Book Review

The Social Impact of AIDS in the United States

N Engl J Med 1994; 330:71-72January 6, 1994

Article

The Social Impact of AIDS in the United States
Edited by Albert R. Jonsen and Jeff Stryker. 322 pp. Washington, D.C., National Academy Press, 1993. $34.95. ISBN: 0-309-04628-9

This book, the work of a committee of the National Research Council of the National Academy of Sciences, is a preliminary report on the social consequences of the AIDS epidemic in this country. The panel is properly modest about its efforts: “No attempt has been made to write a comprehensive history. . . . Instead we have been selective in looking at those institutions for which sufficient information is available to describe impact and response.”

The main focus of this report is the pattern of institutional response, or lack of response, to the AIDS epidemic. More than 10 years after the first descriptions of this new disease, AIDS has remained largely a disease of homosexuals and disadvantaged urban minority populations, rather than, as was first feared, a disease affecting all populations and social classes. “The convergence of evidence shows that the HIV/ AIDS epidemic is settling into spatially and socially isolated groups and possibly becoming endemic within them.”

The panel examines several institutional systems: public health, health care financing, clinical research and drug testing, religion, voluntary and community-based organizations, and prisons. Its members also describe the special situation of children and families; the final chapter uses New York as an example of a city's response to the epidemic.

This report represents a first approximation of an analysis of the social effects of the AIDS epidemic. As the panel states, it is too early for any definitive assessment of the impact of the epidemic on the nation's institutions, social norms, or policy. But as a first attempt to understand what AIDS has meant to our national life, the report makes a substantial contribution. In this book one can find a description, based on the available data, of the social changes and responses evoked by the epidemic. The committee notes repeatedly how much more scientific inquiry is required to understand fully the effects of this disease on society.

The chapters on clinical research and drug regulation and on religion and religious groups are especially interesting. I wish, however, that the committee had extended its inquiry further into the effects of the epidemic on the scientific community. Although the authors note that AIDS has given new life to the field of infectious diseases, they have not inquired into its effects, if any, on the basic research agenda at the national or the university level. I cannot help but wonder how many young investigators will receive academic tenure on the basis of their research on the HIV virus or how many serendipitous advances in other areas will result from AIDS research. But perhaps it is too early to tell.

Although the book is better written than many committee reports, the language seems to suffer from a curious blandness. Moreover, the panel specifically chose not to make suggestions about solutions to identified problems or to propose an agenda for further scientific inquiry. In an attempt to be scientifically neutral, the authors have avoided any type of statement about values. For example, when the panel states, “The institutions that we studied are particularly weak at those points at which the epidemic is likely to be most destructive,” I longed for something stronger, some call for attention and resources for these “spatially and socially isolated groups.” I dare say my reaction stems from my own work in a city hospital in a disadvantaged area of New York City, but some hint of moral indignation would have made me feel better.

Margaret C. Heagarty, M.D.
Columbia University-Harlem Hospital Center, New York, NY 10037