With tens of thousands of new cases of AIDS each year and more than a million Americans infected with HIV, the virus that causes it, one might assume that the deadly disease is profoundly changing the U.S. and its institutions. That's what Albert R. Jonsen, chairman of the department of medical history and ethics at the University of Washington School of Medicine, expected to find when he began leading a study for the National Academy of Sciences on the social impact of AIDS. But after looking at everything from health care and prisons to religion and law, Jonsen says the panel concluded that "the social impact has not been very great."
That's because AIDS is most prevalent among gays and in "marginalized, ghettoized communities" that are home to drug addicts and poor minorities. The NAS report, due out this fall, documents an overloaded health care system and a surge in volunteerism in such areas. But outside these epicenters, AIDS has had little impact--which helps explain why the country has failed to follow suggestions by the National Commission on AIDS for such steps as more explicit prevention efforts and additional treatment programs for drug users. Says Jonsen: "The impact of AIDS is not great enough to mobilize the kinds of energies that those recommendations require."