Much to Do

New signs of action at federal, state and county levels to create commissions on AIDS signal an awareness by political leaders of the urgency of dealing more effectively with the epidemic. It is high time.

In Washington the White House is moving ahead with plans for a national commission, as recommended almost a year ago by the Public Health Service, and parallel legislation for a 21-member national commission has bipartisan support in Congress.

In Los Angeles the county Board of Supervisors has voted unanimously to create both an advisory commission on AIDS and a technical advisory body.

Only in Sacramento is there uncertainty. There is a serious risk that the issue will be converted into a partisan quarrel in the Legislature, a temptation to which Republican leadership appears to be particularly vulnerable. The key figure is Gov. George Deukmejian, who until now has not given leadership on the issue. But the omnibus AIDS legislation, AB 87, has been redrafted into a form that would seem to meet the governor’s earlier objections. The legislation has been endorsed by President Reagan’s surgeon general, Dr. C. Everett Koop. It would create a state commission with broader policy responsibilities than the advisory committees that have been set up within administrative departments of the state. It would establish protections against discrimination without which the prevention and care programs are crippled. And it would provide for sharing confidential information among professional care providers along the lines proposed by the governor himself last year when he vetoed legislation to outlaw discrimination against AIDS patients. But when it moved out of committee this week only one Republican, significantly a doctor, voted for the measure.

The usefulness of these commissions will depend on the quality of their members, on the professional commitment of their leaders and on the staffs that are provided. Los Angeles County has a model in the AIDS Task Force established in 1984 by Los Angeles Mayor Tom Bradley and Supervisor Ed Edelman when it was clear that neither the Los Angeles City Council nor the Board of Supervisors was prepared to act. The task force now will be disbanded. It would be a great loss, however, if its expertise were lost. Dr. Neil Schram, the expert chairman, has given leadership when there was none, and some of the other leading experts on AIDS and the control of communicable diseases have served with him on the 26-member commission.

Under provisions of the county plan, the new county AIDS Commission will have 15 members. Each of the five supervisors will name two. In addition there will be representatives from the Hospital Council, Los Angeles County Medical Assn., Red Cross, AIDS Project Los Angeles, and the Gay and Lesbian Community Services Center in Hollywood. The seven-member technical advisory group will be made up of representatives of the Centers for Disease Control, the surgeon general, presiding judges of the Superior and Municipal courts and the SC, UCLA and Loma Linda medical schools.

This action by the county supervisors is timely. San Diego and Orange counties have taken similar steps. The action by Los Angeles County supervisors coincides with the budget time and the pressing need to act quickly to put into place an adequate program. San Francisco, already spending 10 times what Los Angeles County spends for a similar caseload, has proposed a 43% budget increase for next year. But even at that level of expenditure the San Francisco program has major gaps, including a shortage of intermediate-care beds that are increasingly required as the epidemic grows. The Los Angeles County program is distinguished more by its gaps than by its achievements.

The long delays in moving decisively in Washington, in Sacramento and in Los Angeles cannot be excused. Some ideologues have obstructed effective action through narrow ignorance, seeming more concerned with judging the sexual promiscuity and intravenous drug use that facilitate the spread of the disease than in grasping the realities of the most serious public health problem of modern times. Further delays and indecision are more reprehensible, because now ignorance cannot be a valid defense. And further delays and indecision are more dangerous, because the failure to educate and to treat appropriately puts everyone at risk.