Limited AIDS Impact on U.S. Seen by Panel

Disputing the widely held belief that the AIDS epidemic will eventually reach deeply into all elements of American society, a study by the prestigious National Research Council contends that the disease will have only limited impact on much of the nation.

Fewer segments of the population will ultimately be touched by the disease because it is concentrated in “socially marginalized” groups, says the 300-page report, drawn up for the National Academy of Science by a panel of experts representing such diverse disciplines as public health, sociology and religion.

The report predicts that the epidemic will “disappear” not as a result of medical advances, “but because those who continue to be affected by it are socially invisible, beyond the sight and attention of the majority population.”

The findings are not meant to suggest that AIDS should be treated less seriously by health and government officials or the public. Rather, the report seeks to analyze the actual effects of the disease and to measure them against the predictions made by health professionals and AIDS activists.

“Predictions of the imminent collapse of the health care system due to the epidemic, for example, now look shrill,” the report argues. But conversely, it says, “hopes that the epidemic would force the country toward more rational and equitable reform of the system now also seem unrealistic.”

The authors offer no major recommendations based on their findings. But their report could play some role in determining the social and medical policies of the new Clinton Administration, which is just beginning to review policies that have been in place over the last 12 years of Republican rule.

During his election campaign, Clinton pledged to increase federal funding to fight AIDS. He did so, in part, because of pressure from gay activists whose ability to influence the future President suggests they are not among the “socially invisible” elements of society referred to in the report.

The findings caught researchers in the medical and public health fields by surprise.

Although reluctant to comment extensively because she had not seen the study, Dr. June Osborn, chairwoman of the National Commission on AIDS, said that although the National Research Council “characteristically does things carefully . . . it sounds like things have gone awry.”

It is difficult to understand, she said, that “an epidemic that will kill one and a half million people” will have an impact that “is less than we thought.”

“It’s going to take a lot to shake me from the conclusion” that the impact of the disease will be widely felt, said Osborn, who is dean of the University of Michigan school of public health.

The findings were based to a large extent on studies of the AIDS impact on New York City, which it called “one epicenter of the epidemic.” Although “certain confined areas and populations have been devastated and are likely to continue to be,” the report said, “many geographical areas and strata of the population are virtually untouched by the epidemic and probably never will be.”

“Instead of spreading out to the broad American population, as once feared, HIV is concentrating in pools of persons who are also caught in the ‘synergism of plagues’: poverty, poor health and lack of health care, inadequate education, joblessness, hopelessness and social disintegration converged to ravage personal and social life,” the report said.

Jeff Levi, director of government affairs of the AIDS Action Council, expressed concern that the study, if misinterpreted, could be seen as minimizing the human dimensions of the disease even if its effect on social institutions is limited.

“We wouldn’t want to be taken to be saying these lives don’t matter,” said Jeff Stryker, the study’s director. But after “a fair amount of debate” over its conclusions, he said, the committee found that AIDS will have much less effect than that of the Black Death on 14th Century Europe, to which it has been compared, because the political, social and economic reverberations from AIDS “won’t be long lasting.”