L.A.’s Battle Against AIDS : Efforts to Reach High-Risk Intravenous Drug Users Lag

Los Angeles County, home to one of the largest concentrations of intravenous drug users in the United States, is lagging behind comparable urban areas in efforts to slow the spread of AIDS within this increasingly critical group.

While smaller communities with fewer addicts have aggressive programs to teach needle users about the risks of catching and spreading the AIDS virus, Los Angeles County has yet to make a concerted effort to reach that majority of users not enrolled in drug treatment.

Meanwhile, the number of publicly funded spaces in drug treatment programs in the county has dropped by one-third since 1982--which was just about the time researchers identified needles as a key route through which the fatal disease spreads.

“In many ways, we’re just plain late,” Rabbi Allen Freehling, chairman of the Los Angeles County Commission on AIDS, said in a recent interview. “ . . . I think it has been convenient for leadership to regard the problem as a problem which others face.”

Critics and some health officials attribute the pace of the county’s response mostly to the Board of Supervisors, some of whose members strongly oppose the kinds of programs other cities have implemented to slow the spread of AIDS.

Hostility from the Board of Supervisors has hampered the efforts of the county Department of Health Services, according to AIDS experts and even some department officials. They say the health department has been unable to try the kind of novel measures experts say the epidemic demands.

“People in the county and the health department are afraid to come up with a hard-hitting, direct and honest campaign,” said Supervisor Ed Edelman, a longtime antagonist of the board’s conservative majority and an activist on health-care issues.

“I think our health people are afraid to come in with anything that might be controversial,” he said. “If you let politicians decide what public health program we’re going to have, we’re not going to have a public health program.”

In response, several county officials contend such criticisms are unfair. They said they have simply chosen a different approach: They have spent their time educating treatment program workers about acquired immune deficiency syndrome and encouraging people to “just say no” to drugs.

County health officials also say that they are developing a program under which outreach workers would contact drug users on the streets. The program, to be proposed to the supervisors next month, could be in effect by summer.

Nevertheless, Supervisor Mike Antonovich said it is “ludicrous” to try to persuade drug users to use drugs more safely. The county must not appear to condone drug use, he and others said. Instead, the county should focus its resources on getting and keeping people off drugs.

But some people who have worked with drug users say such an approach is unrealistic.

“There is a nice little aphorism,” remarked Harvey W. Feldman, project director of San Francisco’s Mid-City Consortium to Combat AIDS. “ . . . If we don’t keep people from becoming infected, they will never live long enough to enjoy years of abstinence.”

So far, intravenous drug users make up a relatively small percentage of the reported cases of AIDS in Los Angeles County. As of Dec. 31, 1987, 129 of the 4,243 reported AIDS cases were traced to needle use, according to county health statistics.

But no one knows how many intravenous drug users there are in the county. The Department of Health Services estimates at least 80,000. Irma Strantz, director of the drug abuse program office, said federal figures suggest the true number may be closer to 130,000.

Nor does anyone know how many of those people are infected with the AIDS virus and have not come down with the disease. Rough estimates, based on county studies of drug users in treatment, suggest the infection rate lies somewhere between 2% and 5%.

That percentage is dramatically lower than the rate in cities like New York and Newark, N.J., where studies suggest that at least 60% of intravenous drug users are infected. In San Francisco, studies indicate that 15% of the drug users have been exposed to the virus.

But experts say the low percentage of infection in Los Angeles County may be misleading, in light of the county’s large number of suspected drug users. Five percent of 80,000 to 130,000 could be as high as 6,500.

“I don’t think there is enough sense of urgency,” said M. Douglas Anglund, an adjunct associate professor of medical psychology at UCLA who has been helping gauge the virus’ spread in Los Angeles. Anglund referred to the situation as a “frogs in the pond problem.”

“If frogs duplicate every 10 minutes and eventually will fill the pond, when do you do something about it?” Anglund asked. “Well, you don’t wait until the pond is half-full, because you’ve only got 10 minutes left.”

In San Francisco, outreach workers have been on the streets since mid-1986 in a program that has become a model nationwide. The workers, some of them former drug users, distribute information, condoms and small bottles of bleach to disinfect needles.

New Jersey has had a state-run outreach program since 1984. Chicago has had a federally funded program for two years. New York City intends this year to launch the country’s first experimental needle-exchange program, offering clean needles to drug users who turn in dirty ones.

Even in San Diego County, where 24 of the 727 reported AIDS cases are attributed to needles and the number of intravenous drug users is estimated at 15,000, the county health department has been supervising an outreach program since December, 1986.

It is not yet known whether street outreach programs will eventually succeed in slowing the spread of the AIDS virus. But federal officials are encouraging that approach and drug-abuse researchers say they are convinced that it is having an impact.

In San Francisco, researchers interviewing intravenous drug users in 1986 found that only 3% reported using bleach or knowing that it could kill the virus. By 1987, one year into the outreach program, they found that the level had risen to 70%.

In Los Angeles County, however, efforts to reach drug users have been slow in coming:

- Although a few independent, social service agencies in Los Angeles County are doing outreach work on a limited scale with state money, the county health department has yet to have its own long-planned program approved by the supervisors.

- In 1985, members of the Board of Supervisors ordered the health department to withdraw from circulation a brochure intended to teach drug users how to avoid AIDS. The pamphlet, encouraging drug users to quit or clean their equipment, had been used in San Francisco since 1983.

Several supervisors contended that the needle-cleaning instructions left the impression that the county condoned intravenous drug use. The department replaced the pamphlet with an edited version stressing the importance of quitting. The new version does not mention needle cleaning.

- Funding for drug treatment in Los Angeles County has dropped steadily since 1982 as a result of federal and state cuts. The wait for admission to subsidized treatment ranges from three to eight months, Strantz said.

Although the county intends shortly to add funding for an additional 254 places in various forms of drug treatment, that expansion will bring the total number of slots up to 4,802; that is 2,220 positions fewer than existed in 1981-82.

- Last year, when the federal National Institute on Drug Abuse awarded a series of $1 million grants aimed in part at setting up outreach programs in critical communities, Los Angeles County’s application was one of only a handful that failed to make the grade.

The one critical area that did not receive a grant was Los Angeles, said George Beschner, chief of the community research branch of NIDA, who said he expects the county will reapply and be accepted this year. “They were unable to put together an acceptable application.”

- On Tuesday, the supervisors refused to authorize a study of an experimental needle-exchange program planned for New York City.

Observers and critics offered varying interpretations of the county’s record.

Edelman, who briefly proposed that the county consider a needle-exchange program, accused the county health department of a failure of nerve. After the supervisors’ reaction to the brochure, he said, the department now takes initiatives only “in a watered-down fashion.”

Racism Alleged

Finally, several critics accused Los Angeles County officials of racism in their allocation of money and resources for AIDS education and prevention--a charge that has also been leveled by other groups against other cities and regions.

“There is a great deal of racism in the failure to provide money for intravenous drug users,” said Dr. Neil Schram, former chairman of the Los Angeles City/County AIDS Task Force. “ . . . Giving money to intravenous drug users is not a popular thing, especially as long as they are mostly minorities.”

Antonovich rejected such accusations as “absurd.”

“The county is addressing the problem,” the supervisor said in an interview. “We’re in an era of limited resources. We’re trying to do the best job we can, but it will take the whole community working together.”

County health officials say they have focused their resources on teaching drug treatment programs how to work with people infected with the virus, thus averting the kind of discrimination against users they say has occurred elsewhere.

Strantz rejected Edelman’s assessment that the department had become timid.

“What happens is we move forward, but we have to be careful that everybody understands what the statistics are, why there is a need and why we’re proposing what we’re proposing,” she said.

“We can present methods that others have used and found useful,” said Robert Frangenberg, director of the department’s AIDS program office. “Then you have to look at it and say, ‘Is this appropriate in our community?’

“That’s when the Board of Supervisors comes in,” he added. “You can’t ignore the community. And you can’t ignore the politics.”

Supervisor Deane Dana said needle exchange or bleach distribution would imply that the county condones drug abuse. And Dr. Monroe Richman, of the county’s AIDS commission, said the county would be best advised to target heterosexuals and the sexual partners of drug users.

Richman called intravenous drug users “for the most part, sociopaths” attempting to escape reality. “I really am doubtful this distribution of clean needles is the answer. . . . They couldn’t care less. If they wanted to get clean syringes, they would have.”