Taking the Initiative on AIDS

The time has come for an official advisory commission on AIDS for Los Angeles County. Such a commission could be of great assistance to the Board of Supervisors in the weeks ahead when major budget decisions and major policy shifts will be before the board. And the commission could reassure the community that the AIDS problems in this region are being addressed.

There already is a model for an official county commission in the Los Angeles City/County AIDS Task Force appointed by Mayor Tom Bradley and by Supervisor Ed Edelman. The task force has helped focus attention on this problem, and has demonstrated the value of bringing together the professionals who are involved in fighting the epidemic and in providing care to the rapidly increasing infected population. The essential difference between the task force and the proposed county commission is that the commission would enjoy official status through appointment by the entire Board of Supervisors.

That official status would be meaningless unless it also signaled a decision by the board to provide the substantial resources that are urgently required to control the epidemic and to care for the people who have AIDS. The task force was created because there was a vacuum of leadership in the county and the supervisors failed to commit the necessary resources. But recent board actions indicate that a new approach may be at hand.

Los Angeles County is far behind San Francisco, even though the AIDS caseloads are similar. San Francisco is spending 10 times as much money. And in San Francisco, where city and county are conterminous, a mayor’s task force, including top public health officials, has been in place for five years. Other counties, including Orange and San Diego, also have regional advisory commissions.

There are risks to creating a commission in Los Angeles County. It will not be effective unless it embraces the major professionals already involved with AIDS. It will do more harm than good if it is a political body intended to debate rather than to propose action programs, or if it is a substitute for spending what it takes to get on with the job.

Two needs are already clear: a vastly expanded program of education and a more flexible care program that takes advantage of the more cost-effective and more humane alternatives to in-hospital care.

The importance of education can hardly be exaggerated. There is no known cure for AIDS. But the spread of the fatal disease can be restrained by appropriate safeguards, notably the use of condoms in sexual intercourse and the use of sterile needles in intravenous injections. Those engaged in sex or intravenous drug use need to know the facts, the risks of what they are doing and the ways to reduce that risk. That is why the California Legislature is moving ahead with mandatory AIDS education for secondary-school students.

Los Angeles County, with the third-largest AIDS incidence in the nation, has not yet organized the basic services required to handle the rapidly rising caseload of AIDS patients. In-hospital care is available at major county facilities and some private hospitals. But there are virtually no home-care, day-care, nursing-facility or hospice programs. County supervisors have withheld funding from these programs until there is more state and federal money. The expanded Medi-Cal funding will not be available until early next year. It would be most unwise to wait until then to speed the implementation of care alternatives.

The supervisors have available to them expert advice to facilitate the formation of an effective advisory commission. Bids have been received for the development by autumn of a five-year AIDS plan for the county. A new administrator for the AIDS office in the county Health Department is in place, reflecting the Health Department’s commitment to a more vigorous program. With the advice of the task force, the AIDS Project Los Angeles and other professionals, the supervisors can quickly organize an effective commission to see that not another minute is wasted.