‘We’re always getting calls from people asking how (the victims are) doing . . . They want us to do everything we can to save them. Maybe they see themselves here one day, too.’ : AIDS Epidemic: A Scramble for Funds in Bid to Combat It

Gasping for air, they are wheeled into the respiratory intensive care unit at Los Angeles County-USC Medical Center. Oxygen tubes in their mouths and heart monitors taped to their chests, they usually survive only a few days.

“I’ve seen one in a thousand walk out,” said senior nurse Debbie Gaytan, who for the last five years has treated patients suffering from the deadly acquired immune deficiency syndrome.

Besides their high mortality rate, what distinguishes these AIDS patients from others in the unit, Gaytan said, are the many grieving friends and lovers they leave behind.

“With these patients,” she said, “we’re always getting calls from people asking how they’re doing. They come in. They want us to do everything we can to save them. Maybe they see themselves here one day, too.”

High Exposure Rate

Indeed, for sexually active gay men in Los Angeles the odds are better than one in four that they have been exposed to the AIDS virus, said Dr. John Leedom, head of infectious diseases in the medical center department of medicine.

A scramble for county and state funds to combat the epidemic is under way against a backdrop of an escalating case load and an increasing drain on public health services. The AIDS epidemic has been less visible here than in San Francisco, where the disease is concentrated in a smaller area among a more politically active gay community. But Dr. Martin Finn, the county’s medical director of public health, predicted that within a year the number of cases in Los Angeles County--now 993--will actually surpass those in San Francisco, where 1,308 cases have been diagnosed.

New statistics for the month of June show “a large increase” of 84 additional AIDS cases, up from 48 in May, Finn said. The increase may stem partly from the recent prodding of medical personnel to report AIDS cases to the county Department of Health Services in a more timely fashion, he said.

AIDS cases have increased 73% over last year in Los Angeles County, health statistics show. The type of people afflicted has remained constant--93% of them gay and bisexual, compared to 73% across the nation, where the disease seems to have made deeper inroads into the general population.

Testing Program Proposed

In an effort to assess how the virus is spreading into the heterosexual population here, researchers at County-USC have launched a program to test for AIDS among women booked for prostitution at the Sybil Brand Institute.

The state and the county are expected to at least double the $8 million spent last year to combat AIDS, according to the latest budget drafts. But as the fiscal debate heats up both here and in Sacramento, gay activists are lobbying to quadruple last year’s spending.

Insufficient federal funding has made state aid imperative, they say, to stem the epidemic, which has claimed 11,352 people nationally. AIDS destroys the body’s immune system, leaving it vulnerable to infections.

The impact of the epidemic on county services has been dramatic so far, and health officials fear that if the virus continues to almost double its victims each year, the drain will be overwhelming.

Treating AIDS is extremely costly, with hospitalization costing between $100,000 and $140,000 per patient, said Dr. Neil Schram, chairman of the Los Angeles City/County AIDS Task Force.

“What we have found on a statewide level,” said Bruce Decker, who chairs the governor’s statewide AIDS advisory task force, “is that a larger percentage of AIDS victims fall into Medi-Cal (because) . . . they either lose their insurance when they lose their employment or they exhaust their insurance. . . .

“The impact on medical and health providers in California could be billions of dollars a year within the next two years,” Decker said.

At the County-USC Medical Center, which treats mainly low-income patients, doctors say that AIDS victims, while accounting for only 1% of the patient load, consume at least 4% of the resources. Specialized laboratory tests for AIDS patients have alone cost about $1 million, Leedom estimated.

The hospital, which handles about one-third of the county’s AIDS patients, had 148 admissions for AIDS last year, with each patient staying an average 18 days.

Respiratory Care

One of the four beds in the respiratory intensive care unit is almost always occupied by an AIDS patient, Leedom said. Sometimes they all are.

Last week, two beds were taken by AIDS patients--one a fashion designer and the other an inmate from the County Jail.

Resources have been stretched so thin, according to nurse Gaytan, that it was only with private donations that the unit was able to buy blinds for the windows to replace the bed sheets that had been hanging as curtains.

A new AIDS outpatient clinic was opened at the hospital on a full-time basis several months ago and has already attracted more than 400 patients with varying symptoms. Doctors are now debating whether to set up a special ward exclusively for AIDS patients.

While taxing county health resources, the epidemic has also stirred up turmoil in private hospitals where doctors on down the line to laundrymen have in some cases refused to deal with AIDS patients.

Impending Crisis

Testifying at a recent AIDS conference, Steve Gambel, president of the Hospital Council of Southern California, called for a massive mobilization of medical personnel to head off an impending health crisis.

“The sheer numbers of what is coming is staggering enough. But on top of that, the AIDS victim is not your ordinary sick patient. . . . We simply do not now have the capacity to manage the patient needs of the number of AIDS victims who we must anticipate will require acute health care in the next one to five years.”

Besides challenging the medical community, the epidemic has also put tremendous pressure on the gay community in Los Angeles. Gays in Los Angeles, unlike in San Francisco, are widely dispersed and wield less political clout.

The Board of Supervisors here is dominated by three conservatives, unlike the board in San Francisco, which has a gay representative and other members who are sympathetic to gay rights.

Scratch for Funds

And while San Francisco has been able to dip into a budget surplus to generously fund AIDS treatment and counseling programs, Los Angeles County now faces a $37-million shortfall, forcing gays to scratch for a few scarce dollars.

Garland Kyle at the Gay and Lesbian Community Services Center in Hollywood pointed to another distinction: “In San Francisco, there is no one who has not been affected by AIDS. But the majority of gay people here have not. They do not know somebody with AIDS or who has died from it.”

All this has made mobilization for financing more difficult.

“It’s a shame what has not happened in Los Angeles County,” said Bill Misenheimer, director of the nonprofit Los Angeles AIDS Project.

Pitching an Angle

Frustrated in attracting government money to combat what is widely perceived as a “gay disease,” local gay activists are delivering a new message in this year’s battle for funds. The message is that AIDS is not a gay disease and that it has begun to invade the heterosexual population, too.

“We weren’t getting anywhere,” Kyle said. “That’s why we’re pitching this angle.”

Larry Sprenger, co-chairman of the Municipal Election Committee of Los Angeles, which promotes gay rights, berated Gov. George Deukmejian for recently cutting $11.6 million out of a $17.7-million AIDS package approved by the Legislature.

“There are going to be more and more deaths, and people are going to look back and ask why he didn’t do anything to prevent it,” Sprenger said.

Dr. James Curran of the Centers for Disease Control in Atlanta recently estimated that between 500,000 and 1 million Americans already are infected by the AIDS virus and that perhaps 10% of them will develop the disease.

Sees Downward Trend

But not all experts agree. One prominent epidemiologist said history shows that epidemics have “self-corrective forces.” He predicted that the dramatic upward curve in AIDS cases will “turn over in the next year or two and then fall” as the level of gay sexual activity declines and the nation’s blood supply is made safer through tests that screen donors for the AIDS virus.

While some gay activists say the virus will “spread like wildfire” through the heterosexual community, Finn predicts “a slow, steady increase in cases among heterosexuals” who are less inclined to engage in anal intercourse, which is conducive to spreading the disease.

So far, the virus has been more confined to the gay community in California than in the the rest of the nation. Health statistics show that only about 7% of the AIDS cases here have developed outside the homosexual and bisexual population, compared to 27% nationally.

These cases have afflicted intravenous drug users who shared a needle with an AIDS carrier; hospital patients and hemophiliacs who received blood tainted with the AIDS virus; heterosexuals who had sexual relations with an AIDS carrier, and others who were afflicted for unknown reasons.

Communal Needles

In the East, intravenous drug users have played a key role in spreading the virus into the heterosexual population. In cities like New York, health officials say, drug users congregate at street corner “shooting galleries” to get quick fixes--often with communal needles tainted with the virus.

One result is that in the New York area about 300 babies have been born with AIDS, mostly to mothers who were intravenous drug users. By comparison, in Los Angeles County, only one baby has been born with AIDS to a mother who carried the virus. The other five children in the county who suffer from AIDS were infected through blood transfusions.

While Los Angeles is fortunate from a public health standpoint that the virus has not yet penetrated the heterosexual population to the degree that it has on the East Coast, gay activists contend that the only way to prevent the same problem here is through a massive program to educate the general public about “safe” sexual and hygienic practices that avoid the sharing of body fluids.

Educate the Public

The Los Angeles City/County AIDS Task Force has recommended boosting the proposed county appropriation for AIDS from $10 million to $11.5 million for fiscal 1986. This would include about $500,000 to launch a campaign to educate the public about the virus.

“It’s critical we have this,” Finn agreed. “If we don’t get it here, then we have to get it someplace else--from the state or the federal government.”

Supervisor Deane Dana said: “We have funded AIDS programs regularly and are continuing to do so. But we also have to balance the budget. There are a number of deserving departments and programs who . . . could use additional funding, but there is simply not enough funds to meet all the requests.”

With a vaccine probably years away, health officials such as Dr. Mervyn Silverman, former director of health in San Francisco, maintain that “the only weapon we have against this disease today and in the foreseeable future is information and education. This is a behavioral disease so what we have to do is get behavior changed.”

State Programs

At the state level, $2 million for education programs was appropriated last year. Deukmejian recently authorized spending more than $4 million in fiscal 1986, down from $5 million approved by the Legislature.

Of the $106 million that the federal government appropriated to fight AIDS last year, about $5 million was set aside for education and prevention. But Gary McDonald at the AIDS Action Council in Washington claims that less than $300,000 was spent actually educating the public about sexual practices that will minimize the risk of contagion.

Shirley Barth, head of public information for the Public Health Service in Washington, countered that as much money was spent this year to educate people about AIDS--several million dollars--as to inform them of the risks of smoking cigarettes, which kill more than 100,000 people a year.

$27-Million Campaign

Next year, McDonald said, the council will press for a $27-million nationwide education campaign.

For Los Angeles, he added, a special challenge will be to reach out and inform the large Latino community about AIDS.

Eunice Diaz, director of health promotion and community affairs at White Memorial Hospital, agreed that getting the message across to the Latino community is difficult ‘because the issue of sex, especially homosexuality, is hardly every discussed.”

“Would a (Latino) mother ever advise her son to go out and play safely, handing him a condom? Never in a million years!” said Diaz, referring to the L.A. Cares campaign in Hollywood where an apron-clad mother urges her son to engage in safe sex.

The trouble with education programs, Barth pointed out, is that “you can educate only with what you know. There’s a big move now by the gay community to stress ‘safe sex.’ And we really don’t know what ‘safe sex’ is. For example, using condoms is probably safer, but you’re still not safe .”

Says Leedom at County-USC Medical Center: “The message advocating ‘safe sex’ is wrong. It ought to be, ‘Quit screwing around.’ ”

AIDS IN LOS ANGELES COUNTY AGE

L.A. U.S. Under 13 1% 1% 13-19 0% 1% 20-29 18% 21% 30-39 49% 47% 40-49 23% 21% Over 49 9% 9%

RACE

L.A. U.S. White 75% 59% Black 13% 25% Latino 11% 14% Other 2% 1%

PATIENT CHARACTERISTICS

L.A. U.S. Homosexual/Bisexual 93% 73% Intravenous Drug User 2% 17% Hemophilia Disorder 0% 1% Transfusion 1% 1% Heterosexual Contact 1% 1% Other 2% 7%

HOW CITIES COMPARE

Cases/ Cases Million New York 3,757 412 San Francisco 1,308 402 Miami 405 249 Newark 281 143 Los Angeles 957 128