Confronted by the AIDS epidemic, Joseph chose to make it his issue, adopting a posture that was in striking contrast to that of his predecessor, David Sencer. In arguing for an aggressive campaign to halt the spread of HIV infection, Joseph emerged as one of the nation's leading health officials. His years as commissioner were filled with controversy. In 1988, he began a long, difficult struggle to initiate a needle-exchange program in New York as a way of slowing
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