AIDS: Officials Worry About Rise in Cases Among Women, Children : Number of Women and Children With AIDS on Rise in S.D.

Some new faces are being added to the AIDS family tree. Women. Heterosexuals. Little children.

Though these branches are only just sprouting in San Diego County, they represent to health officials one of the most worrisome new aspects of the development of the disease, which increased 82% in the county last year.

“I think the significant thing in ‘87, which has carried over so far into ‘88, is the increase in women,” said Dr. Donald Ramras, the county’s public health officer. “Last year we had 17 cases reported, whereas in ’86 it was something like 9. The significance here is that in the long run, if this holds up, heterosexual spread will become more and more significant in the community, as will the risk to newborn infants.”

The special medical and emotional problems of dealing with the slow wasting of these tiny bodies are only beginning to be considered in the city.

Because of their immature immune systems, babies born infected with the AIDS virus generally show symptoms sooner and die faster than do adults. Furthermore, they and their mothers lack the support structures and political organization that have helped the biggest group of AIDS victims, gay men, cope with the disease.

Bad Turn in March

Until March, there were only three children under age 13 who had AIDS in the county. All had acquired the disease from contaminated blood or blood products, an infection source that has been largely eliminated because of the screening of the nation’s blood supply. But in March, county officials logged the first two instances of children, a boy and a girl, who acquired the AIDS virus in utero.

In one case, a parent had received contaminated blood or blood products. The other appears to be a case of purely heterosexual transmission of the disease to the mother, said Dr. Michele M. Ginsberg, the county epidemiologist who is tracking the disease’s spread.

Significantly, in neither case was there any indication of intravenous drug use, a prime infection route for the disease in women and their newborns in East Coast cities.

Also, in neither case does the mother have symptoms of the disease yet, Ginsberg added.

For women, this points to one of the most insidious aspects of AIDS. Not only does it threaten them, but also they can give birth without knowing they have unwittingly doomed their child to an early death from a disease that has no known cure.

AIDS, acquired immune deficiency syndrome, is a fatal disease that disables the body’s infection-fighting immune system. It is caused by human immunodeficiency virus, HIV, and spread through sexual contact and contaminated blood.

Though no one can be sure how much AIDS will be seen in children here, doctors at Children’s Hospital and at UC San Diego Medical Center have begun planning to be ready if such a wave does wash over the city.

“We’re trying to set up a program like we did in Orange County so that if it does hit, we’ll already have something worked out,” said Dr. Jamieson Jones, a neonatologist at Children’s Hospital in San Diego. Jones also directs an AIDS clinic for women and children at UC Irvine Medical Center. “These people don’t have the support services that the gay community does.”

Child Sufferers Abandoned

In East Coast cities where AIDS is rampant among drug abusers, infected children can spend months in the hospital because--taken from or abandoned by their addict mothers--they are not wanted by fearful foster parents. The Orange County program calms those

fears with education about the disease.

“In Orange County, we already have foster parents trained and ready to take children with the virus,” Jones said.

The women, too, need special help, he said.

“These mothers have special needs because not only are they affected but their children are affected. And they have a lot of guilt,” Jones said.

Dr. Christopher Mathews, director of UCSD’s Owen Clinic for AIDS patients, said he hopes to work with community medical clinics in areas of San Diego where drug abuse is most common to begin better identifying women who may be infected with HIV.

If doctors in the clinics take sexual histories from women, and create a climate where uninformed women can ask questions about AIDS, the whole community would be served, he said. It also might prevent births of HIV-infected children.

“We don’t know how many women are infected with this virus in San Diego County. Women don’t go in for screening with anywhere near the rate of the people who consider themselves in risk groups. There may well be quite a few women in San Diego County who are infected but don’t know they’re in a risk group,” Mathews said.

Women at Risk

For instance, having used intravenous drugs in the past places the woman at risk of being infected. Heterosexual contact with a bisexual or drug-abusing partner even several years ago also might be a risk.

Indeed, of the 30 females with AIDS in San Diego County, 10 cases were linked to drug abuse and another nine came from heterosexual contact with an infected partner. Nine others are in women who received contaminated blood or blood products, one was the daughter of an infected mother and one was undetermined. And, as elsewhere, the primary heterosexual AIDS risk in San Diego appears to be to women; 9 of the 12 heterosexual cases are among women.

Overall, 817 county residents have had the disease through the end of March, and 460 had died by then, said Ginsberg, who tracks AIDS’s progress for the county.

The total increased by a record 52 cases during March, but that could be as much a result of happenstance as any real increase in disease, she said. She noted that the steep increases in the number of new cases of AIDS recorded annually and in the number of total cases are gradually leveling out.

For instance, in 1984 the number of new AIDS cases doubled over the previous year. In 1985, new cases were 280% the number of new cases recorded in the previous year. In 1986, they were 180% of the 1985 figure, a percentage that declined to about 148% in the 1987-to-’86 comparison. She expects the number of new cases in 1988 to be 130% to 140% of the number recorded in 1987.

So far, there have been 331 new cases diagnosed in 1987, but lags in reporting the disease could raise that as high as 360, Ginsberg said.

Will Continue to Increase

Drawing conclusions from such figures, and predicting what the disease will do, is especially difficult in San Diego, Ginsberg said.

“The person we diagnose now was infected five or more years ago. Therefore, we know that the number of cases will continue to increase,” Ginsberg said. “The other thing is we’re a rapidly growing community. And whatever area of the country they move from they carry with them the rate of infection or likelihood of infection from that region.”

Her own study found that 20% to 25% of the people diagnosed with AIDS in San Diego whom she surveyed had not lived in San Diego two years before they were diagnosed, so they probably had been infected elsewhere.

Statewide, the AIDS picture is changing, said Thelma Frazier, director of the California Office of AIDS.

“We had indicated when we did our projection that by 1991 one-third of the cases would be in San Francisco, one-third in Los Angeles and one-third in the rest of the state. What we’re seeing is that we have already met that projection,” Frazier said.

Her office predicts there will have been 50,000 AIDS cases in California by 1991, and about 34,000 deaths. As of April 18, there were 12,915 AIDS cases in the state, second only to New York.

Lance Clem, education projects coordinator for the San Diego AIDS Project, said the agency had seen a record of 40 new clients in March, compared to the usual total of about 30. Already this month, new clients number 31, he said.

He suggested that this represents a “ripple effect” in which AIDS, formerly a disease of large cities, is moving into medium-sized cities.

But Andrew Moss, associate professor of epidemiology at UC San Francisco, noted that there are AIDS cases everywhere in the nation now, not just in cities.

Three Distinct Waves

“I think there are three distinct waves in terms of spread. There’s the gay wave, there’s the drug use wave, and then there’s--question mark--the heterosexual one,” Moss said.

For the future, the question of whether AIDS makes inroads in the heterosexual population and children is tied into whether its spread can be stopped among intravenous drug users, he and other epidemiologists say.

Nationwide, half of the women with AIDS were infected through intravenous drug abuse, and another quarter through heterosexual contact, according to the U.S. Centers for Disease Control. Among children with AIDS, 76% received the virus from having a parent who had the disease or was at risk for it.

So far, there have been only 26 IV-drug-related cases of AIDS in San Diego, Ginsberg said.

But, because HIV can live several years in the body before symptoms occur, that number isn’t necessarily reassuring. Ginsberg said she also fears that the time lag between changes in sexual behavior and a decline in the disease will frustrate the public.

“If you could cease transmission today, we would continue for a number of years to see growing numbers of illnesses reported,” she said. “I’m afraid the public might be frustrated when they continue to see increasing numbers of reported cases.”

NEW AIDS CASES IN SAN DIEGO COUNTY ‘81: 2 ‘82: 4 ‘83: 22 ‘84: 44 ‘85: 122 ‘86: 224 ‘87: 331 ‘88: 85 (through 3/31/’88) SOURCE: San Diego County Department of Health Services