How Has Federal Research on AIDS/HIV

Disease Contributed to Other Fields?

April 1990

NTIS order #PB90-253774
HOW HAS FEDERAL RESEARCH ON AIDS/HIV DISEASE

CONTRIBUTED TO OTHER FIELDS?

Jane E. Sisk, Study Director

Maria Hewitt, Study Co-Director

Paula Chludzinski, Research Assistant

Other Contributing Staff

Evi Hatziandreu, Analyst

Margaret McLaughlin, Analyst

Carol A. Guntow, P.C. Specialist

Carolyn D. Martin, Word Processor Specialist

Health Program

Office of Technology Assessment

U.S. Congress

Washington, DC 20510-8025

April 1990

A Staff Paper

in OTA’s Series on

AIDS-Related Issues

The views expressed in this Staff Paper do not

necessarily represent those of the Technology

Assessment Board, the Technology Assessment

Advisory Council, or their individual members.
CONTENTS

Chapter Page

1.

.

2.

3.

4.

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... ........... ............ .......... 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... ........... ........... ......... 3

OTA’s Survey on Contributions of Research on AIDS and HIV to Other Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................... .................. 5

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ ............ ........... ... 6

Contribution of AIDS/HIV Research to Other Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Basic Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... 7

Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... ........ 9

Applied Medical Sciences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... 10

Public Health and Health Services Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Opinions Regarding Federal Funding Spending for AIDS/HIV Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Current Level of Funding for AIDS/HIV Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Diversion of Research Funds to AIDS/HIV from Other Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ............ ............ ......... 17

Appendix

A. Method of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ............ A-1

B. Instrument of the OTA Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1

C. Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... .......... c-1

D. OTA Survey Respondents’ Primary Fields of Expertise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1

E. Specific Examples of Contributions of AIDS/HIV Research to Other Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-1

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ ........................... ............ 19

Tables

Table Page

1.

2.

3.

4.

5.

6.

7.

8.

Total Federal Expenditures on AIDS/HIV, Fiscal Years 1982-1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Federal Spending on AIDS/HIV Research by Agency, Fiscal Years 1982-1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

National Institutes of Heakh Expenditures for AIDS/HIV Research, Fiscal Year 1990. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Training, Professional Activity, Training, and Age of OTA Survey Respondents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Contributions of AIDS and HIV Research to Advances in the Basic Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Contributions of AIDS and HIV Research to Advances in the Medical Disciplines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Contributions of AIDS and HIV Research to Advances in the Applied Medical Sciences,

Epidemiology, and Public Health and Health Services Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

OTA Survey Respondents’ Opinions About the Level of Federally Funded AIDS/HIV

Research by Whether They Are Engaged in AIDS/HIV Professional Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
9. OTA Survey Respondents’ Opinions About the Level of Federally Funded AIDS/HIV

Research by Whether They Receive External Funding or Federal Funds for AIDS/HIV Research...........l4

10. OTA Survey Respondents’ Extent of Agreement/Disagreement with the Statement,

“Too Much Research Funding Has Been Diverted to AIDS/HIV From Other Fields,”

By Respondents’ Involvement in AIDS/HIV Professional Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

11. OTA Survey Respondents’ Extent of Agreement/Disagreement with the Statement,

“Too Much Research Funding Has Been Diverted to AIDS/HIV From Other Fields,”

By Whether They Receive External Funding or Federal Funds for AIDS/HIV

Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................... ,.......15

Figures

Figure Page

1. OTA Survey Respondents’ Proportion of Professional Activities That Relate to AIDS/HIV........................6

2. OTA Survey Respondents’ External Funding, 1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

3. OTA Survey Respondents’ Opinion About Level of Federally Funded AIDS/HIV Research.....................l3

4. OTA Survey Respondents’ Agreement with the Statement: “Too Much Research Funding

Has Been Diverted to AIDS/HIV Research From Other Fields” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
SUMMARY

The House Committee on Government

Operations, Subcommittee on Human

Resources and Intergovernmental Relations asked the Office of Technology

Assessment (OTA) to document the extent

to which federally funded research on

AIDS/HIV has contributed to advances in

other fields including biomedical and

behavior research, prevention, patient care,

and health care financing. In response to

this request OTA conducted a survey of

distinguished biomedical and social

scientists. This Staff Paper reports on the

results of that survey.

In February 1990, OTA mailed a

questionnaire to a multidisciplinary group

of scientists that asked them to rate the

contributions of federally funded AIDS/

HIV research to advances in 42 different

fields that comprised five broad areas:

basic sciences, medicine, applied medical

sciences, epidemiology, and public health

and health services research. OTA also

asked the scientists to express their

opinions about the current level and

allocation of federal funds for research.

Thirty-seven percent of 400 scientists asked

to complete the questionnaire completed

it.

According to OTA survey respondents,

significant benefits from AIDS/HIV

research have flowed to a wide variety of

fields. More than one-half of respondents

indicated that AIDS/HIV research had

contributed substantially to the basic

science fields of virology, immunology,

microbiology, and molecular biology. An

increased understanding of gene

expression, the immune system, viral

evolution, and disease susceptibility were

among the specific examples of contributions to advances in the basic sciences cited

by respondents.

Infectious disease, oncology, neurology,

hematology, and pulmonary medicine were

medical disciplines cited by at least 40

percent of respondents as having benefited

greatly from AIDS/HIV research.

Increased insights into mechanisms of

dementia and multiple sclerosis, and

improved understanding of the development of children’s immune systems are

among the contributions of AIDS/HIV

research to advances in medical research

cited by respondents. More than one-third

of respondents felt that AIDS/HIV

research had contributed substantially to

advances in diagnostics, drug development,

other therapeutics, and vaccine development.

In the areas of public health and health

services research, OTA survey respondents

indicated that AIDS/HIV research has led

to improved epidemic-modeling techniques, has furthered the development of

new methods for the conduct of clinical

trials, has stimulated research on health

behavior change, and has provided

prototype programs for targeting health

education to high-risk populations. Furthermore, AIDS/HIV research was cited as

having stimulated research on communitybased models of care, clarified routes and

mechanisms of sexually transmitted

disease, provided insights into the effectiveness of drug treatment programs, and

improved our understanding of social

stigma and prejudice.

-1-
2- How Has Federal Research on HIV Disease Contributed to Other Fields?

Nearly one-half of respondents indicated

that Federal spending for AIDS/HIV

research was about right and nearly onethird felt that spending was too low. A

near equal proportion agreed as disagreed

(48 vs. 44 percent) that too much of

available research funding has been

diverted to AIDS/HIV research from other

fields. Not surprisingly, opinions about the

level of Federal spending for AIDS/HIV

research vary according to whether the

respondent had received Federal funds,

and whether those funds were for

AIDS/HIV or non-AIDS/HIV research.

As those not in receipt of any external

funding (nearly one-half of OTA survey

respondents) are more likely to be

“unbiased” in their opinions regarding

funding, their responses are of special

interest. Over 80 percent of respondents

without external support felt that

AIDS/HIV funding is about right or too

low, and while more than one-half did not

agree, nearly one-third agreed that too

much research funding has been diverted

to AIDS/HIV research from other areas.

In conclusion, results from the OTA

survey indicate that, in the opinion of the

scientific community, AIDS/HIV research

has made many important contributions to

advances in the biomedical and behavioral

sciences. This finding is especially

noteworthy given that substantial lead time

is needed for advances to influence other

fields. The dominant sentiment of survey

respondents supports current or augmented

Federal AIDS/HIV research spending

levels. At the same time, opinion was

divided on the question whether too much

research funding has been diverted to

AIDS/HIV research from other fields.

The results raise for continued consideration the appropriate allocation of research

funds among HIV, other targeted areas,

and basic science.
INTRODUCTION

As awareness of the enormity of the AIDS

epidemic has grown, Federal funding targeted to

AIDS and other HIV disease has increased accordingly. From $8 million in fiscal year 1982, the year

after AIDS was frost diagnosed in the United States,

total Federal spending for medical care, public health

activities, and research related to HIV disease has

risen steadily and totals $2.9 billion for fiscal year

1990 (table 1). Over the same period, federally

funded research on HIV disease rose from $3 million

to $1.16 billion (table 2).

For fiscal year 1991, the President has requested

a 7-percent increase in funding for HIV research, a

somewhat smaller percentage and absolute increase

than in previous years. Although the increase in total

Federal funding for HIV disease would slow under

the President’s budget request for fiscal year 1991,

spending for fields other than research would receive

a larger share of the total allotment.

From divergent viewpoints, concern has been

expressed that the Federal Government is spending

too much and that it is spending too little on HIV

research, compared with funding for other medical

conditions (1,6,7,16). Critics of rising expenditures

on HIV disease point out that HIV funding has

exceeded funding for heart disease and rivals funding

for cancer, despite the much greater number of

deaths from these latter diseases. Although HIV

funding makes up about 10 percent of the total

budget of the National Institutes of Health in fiscal

year 1990, it accounts for 47 percent of the budget of

the National Institute for Allergy and Infectious

Disease (table 3). Although it is unclear whether the

most significant breakthroughs for HIV-infected

Table l-Total Federal Expenditures

on AIDS/HIV, Fiscal Years 1982-1991

(millions of dollars)

AIDS/HIV Percent

Year expenditures increase

1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1983 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1991a.......... . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

44

104

208

507

926

1,594

2,227

2,936

3,463

450%

136

100

144

83

72

40

32

18

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $12,017

a

Figures for 1990 are appropriations requested in the President’s

budget.

SOURCE: U.S. Department of Health and Human Services,

Public Health Service Budget Office (13).

Table 2-Federal Spending on AIDS/HIV Researcha by Agency, Fiscal Years 1982-1991

(millions of dollars)

Agency/Department 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991b

Department of Health and

Human Services

Public Health Service . . . . . . . . . . . . . . . . . . . . 3 22 57 83 164 317 607 942 1,115 1,209

Department of Veterans Affairs . . . . . 0 0 2 3 3 6 8 11 14 14

Department of Defense . . . . . . . . . . . . . . . . . . . 0 0 0 0 38 22 12 27 34 22

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 0 0 0 1 1 0 0 0

Total c

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 22 59 86 204 354 626 980 1,163 1,245

aMethods used in the preparation of the 1982-1988 figures differ from those used for the 1989-1991 figures. If the 1989 figures were

prepared using the same methods as were used for the prior years, the figures would be 815, 14, 27, and O, for the Public Health Service,

bDepartment of Veterans Affairs, Department of Defense, and other, respectively.

Figures for 1991 are amounts requested in the President’s budget. All other figures are actual appropriations.

cDue to rounding, some columns may not add to totals.

SOURCE: 1982-1988 data: Winkenwerder, W., Kessler, A.R, and Stolec, RM. (16); 1989-1991 data: U.S. DHHS, Public Health Service

Budget Office (13).

-3-
4- How Has Federal Research on HIV Disease Contributed to Other Fields?

individuals will come through targeted, missionoriented research or through basic research, targeted

HIV research appears to be receiving priority (3,6).

Proponents of greater HIV funding stress that

current deaths understate the burden of HIV disease.

Perhaps 1 million people in the United States are

infected and likely to die from HIV disease, and the

disease is spreading at epidemic rates in some populations. Furthermore, AIDS has been concentrated

among adults age 25 to 45. From 1987 to 1988, HIV

rose from the seventh to the sixth leading cause of

years of potential life lost, a reflection of a 30-

percent increase in life-years lost in that one year

(14). Proponents also view funding for HIV research

as a good investment in many other disciplines, since

AIDS touches on many basic, clinical, and social

sciences.

To provide additional information to clarify this

debate, the House Committee on Government Operations, Subcommittee on Human Resources and

Intergovernmental Relations, requested the Office of

Technology Assessment (OTA) to document the

extent to which federally funded research on HIV

disease has contributed to advances in other fields.

The subcommittee was interested in contributions

pertaining to a wide range of fields, including

biomedical and behavior research, prevention,

patient care, and financing. In response to that

request, OTA undertook a survey of biomedical and

social scientists. This Staff Paper reports on the

results of that survey.

Table 3-National Institutes of Health

Expenditures for AIDS/HIV Research,

Fiscal Year 1990 (thousands of dollars)

Percent of

AIDS/HIV Institute’s total

Institute expenditures expenditures

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heart, Lung, and Blood . . . . . . . . . . . . . . . . .

Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetes, Digestive, and Kidney . . .

Neurological . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergy and Infectious Disease . . . . .

General Medical Science . . . . . . . . . . . . . . .

Child Health and

Human Development . . . . . . . . . . . . . . .

Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Environmental Health Sciences . . . .

Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arthritis and Musculoskeletal . . . . . .

Research Resources . . . . . . . . . . . . . . . . . . . . . . .

Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fogarty International . . . . . . . . . . . . . . . . . . . . .

National Library of Medicine . . . . . . .

Other/miscellaneous . . . . . . . . . . . . . . . . . . . . . .

$150,304

42,056

4,662

5,320

16,158

393,083

14,614

26,749

5,533

4,291

859

1,238

44,558

987

4,898

493

27,729

9%

4

3

1

3

47

2

6

2

2

< 1

1

12

3

29

1

8

SOURCE: U.S. Executive Office of the President, Office of

Management and Budget (15).
OTA’S SURVEY ON CONTRIBUTIONS OF RESEARCH ON AIDS

AND HIV TO OTHER FIELDS

In February 1990, OTA conducted a survey of

distinguished biomedical and social scientists to

examine the contribution that federally funded AIDS

and HIV research has made to advances in other

biomedical and social science fields. In addition,

scientists were asked their opinions about Federal

funding of AIDS/HIV research.

Methods

A self-administered questionnaire was mailed to

400 individuals who were randomly selected from a

group of 801 scientists. Thirty-seven percent of 1

questionnaires (147/400) were returned either fully

2 Characteristics of th e

or partially completed.

respondents are shown in table 4. The respondents’

employment, professional activity, training, expertise,

and age characteristics were as follows:3

o

0

0

Employment--Over two-thirds of respondents

(67 percent) were employed in non-profit organizations, including universities; 15 percent

were employed by Federal or State government; and 8 percent were employed in

private business.

Professional activity--More than one-half (56

percent) of respondents were engaged in

research; 40 percent in administration; 16

percent in education; and 16 percent in patient

care.

Training--Nearly three-quarters (72 percent)

were physicians, and nearly one-third (30

percent) held a Ph.D. degree.

1 A copy of the questionnaire is included in app. A. Information

regarding the instrument pilot testing and survey randomization

techniques is included in app. B.

2 An additional 39 questionnaires were returned to OTA blank,

primarily because the respondent did not feel they had the

expertise needed to complete the questionnaire or because they

had retired. An additional 5 questionnaires were returned, but

were not included in the analysis because they had been completed by someone other than the person asked to complete the

questionnaire. If these questionnaires are included, the response

rate is 48 percent.

3 Percents may not sum to 100 because some respondents listed

more than one response or because no opinion responses are not

included (see table 4).

o Expertise--Forty-nine percent of respondents

identified their primary field of expertise within

medical disciplines; 18 percent in one of the

Table 4--Employment, Professional Activity,

Training, and Age of OTA Survey Respondents

Frequency Percent

Primary employer

Federal or State government . . . . . . . . . . . . . . . . 22

Non-profit organization,

including university . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Private business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15.0

67.3

8.2

9.5

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Major professional activitya

Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Level of training

MD only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PhD only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MD and PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MD and other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PhD and other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Primay field of expertise

Basic sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Public health and health

services research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

147

79

24

24

58

10

94

33

7

9

2

2

147

27

72

4

15

16

13

100.0

56.0

16.3

16.3

39.5

6.8

64.0

22.4

4.7

6.1

1.4

1.4

100.0

18.4

49.0

2.7

10.2

10.9

8.8

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Age

<= 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

36-50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

51-65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

>=66 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

100.0

1.4

19.7

44.9

34.0

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 100.0

a

Percentage does not sum to 100 and frequency to 147

because some respondents listed more than one activity.

Frequencies are out of 147 responses, i.e., n= 147.

SOURCE: Office of Technology Assessment, 1990.

-5-
6- How Has Federal Research on HIV Disease Contributed to Other Fields?

o

basic sciences; and 13 percent in public health

or epidemiology.4

Age--Nearly half (45 percent) of respondents

were in the 51 to65 year age range; slightly

over one-third (34 percent) were 66 and older;

and one-fifth (20 percent) were 36 to 50 years

old.

Survey respondents included both AIDS/HIV

researchers and scientists with no professional

activities related to AIDS/HIV. Sixty-three percent

of respondents were engaged in some AIDS/HIV

professional activities, but most of these spent less

than 20 percent of their time on AIDS/HIV activities

(figure 1). Respondents were less likely to have

received Federal funds for AIDS/HIV research than

for other research areas. Only 16 percent of respondents received Federal funds to conduct AIDS/HIV

research, while slightly more than one-quarter (28

percent) received Federal funds to conduct nonAIDS/HIV research (figure 2). Fewer than 10

4Detailed responses to the expertise question are shown in

app. D.

P

e

r

c

e

n

t

o

tr

e

s

P

0

n

d

e

n

t

s

5 0 %

4 0 %

3 0 %

2 0 %

1 o%

o%

percent of respondents received external funding

from nonfederal sources for either AIDS/HIV or

other research (figure 2).

Results

Contributions of AIDS/HIV Research to

Other Fields

Survey respondents were asked to rate, on a scale

from 1 to 105 the contributions of federally funded

AIDS/HIV research to advances in 42 different

fields that comprised five broad areas:

o basic sciences,

o medicine,

o applied medical sciences,

o epidemiology, and

o public health and health services research.

Respondents used the same 10-point scale to rate

their levels of expertise for each area.

5On the 10 point scale 1 indicated “none at all,” 5 and 6 indicated “somewhat,” and 10 indicated “very much.” Zero was used

to express “no opinion.”

Figure 1 --OTA Survey Respondents’ Proportion of Professional Activities

That Relate to AIDS/HIV

(n=145)

.——

37.2%

9.7%

m

4 0 %

2.8% 3.4%

4.8%

0 %

1.4%

0 1-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69X ?0-79% 80-89% 90-100%

<--------- Percent of professional activities that relate to AIDS/HIV ------~ -->

- Response in percent

SOURCE: Off ice of Technology Assessment, 1990.
OTA’S Survey on Contributions of Research on AIDS and HIV to Other Fields -7

Basic Sciences

The basic science fields reported to have benefited

the most from AIDS/HIV research include virology,

immunology, microbiology, and molecular biology

(table 5). More than one-half of respondents

(irrespective of their level of expertise in the field)

indicated that AIDS/HIV research had contributed

to these fields substantially (i.e., a rating of 7 to 10).

Among experts in the respective fields, almost all felt

that virology (96 percent) and immunology (94

percent) had benefited substantially from

AIDS/HIV research, and nearly three-quarters (73

percent) of microbiology experts indicated substantial benefits in their field. Fields cited most frequently with “little to no” contributions from

AIDS/HIV research include genetics, pathology, and

biochemistry.

Respondents cited many examples of contributions

of AIDS/HIV research advances in basic biological

sciences, especially in molecular biology and

immunology. Specific examples of contributions of

AIDS/HIV research were cited for all basic science

fields and are summarized here. Appendix E

includes a complete listing of contributions cited by

survey respondents.

o Iincreased understanding of the mechanisms by

which viral and cell factors control gene

expression is broadly applicable to other

systems.

o Increased understanding of the immune system,

particularly the roles of subsets of lymphocytes

and their regulation by cytokines. Knowledge

of the intricate relationships among cells of the

immune system has facilitated understanding of

intercellular communication.

o Studies of the development of new strains of

HIV has applications to genetic studies of

mutation rates and viral evolution.

o Improved concepts of the pathological consequences of infectious agents, especially in the

central nervous system.

o Increased understanding of opportunistic infections and the role of genetic factors that

influence susceptibility to infection.

o Improved understanding of the lifecycle of the

Figure 2--OTA Survey Respondents’ External Funding, 1989

(n=142)

— .

Federally funded

27.5% for non AIDS/HIV

~.

research

Federally funded for

AIDS/HIV research

162% Nonfedera] externai funding

7’% for non AIDS/HIV research

1.4% ‘Onfederal external fundin g

for AIDS/HIV research

SCMJRCE : Off ice of Technology Assessment, Iwo.

47.9 %

No external

funding
Table 5-Contribution of AIDS and HIV Research to Advances in the Basic Sciences

Contribution of AIDS/HIV researc h

a

Contribution of AIDS/HIV research

Respondants expertis e

a

according to al l respondants ac cordin g to exprt s

b

i n fiel d

Percent Percent

Basic No Littl e Ver y No

sciences

Littl e Ver y

Number opinion to none Somewhat much Number opinion to none Somewhat much Number opinion to none somewhat muc h

Biochemistry. . . . . . . 116 9.5 49.1 19.8 21. 6 112 24.1 22. 3 21. 4 32.1 4 8 0 . 0 37. 5 25. 0 37.5

Cell biology. . . . . . . 117 9 . 4 50. 4 19.7 20. 5 114 17.5 15.8 17.5 49.1 4 7 0 . 0 19.1 21.3 59. 6

Genetics . . . . . . . . . . . 116 9 . 5 53. 4 19.8 17. 2 113 21. 2 25. 7 20.4 32.7 43 0.0 34.9 20.9 44.2

Immunology.... 121 9.1 48.8 21.5 20.7 117 12.0 4.3 9.4 74.4 51 0.0 3.9 2.0 94.1

Microbiology . . . . . . . 117 10.3 51.3 18.8 19.7 113 18.6 13.3 13.3 54. 9 45 0 . 0 13.3 13.3 73.4

Molecular biology. . 119 10.1 48. 7 23.5 17. 6 115 17.4 17.4 13.0 52. 2 49 0 . 0 20. 4 18.4 61. 2

Pathology . . . . . . . . . . 114 12.3 53. 5 26.3 7 . 9 112 25.0 23.2 22.3 29.5 39 0.0 25.6 28.2 46.2

Pharmacology . . . . . . . 114 9 . 6 49.1 29. 8 11.4 112 19.6 16.1 28. 6 35. 7 4 7 2.1 21. 3 44. 7 31. 9

Virology . . . . . . . . . . . 115 8 . 7 51. 3 23.5 16.5 112 17.0 0 . 0 8 . 0 75.0 46 0 . 0 0 . 0 4 . 3 95. 7

aRea~ntg ~ra aak~ to rate their ex~rtige ad c~tribljtions of A1oS/H[V research ~ B 10 pint scale with ~ i~icating n- at al( ati 10 indicating very ~ch.

Thia table grq responses from 1 to 4 into “(ittie to none , II s ad 6 into l!scmewhat,~i and 7 to 10 as Wery fnuch.”

kxperts were those reporting ‘scmwhatm t o

,Ivery -h~l exwrtise (i.e., a rating of 5 to 10).

SUJRCE: Office of Technology Assessment, 1990,

Table6--Contributlon of AIDS and HIV Research to Advances in the Medical Disciplines

Contribution of AIDS/HIV research aContrbution of AIDS/HIV researc h

Respondents' expe rtis e

a according to all respondents accordin g t o expertsm b

i n fiel d

Percent Percent Percent

Medica l No Littl e Ver y No Littl e Ver y No Littl e Very

discipline s Number opinion to none Somewhat much Number opinion to none somewhat much Number opinion to none Somewhat much

Cardiology . . . . . . . . . . 1 0 7

Dentistry. . . . . . . . . . . 105

Dermatology . . . . . . . . . 108

Endocrinology . . . . . . . 106

Family practice . . . . . 105

Gastroenterology. . . . 108

Hemetology. .... ... .

o 1 1 0

lnfectious disease. . 115

Nephrology. . . . . . . . . . 105

Neurology . . . . . . . . . . . 113

Obstetrics /

gynecology . . . . . . . 105

oncology . . . . . . . . . . . . 110

Ophthalmology. . . . . . . 103

Pathology . . . . . . . . . . . 106

Pediatrics . . . . . . . . . . 112

Psychiatry . . . . . . . . . . 110

Pulmonary medicine. . 106

Rheumatology. . . . . . . . 103

11. 2

15. 2

8 . 3

10.4

10.5

9 . 3

9 . 1

7 . 8

10.5

8 . 8

15.2

9.1

14.6

11.3

12.5

13.6

9.4

11.7

45.8

70.5

63.9

54.7

55.2

53.7

50.9

40.9

58.1

53.1

71.4

56. 4

71. 8

55. 7

55. 4

53. 6

52. 8

59. 2

24.3

10.5

23.1

21.7

17.1

24.1

20.9

21.7

23.8

28.3

10.5

18.2

13.6

27.4

19.6

19.1

27.4

19.4

18. 7

3 . 8

4 . 6

13.2

17.1

13. 0

19.1

29. 6

7 . 6

9 . 7

2 . 9

16.4

0 . 0

5 , 7

12. 5

13. 6

10.4

9 . 7

105 31.4

105 35.2

106 24.5

103 29.1

105 33.3

106 30.2

109 22.9

114 15.8

104 28.8

111 19.8

103 32.0

107 19.6

104 39.4

106 29.2

110 25.5

108 26.9

105 21.0

102 32.4

55. 2

42. 9

26.4

47. 6

40. 0

27.4

11.9

3 . 5

43. 3

22. 5

38. 8

20. 6

30. 8

18.9

23. 6

36.1

16.2

43.1

10.5

13.3

23.6

14.6

13.3

22.6

22.9

10.5

22.1

15.3

16.5

15.0

15.4

25.5

20.9

12.0

22.9

13.7

2 . 9

8 . 6

25. 5

8 . 7

13,3

19.8

42. 2

70. 2

5 . 8

42. 3

12.6

44.9

14.4

26.4

30,0

25.0

40.0

10.8

4 6

14

3 0

3 7

3 6

40

44

59

33

43

14

38

14

35

36

36

40

30

6 . 5

0.O

3 . 3

8 . 1

8 . 3

2 . 5

0 . 0

1 . 7

0 . 0

2 . 3

7.1

0.0

0.0

0.0

0.0

5.6

0.0

0.0

82. 6

42. 9

20. 0

62. 2

50. 0

30. 0

13.6

57. 6

16.3

28. 6

7 . 9

28. 6

17.1

19.4

44. 4

12.5

53. 3

8 . 7

35. 7

26. 7

18,9

22.2

30.0

22. 7

1 . 7

33.3

14.0

35. 7

18.4

42. 9

40. 0

27. 8

8 . 3

27.5

30. 0

2 . 2

21.4

50.0

10.8

19.4

37.5

63. 6

93.2

9.1

67. 4

28.6

73,7

28. 6

42. 9

52. 8

41. 7

60. 0

16.7

ORe$~tg ~re ask~ to rate their ejprtf$e ad c~tri~ti~s of AIos/~Iv research M a 10 pint Sca(e with 1 indicating none at ail and 10 indiCi3ti~ Very -h.

Thia table groups responaes from 1 to 4 into ‘tittle to none , M 5 ad 6 in t

o I$sm#lat,@ and 7 to 10 aa Wery -h.”

kxparts were those reporting %cmewhatn to ”verymuchn expertise (i.e., a rating of 5 to 10).

SOURCE: Office of Technology Asaesament, 1990.
OTA’S Survey on Contributions of Research on AIDS and HIV to Other Fields -9

virus, which provides insights into the lifecycles

of other viruses, especially other retroviruses.

The elucidation of particular aspects of viral

structure and function has applications to

studies of other viruses. These include a better

understanding of virus uptake by cells, the

integration of viral genetic material into the

host cell genome, and the mechanism of viral

latency.

The results of research on the structure and

function of viral enzymes has many applications

to other systems. These proteins, encoded by

the viral genetic material, catalyze reactions

important for the replication of the virus.

These studies have been extended into the

design of chemicals that inhibit the activity of

the enzymes essential to the pathogenesis of

the virus. Inhibitors are potential antiviral

drugs. This approach to the treatment of viral

disease has applications to other viral and

fungal diseases and to cancer.

Research on HIV has sparked further experimentation on the treatment of viral diseases in

addition to the design of enzyme inhibitors.

The approaches being explored include

blocking of receptors important for the cellular

uptake of viruses, the use of synthetic peptides,

and the use of “antisense RNA” in the

treatment both of viral diseases and cancer.

Research on AIDS has led to new techniques

for the growth and assay of viruses in culture,

the development of a mouse model for studying

immunodeficiency, and further applications of

the polymerase chain reaction.

Research on AIDS has also spurred the development of retroviruses as vectors for gene

transfer, the expression of active enzymes in

E.coli, the development of tests for toxicity, and

the development of diagnostic probes.

Medicine

Infectious disease, oncology, neurology, hematology, and pulmonary medicine were medical disciplines cited by at least 40 percent of respondents

(irrespective of their level of expertise in the field) as

having benefited greatly (i.e., a rating of 7 to 10)

from AIDS/HIV research (table 6). More than onehalf of the scientists with expertise in these five

medical disciplines also indicated that contributions

of AIDS/HIV research had been substantial. More

than half of respondents with expertise in pediatrics

and dermatology also indicated that AIDS/HIV contributions had been substantial. Cardiology and

endocrinology were the medical disciplines cited

most often for which AIDS/HIV research had made

little to no contribution.

Specific examples of contributions of AIDS/HIV

research were cited for all medical disciplines and

are shown in appendix E. In general, respondents

indicated that AIDS/HIV research has improved our

detailed understanding of viruses, viral-induced

changes in cell function, and the viral-cell interaction

in induction of diseases. In addition, respondents

indicated that AIDS/HIV research has 1) enhanced

knowledge of the function of the immune system and

autoimmune disease (e. g., lupus, rheumatoid

arthritis), and 2) provided valuable insights in

oncology, such as the mechanism of oncogenesis

(e.g., gene control and cell proliferation and

regulation), viral etiology of neoplasms, and

immunodeficiency -associated cancers. Survey

respondents indicated that AIDS/HIV research had

improved knowledge in a variety of medical

disciplines--neurology, infectious diseases, obstetrics

and gynecology, pediatrics, psychiatry--and

influenced the applied medical sciences with

enhanced knowledge in diagnostics and drug and

vaccine development. Specific examples of contributions cited most often by survey respondents were as

follows:

Neurology

Increased understanding of blood-brain barrier

effects;

Increased knowledge of the role of viruses in

central nervous system (CNS) disorders; and

Increased insights into mechanisms of dementia,

multiple sclerosis, and degenerative diseases of

the CNS.

Infectious diseases

Increased understanding of immunodeficiencyassociated infection;

Increased knowledge of opportunistic viral

illness;

Detailed understanding of pneumocystis carinii

pneumonia (PCP); and

Improved understanding of the transmission of

sexually- transmitted diseases.
IO - How Has Federal Research on HIV Disease Contributed to Other Fields?

Obstetn”cs/gynecology and pediatrics

o Improved understanding of maternal-fetal Viral

transmission and cell transfer;

o Improved understanding of passive immunity;

and

o Improved understanding of the development of

the nervous and immune systems in children.

Psychiatry

o

0

0

0

0

Improved understanding of the environment

and the social interactions of IV drug users;

Improved understanding of the use and effectiveness of behavior modification;

Improved understanding of patients’ and

families’ reaction to terminal illness;

Increased focus on studies of sexual behavior;

and

Improved understanding of the psycho-socialmedical care of complex illness affecting mind,

body, and family.

Dermatology

o Improved understanding of the nature of skin

pathology in immunodeficient subjects.

Gastroenterology

o Increased knowledge of the mechanism of

inflammatory bowel disease.

Dentistry

o Increased understanding of the need for

improvements in infection control.

Ophthalmology

o provided new understanding of cytomegalovirus

(CMV) retinitis.

Applied Medical Sciences

More than one-half of experts in each of the four

applied medical sciences--diagnostics, drug development, other therapeutics, and vaccine development--indicated that AIDS/HIV research had

contributed substantially to advancements in these

fields (table 7). Drug development was cited most

often as having benefited from AIDS/HIV research.

Specific examples of contributions cited most often

by survey respondents were as follows:

Diagnostics

o Facilitated development of newer diagnostic

tests (e.g., polymerase chain reaction (PCR),

radioimmuno assays);

o Facilitated development of rapid diagnostic

serologic tests for screening; and

o Facilitated the development of pulmonary diagnostics for viral respiratory illnesses.

Drug development

o

0

0

0

0

Facilitated development of drugs to inhibit viral

replication;

Improved techniques of targeted drug development;

Facilitated development of antibiotics including

antiviral, antiparasitic, and antibacterial

therapies;

Facilitated expedited FDA approval

ments; and

Improved treatment of lung infections.

Vaccine development

of treat0

0

0

Improved basic understanding of vaccines;

Improved understanding of applications of

genetic engineering techniques and recombinant technologies to vaccines; and

Improved understanding of the development of

vaccines against agents that mutate rapidly.

Other

o Development of safer blood banking.

Epidemiology

More than one-half of all respondents and threequarters of experts indicated that AIDS/HIV

research had contributed substantially to disease surveillance and understanding the natural history of

disease (table 7). Nearly one-half of respondents

with expertise in biostatistics felt that AIDS/HIV

research has made substantial contributions to their

field, but more than one-third indicated that

AIDS/HIV research had made little to no contribution to this field.

Specific example of contributions of AIDS/HIV

research to epidemiology cited by respondents

included:

o Improved epidemic-modeling techniques;

o Development of new methods for the conduct

of clinical trials (e.g., community trials) and the

evaluation of new drug treatments;6

60ne respondent felt the advent of community trials was a negative consequence of AIDS/HIV research. He indicated that

there has been a “sanctioning of uncontrolled and unsophisticated

trials for drug efficacy.”
OTA’S Survey on Contributions of Research on AIDS and HIV to Other Fields ~ 11
12- How Has Federal Research on HIV Disease Contributed to Other Fields?

o

0

0

Improved methods for evaluating health risks

and studying unique populations and risk

groups;

Improved disease surveillance methods and

disease reporting; and

Improved understanding of behaviors that put

people at risk for disease.

Public Health and Health Services

Research

The fields of sexually transmitted disease, health

behavior change, health education, and substance

abuse were cited as having benefited substantially

from AIDS/HIV research by more than one-half of

experts in these areas (table 7). The category of

health care organization and delivery was cited most

often as having benefited the least from AIDS/HIV

research.

Specific example of contributions of AIDS/HIV

research to public health and health services research

included:

Health Behavior Change

o stimulated research on the relationship between

lifestyle changes, such as alcohol/drug abuse,

and high-risk health behaviors;

o Stimulated research into the relationship among

knowledge, attitudes, and health practices. Has

provided confirmation that increased

knowledge of disease and prevention leads to

changes in risk behaviors among some risk

groups;

o Increased understanding of safe sex practices;

and

o Provided prototype programs for targeting

health education to high-risk populations.

Health Care Financing

o AID S/HIV has illustrated the financial

ramifications of catastrophic illness and

problems in health care financing (e.g., gaps in

Medicare/Medicaid funding);

o AIDS/HIV has focused attention on the cost of

drugs and drug development; and

o AIDS/HIV has raised issues regarding reimbursement for experimental therapies.

Health Care Organization and Delivery

o Stimulated research on community-based

models of care (e.g., home care, hospice care,

case management, community supports);

o Stimulated research on long-term care issues;

and

o Has focused attention on primary prevention

(e.g., research on prevention of substance

abuse) and early intervention and treatment.

Health Education

o

0

0

Stimulated research on the effectiveness of

health education in preventing high-risk

behaviors and disease;

Facilitated public understanding of communicable disease and infection control (e.g.,

sexually transmitted disease);

Has provided clear connection between lifestyle

practices and disease; and

o Stimulated research into the design and conduct

of health education programs (e.g., use of television and mail health education campaigns).

Sexually-Transmitted Disease

o Clarified routes and mechanisms of sexually

transmitted disease (STDs);

o Facilitated an understanding of other STDs

(e.g., herpes, chlamydia) and the role of coinfection;

o Improved knowledge of sexual behavior, especially within groups at high risk of STDs; and

o Lessons regarding the control of AIDS/HIV are

broadly applicable to control of other STDS.

7

Sociology/Anthropology

o

0

0

Improved understanding of social stigma and

prejudice;

Revealed our lack of knowledge of sexual attitudes and customs; and

Furthered understanding of risk-taking

behaviors, social organizatin, and decisionmaking processes.

Substance Abuse

o Improved understanding of behavioral patterns

and modification;

o Improved understanding of factors leading to

substance abuse, patterns of illicit drug use, and

the “drug culture;” and

o Provided insights into the effectiveness of drug

treatment programs.

70ne respondent reported that AIDS/HIV has led to the gross

compromise of principles for the control of communicable

disease.
OTA’S Survey on Contributions of Research on AIDS and HIV to Other Fields -13

Opinions Regarding Federal Spending for

AIDS/HIV Research

Current Level of Federal Funding for AIDS/HIV

Research-Nearly one-half of survey respondents felt

that the current level of federally funded AIDS/HIV

research was about right. A greater proportion of

respondents felt that funding was too low (31

percent), rather than too high (18 percent) (figure

3).8 Scientists with some professional activity related

to AIDS/HIV were more likely to perceive

AIDS/HIV funding as too low or about right than

those not engaged in AIDS/HIV activities (table 8).9

d no opinion regarding federal spending

on AIDS/HIV research.

sional activity related to AIDS/HIV was statistically significant as

Table 8--OTA Survey Respondents’ Opinions

About the Level of Federally Funded

AIDS/HIV Research by Whether They Are

Engaged in AIDS/HIV Professional Activitiesa

Professional activities

Opinion about

related to AIDS/HIV

level of Federal

AIDS/HIV funding (n=49) (n=87)

Too low . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.5% 33.3%

About right . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.7 51.7

Too high . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32.7 10.3

No opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 4.6

a

These differences in opinion are statistically significant as

Figure 3--OTA Survey Respondents’ Opinion About Level of

60%

50%

4 0 %

3 0 %

20%

1 o%

Federally Funded AIDS/HIV Research

(n=138)

—

45.7%

31.2%

I 5.1%

18.1%

No opinion Too l o w About right Too high

SOURCE: Office of Technology Assessment, 1990.
14- How Has Federal Research on HIV Disease Contributed to Other Fields?

Statistically significant differences in opinion about

levels of Federal funding for AIDS/HIV research

are evident according to whether respondents

received external funding in 1989, and whether that

funding was from the Federal Government for

AIDS/HIV research. Of the respondents that

received no external funding, more than one-half felt

that Federal AIDS/HIV funding was about right,

and nearly one-third indicated that it was too low.

Of those who received Federal funds for AIDS/HIV

research, one-half felt that funding levels were too

low, and the other one-half felt that funding was

about right. By contrast, 38 percent of respondents

who had received external funding for nonAIDS/HIV research felt that AIDS/HIV funding

was too high (table 9).

4 0 %

3 0 %

2 0 %

1 O%

0%

Table 9--OTA Survey Respondents’ Opinions

About the Level of Federally Funded

AIDS/HIV Research by Whether They

Receive External Funding or Federal Funds

for AIDS/HIV Researcha

External funding

Opinion about For For AIDS/HIV

level of Federal No external non-AIDS/ Federally funded

AIDS/HIV funding HIV research research

funding (n=62) (n=48) (n=24)

Too low . . . . . . . . . . . . . . . 32.3% 22.9% 50.070

About right . . . . . . . . . 51.6 35.4 50.0

Too high . . . . . . . . . . . . . . 8.1 37.5 0.0

No opinion . . . . . . . . . . 8.1 4.2 0.0

a

These differences in opinion are statistically significant as

determined by the chi-square test (p< .01).

SOURCE: Office of Technology Assessment, 1990.

Figure 4--OTA Survey Respondents’ Agreement with the Statement:

“Too much research funding has been diverted to AIDS/HIV research from other fields”

(n=141)

I

13.5%

34%

35.5%

Strongly agre e Agre e No opinio n Disagree Strongly disagree

- Response in percen t

SOUCE: Office of Technology Assessment, 1990.
OTA’S Survey on Contributions of Research on AIDS and HIV to Other Fields ~ 15

Diversion of Research Funds to

AIDS/HIV From Other Fields

Nearly half (48 percent) of all survey respondents agreed or strongly agreed that “Too much

research funding has been diverted to AIDS/HIV

research from other fields.” A nearly equal proportion (44 percent) disagreed or strongly disagreed Respondents with this statement (figure 4).10

engaged in some AIDS/HIV professional activities

are less likely to feel that too much research funding

10Almost all (% percent) respondents who felt that Federal

funding for AIDS/HIV research is too high agreed that “too

much research funding has been diverted to AIDS/HIV research

from other fields,” Slightly more than two-thirds (65 percent) of

those who felt that Federal funding for AIDS/HIV research is

too low disagreed, but 30 percent agreed that too much funds had

been diverted from other fields. Among those indicating that

Federal AIDS/HIV research funding is about right, 44 percent

agreed and 49 percent disagreed that too much diversion had

occurred.

Table IO-OTA Survey Respondents’ Extent

of Agreement/Disagreement with the Statement,

“Too Much Research Funding Has Been

Diverted to AIDS/HIV From Other Fields,”

by Respondents’ Involvement in AIDS/HIV

Professional Activitiesa

Respondents’ professional involvement

in AIDS/HIV activities

Extent of agreement Yes

with statement (n=49) (n=90)

Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.4% 10.0%

Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.7 32.2

No opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2 7.8

Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.5 41.1

Strongly disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.2 8.9

a

These differences in opinion are not statistically significant as

determined by the chi-square test (p= .32).

SOURCE: Office of Technology Assessment, 1990.

has been diverted than those without such activities,

but these differences are not statistically significant

(table 10).

There were statistically significant differences in

opinion about diversion of research funds according to

whether respondents received external funding in 1989,

and whether that funding was from the Federal Government for AIDS/HIV research. Thirty percent of

scientists that received no external funding in 1989

agreed or strongly agreed that too much research

funding had been diverted to AIDS/HIV research

from other fields. Scientists receiving external funds

for non AIDS/HIV research were more than twice as

likely to feel that research funds had been diverted.

More than one-third (38 percent) of scientists

receiving Federal AIDS/HIV funds felt that too much

research funding had been diverted to AIDS/HIV, but

58 percent disagreed or strongly disagreed that funds

had been diverted (table 11).

Table 1 l--OTA Survey Respondents’ Extent of

Agreement/Disagreement with the Statement,

“Too Much Research Funding Has Been

Diverted to AIDS/HIV From Other Fields,”

by Whether They Receive External Funding or

Federal Funds for AIDS/HIV Researcha

External funding

Non-Federally AIDS/HIV

Extent of funded and Federally

agreement No external non-AIDS/HIV funded

with funding research research

statement (n=64) (n=49) (n=24)

Strongly agree . . . . . . . 6.3% 30.6% 0.0%

Agree . . . . . . . . . . . . . . . . . . . . 23.4 42.9 37.5

No opinion . . . . . . . . . . . . 14.1 4.1 4.2

Disagree . . . . . . . . . . . . . . . . 46.9 14.3 50.0

Strongly disagree... 9.4 8.2 8.3

a

These differences in opinion are statistically significant as

determined by the chi-square test (p< .01).

SOURCE: Office of Technology Assessment, 1990.
DISCUSSION

The respondents to OTA’s survey indicated that

significant benefits from AIDS/HIV research have

flowed to a wide variety of fields ranging from the

basic sciences to clinical applications and public

health. More than one-quarter of respondents, for

example, reported that AIDS/HIV research has contributed greatly to advances in all of the basic

sciences and half of the medical disciplines included

on the survey. These findings are especially

noteworthy given that, as one respondent commented, substantial lead time is needed for advances

to influence other fields.

Although OTA employed a survey of biomedical

and social scientists to learn of contributions of

AIDS/HIV research to other fields, methods other

than surveys may be used to evaluate the usefulness

of research. For example, bibliometric methods can

examine the extent to which certain publications are

used by others, and economic evaluations can assess

the returns to investment in research.

Bibliometric methods have been successfully used

to measure how the publications of a particular

researcher or a research institute are utilized. 1 The

research discipline of bibliometrics evaluates

scientific publications as a measure of research

output and relies on the existence of large databases

containing key information on the published literature. One bibliographic method that could be used

to investigate the contributions of AIDS/HIV

research to other fields involves identifying a set of

articles representing federally funded research in the

National Library of Medicine’s literature database

MEDLINE (or AIDSLINE) and examining to what

extent the non-AIDS/HIV literature cite these

articles by using the Institute for Scientific

1Bibliometric methods have also been used to study researcher

productivity, the evolution of scientific fields, the diffusion of

scientific ideas, program evaluation, and the identification of

innovative areas of scientific research (4,5,8,10,11).

Information’s database of articles and their

references (the Science and Social Science Citation

Indexes (SCI and SSCI)).2,3

Economic analyses have been used to measure

the “spinoffs” and “spillovers” of research conducted

by some Federal agencies. For example, the overall

benefits to society from four technologies stimulated

by work at the National Aeronautics and Space

Administration (NASA) --gas turbine engines,

integrated circuits, cryogenics, and an advanced computer program dealing with structural analysis--were

estimated to be about $7 billion over a 10-year

4 Another approach used to evaluate period (12).

NASA spinoffs is to study how industry uses the

licenses and patent waivers granted by NASA. Some

benefits of federally funded research are difficult to

measure. The creation of a multibillion dollar

satellite communications industry and a tenfold

reduction in the cost of satellite communications, for

example, can be traced to NASA’s space research

and development program (12).

Because substantial Federal funding for HIV

research is relatively recent, dating only from the

latter part of the 1980s, it would be premature to

evaluate the economic implications of its applications

in other fields. Even in the best of circumstances,

one would expect several years to elapse from the

start of research on HIV to applications to HIV

disease and an even longer lag for advances from

HIV research to be incorporated into other fields

and produce tangible economic benefits.

2Another approach would involve identifying a set of highlycited AIDS/HIV research articles within SCI and seeing to what

extent these articles are cited by non-AIDS/HIV articles within

both SCI and SSCI.

3The principal difficulty in conducting these analyses is distinguishing the AIDS/HIV literature from the non-AIDS/HIV

literature. Any bibliometric analysis would require retrieving

articles or their abstracts and reviewing them for content.

4The analysis was conducted in 1975 for the period 1975 to 1984.

Economic benefits were measured in constant 1975 dollars (12).

-17-
18- How Has Federal Research on HIV Disease Contributed to Other Fields?

Two studies exemplify approaches to address

underlying issues related to funding for HIV

research, namely the appropriateness of the distribution of resources between HIV and other research

areas and the distribution of HIV research funding

among different categories.

Using funding levels for fiscal year 1986, Hatziandreu and her colleagues compared Federal

spending for biomedical research that was targeted

to HIV disease with spending for other leading

causes of death in the United States (2). Based on

expected deaths and potential years of life lost for

1991, they calculated research expenditures per unit

of disease burden for several conditions. They concluded that AIDS was receiving about the same

priority as cancer and that there was no indication

that funding for AIDS was excessive relative to

cancer and heart disease. Compared with 1986,

however, funding for HIV research has increased

about fourfold. Comparable figures are not available

for current Federal funding of research on cancer

and heart disease.

To examine the allocation of funds for HIV

research among alternative uses, Siegel and her colleagues surveyed members of the Institute of Medicine’s Committee on AIDS, a multidisciplinary

group that had studied Federal HIV policy (9).

Compared with the distribution contained in the

expected budget for fiscal year 1987, the dominant

sentiment of these experts favored increased funding

for research on behavioral and social science.

The findings of OTA’s survey also address the

issue of allocating resources among different

research areas. Although over three-quarters of the

respondents felt that Federal spending for

AIDS/HIV research was about right or too low,

nearly half felt that too much of available research

funds has been diverted to AIDS/HIV research from

other fields. These responses indicate not only

support for current or augmented Federal

AIDS/HIV research funding levels but also concern

that other research areas are not adequately funded.

Not surprisingly, responses to questions about the

level of Federal spending for AIDS/HIV research

depend on whether scientists are engaged in

AIDS/HIV research and whether they depend on

Federal resources. Scientists in receipt of Federal

funds for AIDS/HIV research are most likely to hold

the opinion that Federal AIDS/HIV funding is too

low, and more than two-thirds of scientists receiving

external finding for other-than AIDS/HIV research

felt that too much research funding has been diverted

to AIDS/HIV from other areas.

Nearly one-half of OTA survey respondents

received no external funding in 1989. The opinions

expressed by these respondents are of particular

interest because they are less likely to have vested

interests in funding policies. Over one-half of these

respondents felt that AIDS/HIV funding is about

right, and nearly one-third felt that funding was too

low. Only eight percent felt that AIDS/HIV funding

was too high. On the question of diversion of

research funds, more than one-half of scientists

without external funding did not agree, but nearly

one-third agreed that too much research funding has

been diverted to AIDS from other areas. Over onehalf of scientists who receive Federal support for

AIDS/HIV research disagreed that research funds

have been diverted to AIDS from other areas, but as

many as 38 percent agreed that diversion has

occurred.

In addition, in separate comments, survey respondents raised the issue of allocating resources to HIV

and other targeted fields versus to basic research.

One respondent, for example, pointed out that contributions from basic research conducted prior to the

HIV epidemic had furthered advances in subsequent

HIV research and, while questioning the contributions of HIV research to basic biology, felt that,

“...our understanding of basic biology has made possible all AIDS research.”

In conclusion, results from OTA’s survey indicate

that, in the opinion of the scientific community, HIV

research has made many important contributions to

advances in the biomedical and behavioral sciences.

Furthermore, the dominant sentiment of survey

respondents support current or augmented levels of

HIV research. Opinion was divided on the question

of whether too much research funding has been

diverted to AIDS/HIV research from other fields.

The results raise for continued consideration the

appropriate allocation of research funds among HIV,

other targeted areas, and basic science.
References

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Booth, W., “No Longer Ignored, AIDS Funds

Just Keep Growing,” Science 242(4880):858-859,

Nov. 11,1988.

Hatziandreu, E., Graham, J.D., and Stoto, M.A.,

“AIDS and Biomedical Research Funding:

Comparative Analysis,” Reviews of Infectious

Diseases 10(1):159-167, Jan.- Feb. 1988.

Lucchesi, J. C., “NIH Budget Crisis,” (letter)

Science :393, January 1990.

Narin, F., “Bibliometric Techniques in the

Evaluation of Research Programs,” Science and

Public Policy 14(2):99-106, April 1987.

Narin, F., Concordance Between Subjective and

Bibliometric Indicaton of the Nature and Quality

of Performed Biomedical Research, A Program

Evaluation Report for the Office of Program

Planning and Evaluation, National Institutes of

Health, Public Health Service, U.S. Department

of Health and Human Services, April 1983.

Palca, J., “Hard Times at NIH,” Science

246(4933):988-990, Nov. 24,1989.

Rogers, D.E., “Federal Spending on AIDS--How

Much Is Enough ?,” New Engl. J. Med.

320(24):1623-1624, June 15, 1989.

Self, P. C., Filardo, T. W., Lancaster, F. W.,

“Acquired Immunodeficiency Syndrome (AIDS)

and the Epidemic Growth of its Literature,”

Scientometrics 17(1-2):49-60, 1989.

Siegel, J. E., Graham, J. D., and Stoto, M.A.,

“Allocating Resources Among AIDS Research

Strategies,W Policy Sciences 23(1):1-23, 1990.

Small, H. and Greenlee, E., “A Co-Citation

Studv

of AIDS Research,” Communication Research

16(5):642-666, October 1989.

11. Small, H. and Pendlebury, D., “Federal Support

of Leading-Edge Research: Report on a Method

for Identifying Innovative Areas of Scientific

Research and Their Extent of Federal Support,”

U.S. Congress, Office of Technology Assessment

Contract Paper J3-4879.0, February 1989.

12. U.S. Congress, Office of Technology

Assessment, Research Funding as an Investment:

Can We Measure the Returns? OTA-TM-SET-36

(Washington, DC: U.S. Government Printing

Office, April 1986).

13. U.S. Department of Health and Human Services, Public Health Service, Budget Office,

unpublished data, Washington, DC, Feb. 28,

1990.

14. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease

Control, “Years of Potential Life Lost Before

Ages 65 and 85--United States, 1987 and 1988,”

Morbidity and Mortality Weekly Report 39(2);20-

21, Jan. 19, 1990

15. U.S. Executive Office of the President, Office of

Management and Budget, Budget of the United

States Government - Fiscal Year 1991 (Washington, DC: U.S. Government Printing Office,

1990).

16. Winkenwerder, W., Kessler, A. R., and Stolec,

R. M., “Federal Spending for Illness Caused by

the Human Immunodeficiency Virus,” New Engl.

J. Med. 320(24):1598-1603, June 15,1989.

-19-
Appendix A

Method of the Study

OTA staff designed a survey instrument to

examine whether AIDS and HIV research has

contributed to advances in other biomedical and

social science fields. Six people with varying degrees

of familiarity with AIDS/HIV research reviewed the

questionnaire and accompanying cover letter. Based

on their comments, OTA staff revised both the

questionnaire and the cover letter (see app. B for

final questionnaire and cover letter).

In February 1990, OTA mailed packets including

a questionnaire, a cover letter, and an addressed

return envelope to 400 people. The recipients were

randomly selected from a membership list of an

organization of distinguished biomedical and social

scientists. The packets differed by type of mail

delivery and type of cover letter. Two hundred were

sent by overnight mail, accompanied by a personalized cover letter (Group A); 100 were sent by first

class mail with a personalized cover letter (Group

B); and 100 were sent by first class mail with a “Dear

Colleague” letter (Group C). The response rates

were 44.5 percent for Group A, 32 percent for Group

B, and 26 percent for Group C.1

 Overnight mail and

personalized cover letter thus increased the response

rates.

The questionnaire solicited comments on 42

different fields that comprised 5 broad areas: basic

science, medical disciplines, applied medical

sciences, epidemiology, and public health and health

services research. The recipient was asked to rate,

on a scale of 1 to 10, the contributions that

AIDS/HIV research had made to each field and the

1Only completed or partially completed questionnaires were

included in calculating the response rate. If returned blank

questionnaires are included, the response rates are 57 percent, 40

percent, and 32 percent for groups A, B, and C, respectively.

recipient’s expertise in each field. The main text of

this document reports the results of this portion of

the survey. The recipients were also asked to give

specific examples of contributions of AIDS/HIV

research to each specific field. Appendix E lists the

responses to this portion of the survey. These

responses include those received during the pilot test

of the questionnaire. Recipients were also asked

questions about AIDS/HIV funding levels and

general demographic information. The main text

also reports the results of this portion of the survey.

Respondents’ primary fields of expertise are listed in

Appendix D.

Seven returned questionnaires included indications that the randomly selected recipient was not the

sole respondent. Six of the 7 questionnaires

indicated that the respondent was someone other

than the randomly selected recipient. These

responses were not included. One questionnaire

indicated that the randomly selected recipient and

another person had jointly filled out the

questionnaire. This questionnaire included

demographic characteristics for both people. Only

the demographic characteristics of the randomly

selected respondent were included; all other

responses were included.

In late February 1990, a draft Staff Paper was

prepared and sent to outside reviewers for comment.

These reviewers came from a range of relevant fields

including HIV biomedical research, non-HIV

biomedical research, public health, medicine, health

care organization and delivery, health education and

behavior, and consumer advocacy. Based on their

comments, the Staff Paper was revised in March

19900

A-1
Instrument

Appendix B

of the OTA Survey

January 31, 199 0

Dear Colleague :

The Congressional Office of Technology Assessment (OTA) is conducting a

survey to learn more about contributions that research funded by the federal

government on Acquired Immunodeficiency Syndrome (AIDS) and the Human

Immunodeficiency Virus (HIV) may have made to advances in other fields.

Findings from the survey will form the basis of an OTA Staff Paper that has

been requested by the Subcommittee on Human Resources and Intergovernmental

Relations, House Committee on Government Operations.

You are one of a group of distinguished biomedical and social scientists

who have been selected to receive the survey. Please complete this form and

return it to OTA in the enclosed envelope by February 12.

Your responses are, of course, confidential and anonymous. The data

gathered will be presented only in aggregate form.

We appreciate very much your participation in the survey. Only by

gathering data from knowledgeable people can we provide Congressional

committees with the accurate, reliable information that they need.

If you have any questions or prefer to respond by telephone, please

contact either Dr. Maria Hewitt or me in the Health Program by phone at

202/228-6590 or by FAX at 202/228-6098.

Sincerely,

Jane E. Sisk, Ph.D.

Senior Associate

B-1
Page 1

1.

OFFICE OF TECHNOLOGY ASSESSMENT, U.S. CONGRESS

SURVEY ON CONTRIBUTION OF RESEARCH ON AIDS AND HIV TO OTHER FIELDS

Use the scale below to indicate to what extent you think federally-funde d AIDS/HIV research has contributed

to advances in the fields listed. Use the same scale to indicate how expert you feel in each field, Please

cite specific examples of contributions in each field with which you are familiar.

additional sheets for all or part of your response.

RATING

FIELDS

Very much

SCALE: 10 ----- 9

---- - 8---- - 7

R A T I N G S

CONTRIBUTION YOUR

OF AIDS/HIV EXPERTISE IN

RESEARCH EACH FIELD

Somewhat

----- 6 ----- 5 ----- 4 ----- 3

If you wish, attach

-----

SPECIFIC EXAMPLES

None

at all

2 ---- - 1

BASIC SCIENCES (e.g., identification of regulatory genes and their functioning)

Biochemistry

Cell biology

Genetics

Immunology

Microbiology

Molecular biology

Pathology
RATING

FIELDS

Very much

SCALE: 10

R A TING S

CONTRIBUTION YOUR

OF AIDS/HIV EXPERTISE IN

RESEARCH EACH FIELD

Somewhat

6 ----- 5 4

SPECIFIC EXAMPLES

Page 2

None

at all

2 ----- 1

Pharmacology

Virology

Other

(please specify)

MEDICAL DISCIPLINES

Cardiology

Dentistry

Dermatology

Endocrinology

Gastroenterology

(e.g., for Oncology application of insights about regulatory genes :

to malignant changes)
B-4 - How Has Federal Research on HIV Disease Contributed to Other Fields?

I

I

t

1

I

I

1

t

I

t

I

I

1

I

t
RATING

FIELDS

Very much

SCALE: 10 ----- 9 ----- 8 -----

R A TING S

CONTRIBUTION YOUR

OF AIDS/HIV EXPERTISE IN

RESEARCH EACH FIELD

7 ---- -

Somewhat

6 ----- 5 ----- ----- -----

SPECIFIC EXAMPLES

9

None

at all

----- 1

Pulmonary medicine

Rheumatology

APPLIED MEDICAL SCIENCES

Diagnostics

Drug development

Other therapeutics

Vaccine development

Other

(please specify) —

(e.g. , for Therapeutics: anti-viral therapy for other illnesses)
Page 5

None

Very much Somewhat at all

RATING SCALE: 10 ----- 9 ----- 8 ----- 7 ----- 6 ----- 5 ----- 4 ----- 3 ----- 2 ----- 1

R A T I N G S

CONTRIBUTION YOUR

OF AIDS/HIV EXPERTISE IN

FIELDS RESEARCH EACH FIELD SPECIFIC EXAMPLES

EPIDEMIOLOGY

Clinical trial

development

Disease

surveillance

Natural history of

disease

Other

(please specify)

PUBLIC HEALTH AND HEALTH

SERVICES RESEARCH

Health care

financing

Health care

organization

and delivery

(e.g. , for Clinical trials: community-based trials)

(e.g. , for Health Education: providing death education to substance abusers)
RATING

FIELDS

Very much Somewhat

SCALE: 10 ----- 9 ----- 8 ----- 7 ----- 6 ----- 5

R A T 1 N G s

CONTRIBUTION YOUR

OF AIDS/HIV EXPERTISE IN

RESEARCH EACH FIELD

Page 6

None

at all

----- 4 ----- 3 ----- 2 ----- 1

SPECIFIC EXAMPLES

Health education

and behavior

change

Sexually

transmitted disease

Substance abuse

Other

(please specify)

OTHER

(PLEASE SPECIFY)
B-8 ~ How Has Federal Research on HIV Disease Contributed to Other Fields?
Appendix B–Instrument of the OTA Survey - B-9
Appendix C

Acknowledgements

This project has benefited from the advice and the review of a number of people. OTA staff would like to

express its appreciation to the following people for their valuable guidance.

Marshall Becker, Ph.D., M.P.H.

School of Public Health

The University of Michigan

Ann Arbor, MI

Anthony Fauci, M.D.

National Institute of Allergy

and Infectious Diseases

National Institutes Health

Bethesda. MD

Margaret Hamburg M.D.

National Institute of Allergy

and Infectious Diseases

National Institutes of Health

Bethesda, MD

Austin R. Kessler, M.B.A.

Office of Assistant Secretary

for Planning and Evaluation,

Health Planning

U.S. Department of Health

and Human Services

Washington, DC

Jeffrey Levi, M.A.

Gay Men’s Health Crisis

Washington, DC

Lincoln E. Moses, Ph.D.

Statistics Department

Stanford University

Stanford, CA

Gary Noble, M.D.

HIV/AIDS Programs

Centers for Disease Control

Atlanta, GA

June E. Osborn, M.D.

School of Public Health

The University of Michigan

Ann Arbor, MI

Michael Rosenblatt, M.D.

Merck, Sharpe, & Dohme

Research Laboratories

Merck & Co., Inc.

West Point, PA

David Kern, M.D. Henry Small, Ph.D.

School of Medicine Institute for Scientific

Stanford University Information

Stanford, CA Philadelphia, PA

c-1
Appendix D

OTA Survey Respondents’ Primary Field of Expertisea

Field Frequency

BASIC SCIENCES

Biochemistry

Bioengineering

Cell biology

Developmental biology

Genetics

Immunology

Microbiology

Molecular biology

Neuroscience

Physiology

Virology

5

2

2

1

4

2

2

2

3

2

2

Total 27

MEDICINE

Anesthesiology

Cardiology

Endocrinology

Family practice

Gastroenterology

Hematology

Infectious disease

Internal medicine

Neurology

Obstetrics/gynecology

Occupational medicine

Oncology

Oral medicine

Pathology

Pediatrics

Psychiatry

Radiology/nuclear medicine

Rheumatology

Surgery

Toxicology

Medicine, unspecified specialty

1

5

1

4

1

1

9

13

3

1

2

5

4

2

7

3

3

2

1

1

3

Total 72

D-1
D-2 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SURVEY RESPONDENTS’-continued

Field Frequency

EPIDEMIOLOGY

PUBLIC HEALTH AND HEALTH

Health care administration

Health care financing

Health education

Health services research

Public health, health policy

Total

OTHER

Aging

Economics

Nursing

Psychology

Public administration

Sociology

Total

UNSPECIFIED

TOTAL

SERVICES

4

RESEARCH

4

1

1

2

7

15

3

4

3

2

1

3

16

13

147

aRespondents’ were asked to report their primary field of expertise in an open-ended format

on the questionnaire.
Appendix E

Specific Examples of Contributions of AIDS/HIV Research

to Other Fields

Number

of responses Specific examples (listed by area and field)

179

21

2

1

1

1

1

1

1

2

2

1

1

1

1

1

1

1

1

1

BASIC SCIENCES

Biochemistry

Biochemistry of polymerase protease, transcriptional activation and regression,

all applicable to different biological systems

Glycoprotein and gene product characterization

Identification of regulatory genes, their function, and role in latency

Mechanism of ribonucleic acid (RNA) synthesis control

Control of transcription and translation

Protein processing

Gene organization

Protein structure/enzyme of human immunodeficiency virus (HIV)

(e.g., reverse transcriptase)

Crystal structure of proteins; design of substrate inhibitor

Studies of aspartic protease and thein inhibition

Novel understanding of protein-deoxyribonucleic acid (DNA) or RNA

interactions

Structure/function studies of inhibitors of reverse transcriptase and viral

protease

Binding of protein to DNA

Interaction of envelope proteins with cellular CD-4 receptors

Viral coded enzymes and their expression

Identified functional domains and mechanism of DNA polymerase

Progress in the “anti-sense” approach to treatment of viral disease and cancer

Isolation of regulatory c-effecter and viral proteins

E-1
E-2 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

22

1

3

2

1

1

1

1

2

1

2

1

2

1

1

1

1

Cell Biology

Regulatory Genes

Cell transport, protein processing interaction by cytokines, autocrin

pathways, cell activation

Cell receptor interactions leading to normal function, abnormal function

and cell death

Identification of cell lines allowing replication

Role of cytokines as growth factors

Compartmentalization of pathologic products

Cell fusion mechanism, transection

Viral effects and cell function

New understanding of RNA splicing and regulation of nuclearcytoplasmic transport, new understanding of regulation of transcription

Understanding of CD-4 receptor function

Mechanism of receptor/ligand endocytosis and transport to and release

from Iysosomes

Understanding of basic growth and development process

Mechanism of latency-- many contributions to cell biology

Viral replication, budding, and morphology

Enhanced understanding of intra and intercellular communication,

(e.g., activation signals, secondary messengers)

Major impact on signal transduction, mechanism of c-effecter

activation/differentiation
Appendix E-Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields - E-3

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

16

2

3

1

2

1

1

1

1

1

1

1

1

34

1

1

1

1

Genetics

Genetic organization and control of all retroviruses including HIV, human T-cell

Iymphotropic virus, (HTLV), other tumor and immunodeficiency viruses

Regulation of gene expression

Mutation rates

Relatedness of HIV and simian immunodeficiency virus

Retroviruses as vectors for gene transfer

Studies of mutation in in vivo

Mechanism of integration into host genome

Mechanism and fidelity of viral RNA reverse transcription and proviral

integration

Recombination

Research on genetic factors that influence susceptibility to infection and

patterns of immune dysfunction

Identification of regulatory genes and their function

Transcriptional regulation

Immunology

Understanding of retroviruses

Understanding basic pathogenesis

Stimulated research on effect of alcohol on immunological system (cellular and

humoral immune responses and neurohormonal immunodulation)

Cell and antibody mediated immune recognition of antigen and prevention of

infection
E-4 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

2

6

1

1

1

1

2

1

2

3

1

1

1

1

1

1

1

Cell mediated immune response controls susceptibility to some protozoal

(Pneumocystis), fungal (Cryptococcus), and bacterial (p.multocida) infections

Elucidation of lymphocyte biology, subsets, networks interactions, profound

insight into CD-4 lymphocyte biology and function

T-cell function, immunoregulation, cellular immunology in general

Mechanism of virus targeting and immunoresponse suppression

Mechanism of immune control of viruses

Pivotal role of CD-8 bearing T-cells in the immune process

Role of immune disregulation

Better understanding of roles of T and R lymphocytes in the immune process

Careful characterization of Iymphokine and monokine regulation and CD-4 and

adhesion molecule function

Enhanced understanding of interactions of cellular components and

Iymphokines

Deeper understanding of immune system and of multiplicity of diagnostic

probes

Immunoregulation, cytokine action, immunodeficiency, animal models

Understanding of resistance of viruses

Importance of microphage as a viral reservoir

AIDS has essentially had a confirmatory role on aspects of cell-mediated

immunity

Knowledge of antibodies to surface antigens operate

Elucidation of peptide sequences that specifically signal T-lymphocytes

Elucidation of immune epitopes
Appendix E–Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields - E-5

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

1

20

1

2

4

2

2

1

1

1

1

1

1

1

1

1

Development of SCID mouse model that can be used to evaluate “human-like”

immune response to a number of pathogens

Model for research on other immune deficiency disorders; insight into normal

and immune function and regulation

Microbiology

Viral genetics

Elucidation of genetic complexity and biology of human and primate

retroviruses

Insight into HIV related opportunistic infections

Co-pathogenesis relations to other retroviruses and to fungi

Served as a paradigm for the study of viral pathogenesis

Microbial pathogenesis

Mechanism of viral latency and transactivation

Virus growth and assay techniques

Methods to allow the search for potential retroviral disease causing agents

Better understanding of all opportunistic infectious agents

Applications of polymerase chain reaction (PCR) techniques to diagnosis of

cancer

Studies of viral evolution and monitoring of viral spread through Africa and

world populations

Field of human retrovirology has been opened

Expression of active enzymes in E.coli
E-6 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

15

3

2

1

1

1

1

1

1

1

1

2

15

2

1

5

1

Molecular Biology

Control of genes, reverse transcriptase mediated alteration of genomes,

insertion of control elements

Broadly applicable principle in transcriptional activation, transcriptional and

translational control mechanism, RNA processing, advances in genetic

engineering

Regulator circuits

Encoding and sequence similarities

Excellent virus for the study of cis and trans regulation factors

Genetic variation, processing signals

Gene structure and regulation

Application of novel strategies (e.g., PCR)

Stimulated use of PCR

Studies of how accessory genes affect viral latency and transcription

Identification of HIV genes and their function and components of HIV Iifecycle

have implications for all other viruses

Pathology

Pathogenesis of viral induced immune suppression

New insights into AIDS dementia, other retroviral nervous system disease such

as Tropical Spastic Paraparism caused by HTLV-1

Better understanding of the pathologies of Kaposi’s sarcoma (KS) and

opportunistic infections

New organ system relationships
Appendix E-Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields - E-7

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

1

1

1

1

1

13

5

3

1

1

1

1

1

22

1

7

Growth of human cells (organs) in immunodeficient animals (mice) -unique

experimental model

Improved concepts of pathological consequences of infectious agents

Understanding effect of virus

Neuropathology of central nervous system (CNS) complications

Microglial or microphage involvement in AIDS encephalopathy

Development of new techniques to isolate and culture microbes in pathology

specimens

Pharmacology

Development of antiviral, antifungal and anticancer therapies/agents

Better understanding of antiviral drug action

Development of CD-4 blocking strategy

Protease inhibitors

New treatment methods, such as synthetic peptides

New drug design and modeling

Targeted drug development established for AIDS provides a model and kind of

knowledge for development and testing compounds against other viruses;

drugs developed against HIV may have other applications; development of

animal models for chemoprevention of retroviral transmission; Development of

tests for toxicity

Virology

Viral Genetics

Profound insight into new classes of retroviruses--human and primate,

immunodeficiency
E-8 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

4

2

1

2

1

1

1

1

1

1

1

168

4

4

8

1

4

Mechanism of retrovirus replication, integration and control of RNA synthesis

Mechanism of persistent infection and latency

Detailed analysis of virus replication

Co-pathogenisis with other related and coexisting viruses

Regulation of retroviral genes by host factors (e.g., 50 kd cellular protein binds

to LTR (long term repeat) of HIV-1 and regulates transcription)

Life cycle of RNA viruses

Identification of receptors, varying protein coats

Latency and integration of retroviruses

Pathophysiology of retroviruses

Other

Psychobiology- relation of specific pathology caused by HIV infection in brain

to behavioral changes in victims- results will eventually have importance for

other dementias (e.g., Alzheimers)

MEDICAL DISCIPLINES

Cardiology

Understanding mechanism of AIDS-related cardiomyopathies

Dentistry

Drastically changed dental research. Dental research has turned significantly to

basic research (virology, microbiology, molecular biology, immunology) in

understanding oral soft tissue and salivary gland disease; has begun to use

biostatistics and epidemiology in more areas and has begun to explore

behavioral and attitude studies;

Emphasized need for and improved infection control
Appendix E--Specific Examples of Contributions of AIDS/HIV Research to Other Fields - E-9

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

1

1

11

2

6

1

1

1

6

2

1

1

1

1

5

1

1

2

1

Understanding oral complications of immunosuppression

Study of the mechanism of thrush

Possible role of salivary components as antiviral agents

Dermatology

New dermatopathic illness (and descriptions of them) secondary to HIV

Broader understanding of nature/treatment of skin pathology in

immunodeficient subjects, including KS

Dermal functions of immunologic system surveillance

Methods for in situ and PCR hybridization

Viral causes of skin deficiencies

Endocrinology

Helped in the development of tools to study autocron events and growth factor

regulation

Better understanding of circulating cytokines

Insights into adrenal failure and AIDS-associated endocrinopathies

Autoimmune system

Understanding of neuro-endocrine pathways

Family Practice

Psycho-social-medical care of complex illness affecting mind, body and family

importance and methods of obtaining accurate sexual history

Management of AIDS in community setting

New focus on epidemiology within family practice research
E-10 - How Has Federal Research on HIV Disease Conributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

9

1

2

1

1

1

1

2

10

1

1

1

1

1

1

1

1

1

Gastroenterology

New gastrointestinal (Gl) illness associated with HIV

Better understanding of development of Ieukepenia, KS, and opportunistic

infections of the GI tract

Improved understanding of Cryptosporidium

Mechanism of inflammatory bowel disease

Interaction of intestinal infections and malabsorption syndromes, nutritional

deficiencies

How other viruses lead to intestinal pathology

Insights into the diagnosis and treatment of GI infections; treatment of chronic

diarrheal disease

Hematology

Understanding of blood transfer in disease

Identification of cellular subpopulations and the function and development

stages for each subtype

New spectrum of immunodeficiency associated cancers

Lymphocyte, microphage biology

Major stimulus to the cloning and study of colony stimulating factors

Role and use of colony stimulating factors

Improved understanding of regulation of bone marrow and mechanism of ITP

Stem cell renewal

Improved protection of the nation’s blood supply
Appendix E-Specific Examples of Contributions of AIDS/HIV Reseamh to Other Fields - E-n

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

18

1

3

3

6

1

1

2

1

2

2

15

1

1

3

1

Insight into role of wide range of blood components and related

dysfunction/disease

Infectious Disease

Understanding the impact of loss of lymphocyte function and therapeutic

strategies for dealing with infections in an immunocompromised host

New spectrum of immunodeficiency-associated infection

Better understanding of spectrum of opportunistic viral illness

Treatment of opportunistic infections, including new antiviral and antifungal

New understanding of multiple infectious agents, including AIDS and several

opportunistic pathogens

New concept in the management of infectious diseases, their epidemiology,

and their prevention

Detailed understanding of a virus

Understanding transmission of sexually related disease

Nephrology

New concepts in glomerulopathies

Neurology

Understanding AIDS encephalopathy

Better understanding of subcortical dementia

New spectrum of associated neurological illness, dementia, and peripheral

neuropathy

AIDS dementia reveals alternative mechanisms of cognitive decline, indirect

chemical bases, with absence of direct pathology
E-12 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

3

1

3

1

1

7

4

1

1

1

21

4

1

1

3

3

2

Better understanding of role of viruses in CNS disorders, improved recognition

of viral causes of subtle disorders of mental function

New understanding of viral encephalopathy at mechanistic and clinical level

Insight into mechanisms of dementia and degenerative CNS disease, HTLV,

and multiple sclerosis

Relevance of microphage-derived cells and possibly soluble protein factors

on the function of the nervous system

Blood-brain-barrier affects CNS microphage and other cells’ roles in infection

Obstetrics/gynecology

Improved recognition of maternal-fetal viral transmission

Avoidance of internal fetal monitoring and use of scalp electrodes

New studies of cervical neoplasias associated with immunosuppression, viral

transmission during pregnancy

Studies of exogenous virus transplacental transmission and transmission

during breastfeeding

Oncology

New understanding of Kaposi’s Sarcoma (KS)

Understanding of viral-induced changes in cell function

Importance of drugs influencing, DNA structure and function

New spectrum of immunodeficiency-associated cancers and further

information about these rare cancers

Mechanism of oncogenesis

New insight into viral etiology of neoplasm
Appendix E-Specific Examples of Contributions of AIDS/HIV Resea~h to Other Fields - E-13

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1 Knowledge of unrestrained epithelial growth that seem to underlie KS and its

relationship to oncogenesis and growth factors

2 Gene control, cell proliferation, and cell regulation as they relate to the

formation of malignant cells

2 Regulatory gene (tat) transected into mice, cancer symptoms of Kaposi’s

sarcoma tat has a direct effect on development of tumors

1 Mechanism of cell transformation

1 Defining genomes of leukemia

7 Ophthalmology

7 New understanding of cytomegalvirus (CMV)-retinitis (therapy with

gancyclovir) will have broader applications

5 Pathology

1 Importance of viral-cell interactions in the induction of disease of all systems

2 Development of more efficient and accurate techniques for measuring

presence of virus in tissues and developing diagnostic technology,

(i.e., T/B lymphocytes and ratios)

1

1

9

2

1

1

2

Use of in situ hybridization to detect HIV

Methods for RNA detection in situ

Pediatrics

Better understanding of maternal-fetal interrelationships, cell transfer, passive

immunity, and genetic basis of disease

New approach to medical and social care

Effects on understanding of pediatric immunodeficiencies (e.g., primary as well

as maternal/fetal transmission of viruses)

Pediatric immunodeficiency and congenital viral infection
E-14 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

2

1

10

1

2

1

1

2

1

1

1

17

5

3

1

3

2

3

Provided insight into development of immune system in children

Insight into neurological development and immune function

Psychiatry

Stimulated research on HIV-related psychopathology

(e.g., AIDS-related dementia)

Improved understanding of AIDS-related dementia (will relate to other

dementias)

Improved understanding of intravenous (IV) drug users interaction and

environment

Behavior modification and studies of high-risk behavior

Reaction to terminal illness

Crisis intervention therapy

Studies of sexual behavior

of patients and families

New approach to substance abuse

Pulmonary medicine

New spectrum of illnesses

New pulmonary diagnostics for viral respiratory illness

Outpatient management of severe viral disease (i.e., aerosolized antiviral

agents for pneumocystis)

Detailed understanding and improved management of Pneumocystis carinii

pneumonia

Improved bronchoscopic techniques

Improved treatment of lung infections (e.g., pneumonias)
Appendix E--Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields ~ E-15

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

4

2

1

1

54

21

2

1

1

4

1

1

1

2

2

1

1

1

1

1

Rheumatology

Autoimmune diseases

Immune cell function

Better understanding of rheumatoid arthritis, lupus, etc.

APPLIED MEDICAL SCIENCES

Diagnostics

Development of PCR

Virus culture

Identification of pathogen, stage of infection, types of immune response, and

cellular populations

Stimulating use/development of newer diagnostic tests such as those

employing PCR and RIA

Antibody, reverse transcriptase and other assays

Protection of the blood supply

Better clinical screening for PCP, KS, CMV retinitis

Development of new diagnostics

Improvement of old diagnostic techniques

Imaging advances-- GI tract, nodes, and mesentery

Rapid diagnostic serologic tests for screening

Improved techniques for measuring T and B lymphocytes

Improved anatomic pathology for diagnosis of tissue infection with viruses

Use of PCR as means of detecting extremely low levels of virus in blood
E-16 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

17

1

1

1

10

1

1

2

3

1

1

1

12

3

1

1

2

1

1

Improved diagnostics for HIV associated disease

Drug development

Drugs that will influence gene expression and prevent viral induced changes in

human genome

Aerosolizes pentamidine for pneumocyctis

Drugs to inhibit viral replication

New antiviral, antiparasitic, antibiotic behavior therapy

Expedited approval use of medication

Initiation of search for protease inhibitors and inhibitors of reverse transcriptase

Technique of targeted drug development

Other therapeutics

CD-4 mimicking recombinant products

Synthetic peptides

Improved microbial treatments

Vaccine development

Many advances in understanding of vaccines in general via HIV work

New concepts in vaccine development (e.g., anti-idiotgsic vaccines)

Application of genetic engineering techniques, work on animal models

Recombinant technologies applied

Learning to produce vaccines against agents that mutate rapidly

Development of simian AIDS vaccine
Appendix E--Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields - E-17

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

1

1

1

1

41

7

1

1

4

1

19

3

2

2

3

1

4

2

New vectors, adjuvants, assay systems

Progress toward developing viruses for complex viruses

Applications of insights into nature of immune response/immunogenecity;

nature and function of adjuvants; Advances in techniques of molecular

biology/ molecular genetics

Other

Safer blood banking

EPIDEMIOLOGY

Biostatistics

New methods for conduct of clinical trials and drug evaluation

Development of methods for clinical trials with high dropout rates

Advances of epidemic modeling techniques

Improved data collection techniques

Clinical trial development

Development of alternative tracks for drug testing

Expedited “real world” trials

Development of multiple sites and investigators in trials

Development of community-based trials

Ability to conduct successful clinical trials in non academic setting

Negative effect: sanctioning uncontrolled or unsophisticated trials for drug

efficacy

Stimulated development of cohort studies of surrogate endpoints
E-18 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

2 AIDS research has helped overcome special study design problems posed by

unique population and risk groups.

11 Disease surveillance

3 Improved methods (e.g., those used by Centers for Disease Control (CDC)),

beyond those used for sexually transmitted diseases; Will have major effects

on other disease surveillance efforts

Risk evaluation

Improved methods of disease ascertainment

Increased awareness of difficulties of surveillance for a stigmatized disease

Improved reporting to the CDC

Surveys by ASPN--more realistic than health department estimates

Greater sophistication in techniques of data collection and analysis

Examination of issues concerning underreporting

Natural history of disease

Large surveys of susceptible and high-risk individuals

Understanding of behaviors (not groups) that put people at risk

Better understanding of the behavior of virus in the CNS

Broader application of role of cofactors, insights into the relationship of

immune function and susceptibility of disease

Other
Appendix E--Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields - E-19

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

68 PUBLIC HEALTH AND HEALTH SERVICES RESEARCH

14 Health behavior change

1 Stimulated prevention research on relation between alcohol abuse and

alcoholism and high risk behavior, particularly unsafe sexual behavior and IV

drug use

1

5

1

1

1

1

2

1

9

1

5

1

1

1

Increased study of lifestyle changes that relate to disease prevention

Increased knowledge of disease leading to change in high risk sexual behavior

among homosexual men

Generally, increased efforts in a traditionally poorly studied area

Safe sex practices

Ability of targeted health education to influence behavior of population groups

(i.e., homosexuals)

Brought to forefront risk behaviors clearly related to infection

Prototype programs for altering behavior-- sexual practices, drug use or abuse

Studies of behavior change- relationship to knowledge and attitudes

Health care financing

Illustrates problems of catastrophic illness

Focused problems on broader deficiencies in health care financing

Focus on cost of drugs and drug development

Raised issues regarding reimbursement for experimental therapies

identification of gaps in Medicare and Medicaid funding
E-20 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

10 Health care organization and delivery

1 Stimulated prevention, early intervention and treatment research on substance

abuse, particularly IV drug use

3 Contributed to understanding long term care issues (not focused on elderly),

hospice, nursing homes, particularly use of community supports (i.e., San

Francisco model)

1

2

1

1

1

12

1

2

1

3

1

1

1

A better understanding of community-based models of care

Expedited knowledge and application of knowledge about out-of- hospital care

previously thought necessary in hospitals

Demonstration of importance of home care, case management

Improved evaluation of treatment programs

Negative effect: principles for the control of communicable disease have been

grossly compromised

Health education

Stimulated research on health education and education efforts in preventing

high-risk behaviors facilitating HIV infection

General education about communicable disease, infection control

Education about sexually transmitted diseases (STDS)

Improved knowledge of how to design and conduct health education

programs to change behavior

Has increased sexuality awareness in school systems and institutions

Has increased awareness of infection control in industry

Has demonstrated clear connection between lifestyle practices and disease

infection
Appendix E-Specific Examples of Contributions of AIDS/HIV Reseaxh to Other Fields - E-21

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

1

1

9

1

1

2

1

1

1

1

1

5

1

1

1

1

1

Has demonstrated the use of television and mail for health education campaign

Design of focused education and education delivery systems to targeted

groups, (e.g., gay men, IV drug users, Blacks, Hispanics) and general

population

Sexually transmitted disease

Routes and mechanisms of transmission

Closer attention to other STDs in prevalence studies

Refocused awareness on STD’s

Knowledge about gay sex behavior

Knowledge of practices and attitudes of gay community

Called attention to lack of knowledge and data on sexual behavior and

practices

Has shown the interrelationship among STDs

Almost all AIDS behavior change research and education strategies are

applicable to control of other STDs

Sociology/anthropology

Better understanding of patterns of sexual behavior among homosexuals and

drug-addicted people

Understanding of stigma, prejudice, gay behavior

Improved survey procedures with hard-to-reach populations

Has emphasized our lack of knowledge of sexual attitudes and customs

Further understanding of individuals’ risk-taking behaviors, social organization,

disorganization, ways to alter people’s decisionmaking processes
E-22 - How Has Federal Research on HIV Disease Contributed to Other Fields?

SPECIFIC EXAMPLES-continued

Number

of responses Specific examples (listed by area and field)

9

4

1

1

1

2

0

2

1

1

4

1

Substance abuse

Increased knowledge and awareness of substance abuse and its patterns

Had an overall stimulating effect on substance abuse research

Focused attention on an underfunded discipline--AIDS/HIV research will relate

to the broader socio-economic and medical problems that drug abuse creates.

Demonstrated the connection of substance abuse to other disease

Increased information about factors leading to substance abuse, about the

‘drug culture,” about treatment programs

Other

OTHER

Radiology- brought about advances cross sectional imaging

Increased public awareness of issues in substance abuse and homosexuality

Additional comments

In 1979, no human or primate immunodeficiency-causing retrovirus were

known. Now there are eight. There are surely many more. Need research to

allow us to prevent such illness and disease, rather than respond to it.

Too soon to tell the results (spinoffs) of AIDS research. It takes a long time for

advances to impact other fields.

There have been many dividends from the AIDS/HIV research, in many

scientific fields. The successful identification of the virus and clarification of its

mode of transmission has helped to convince the American public of the

quality of biomedical research.

AIDS research has made little contribution to our overall understanding of

basic biology. To the contrary, our understanding of basic biology has made

possible all AIDS research.