Facing a drastic budget cut, military medical officers say they are planning to curtail clinical work in treatment of HIV, the virus that causes AIDS, to concentrate instead on developing a preventive vaccine.
With the new emphasis, the officers said, they would be fulfilling the primary mission of military medicine: keeping troops in a state of readiness.
"The effectiveness of the Army as a fighting force is best assured by prevention of HIV infection," Brig. Gen. Russ Zajtchuk, the assistant surgeon general for research and development, wrote in a recent memorandum. "Therapeutic approaches to HIV disease do not make significant contributions to combat effectiveness. If a soldier is already infected, that soldier is a casualty and is of limited use to the force."
Those who support the clinical programs argue that the studies yield invaluable data. In the military population, the progress of HIV infection can be tracked from the earliest stage, since troops are tested regularly.
Service members offer researchers a diverse pool of subjects and are more compliant than civilian volunteers in clinical trials.
Stopping the trials, moreover, would cut off promising drugs and other therapies from service members or their dependents who have HIV, the advocates said.
"We're essentially saying, 'We're going to deny American GIs with this infection access to potentially life-saving medication,' " said Freeland H. Carde II, a retired Navy commander who lobbies in Washington on behalf of people with acquired immune deficiency syndrome.
Rep. Constance A. Morella, a Maryland Republican, said that the current programs had a direct relation to military readiness "because these are people who still want to continue to serve."
There are 7,574 patients covered by programs that would be ended prematurely, abridged or canceled, said Dr. Kenneth F. ++ Wagner, senior research physician at the Henry M. Jackson Foundation for the Advancement of Military Medicine. The nonprofit foundation is the largest private contractor conducting HIV research for the armed forces.
There is still a chance, however, that money will be found to maintain the programs. A White House official, speaking on condition of anonymity, said Friday that this would "very probably" happen.
In any case, he said, no patients now participating in studies would be dropped.
The current annual budget for military research into HIV is $40 million, $13 million of which was requested last year by the Clinton administration, with the balance added by Congress.
When it appeared earlier this year that the Defense Department was balking at spending the additional money, Leon E. Panetta, the White House chief of staff, wrote to Defense Secretary William J. Perry, saying that AIDS research was a "high priority for this administration."
For the coming fiscal year, the administration requested $9.6 million for military research into the human immunodeficiency virus.
Although Congress supplemented the request in the past, it is not clear what will happen this year, given the newly conservative climate, both fiscal and social, on Capitol Hill.
"We have to make our plans on what we expect to get," said Col. William H. Bancroft, director of the military infectious disease research program at the Army's medical research and materiel command in Fort Detrick, Md.
The vaccine trials would be conducted in Thailand.