therapy. HIV/AIDS studies have not been the only ones in which disclosure before publication has occurred, but the intervention of AIDS activists has thrust the dilemma more squarely into the spotlight. The scientific community is grappling with the difficult problems of how to implement a more pragmatic yet still responsible approach to traditional peer review.

Although it is impossible at this time in the epidemic to reach any definitive conclusions about the impact of AIDS on clinical research and the regulation of new drugs, it is apparent that patient activism and the exigencies of the AIDS epidemic have generated the most significant reevaluation of the research and regulation process to occur since World War II.

Voluntary and Community-Based Organizations

Government at all levels was slow to respond to the HIV/AIDS epidemic. The slow response was due partly to a general reduction in the growth of public spending on health care and social welfare and partly to a unique attribute of AIDS: its early association with two highly stigmatized minorities—gay men and intravenous drug users. When governments did respond, their flexibility and capacity to reach the groups in greatest need were limited, especially in regard to prevention education, for which there were constraints on how public monies could be used.

The vacuum was filled very early by an outpouring of volunteer activity. This was in part the result of the pulling together of the gay community in the belief that its members could best care for their own. The movement is also illustrative, however, of collective behavior in a period of social change and the forces that motivate individuals to volunteer their time. The response and mobilization of AIDS volunteers sheds light on the commitments individuals are willing to make to different kinds of social causes and it also points to new directions for understanding the meaning of volunteer work. In both San Francisco and New York, the AIDS crisis catalyzed volunteer movements that spanned both individual helping activities and strategic political campaigns. Particularly in San Francisco, the movement was innovative, effective, and enormously important in helping the gay community come to terms with the epidemic, as well as in shaping the response of the city's institutions to it.

Throughout the country, volunteer movements have carried a surprisingly large share of the burden of caring for AIDS patients, particularly outside hospitals. The cost of the epidemic for public agencies and private insurance has been significantly reduced by the extensive contributions of time and resources from volunteers. In addition, advocacy for appropriate social policies that would both contain the epidemic and protect the rights of affected individuals came from community-based organizations. At present, this powerful force has been weakened somewhat by financial constraints,

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