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Innovations on AIDS

The California Department of Health Services is moving forcefully to improve statewide AIDS prevention and treatment programs, a timely and constructive development.

Dr. Kenneth W. Kizer, director of the department, designated by Gov. George Deukmejian as the lead agency for AIDS-related matters, is taking two innovative steps:

--Creating an AIDS Leadership Committee that will largely fill the void left by the failure until now to appoint a state AIDS commission.

--Developing a framework for local planning that will spur the creation of county and regional AIDS commissions and facilitate better coordination between the state and the local health entities in fighting AIDS.

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The timeliness of these endeavors is evident. The Legislature has before it about 140 bills dealing in one way or another with AIDS. There is a risk of legislative action, in the absence of executive direction, that easily could do more harm than good. That risk now will be minimized by the creation of a committee that will centralize the best thinking in the state in the development of a coherent, coordinated plan of action.

Under the reorganization plan ordered by Kizer, the AIDS Leadership Committee will replace the AIDS Task Force that had been headed by Dr. Marcus A. Conant of San Francisco. Conant will be a co-chairman with Kizer of the new committee. Two other committees that serve the department--the Advisory AIDS Committee, created by statute, and the Inter-Agency Task Force--will remain in operation. Administrative work in Sacramento will continue to be done through the AIDS office, created in 1982, which is headed by Thelma Fraziear.

The new Leadership Committee will be made up of more than 20 persons, and, as Kizer has written in letters of invitation to prospective members, will “serve as the department’s primary advisory body for AIDS issues and policies.” In a preliminary initial agenda, Kizer has proposed 12 important tasks--including the development of strategies for dealing with high-risk populations like intravenous drug users, the question of reporting human immunodeficiency virus test results, and the controversy over the notification of partners of those testing positive to HIV.

At the same time, Kizer has released a draft framework for local planning of AIDS prevention and treatment designed to encourage local and regional governments to appoint AIDS commissions, to adopt specific plans and to appoint AIDS coordinators. While the state has no authority to enforce such steps, it does have the power of the purse. Behind the recommendations are indications that state funding will be closely coordinated, with the advice of the Leadership Committee, with local programs that conform to the proposed framework. This in turn will encourage a decentralization of planning and more flexibility in programming to meet the widely varying forms that the epidemic has taken in the state.

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The draft report was released Wednesday to state health officers for their comments. It is the work of Kizer, Conant, Fraziear and Dr. Donald P. Francis, the Centers for Disease Control AIDS adviser in California. It makes good sense. Clearly its prompt implementation by local health departments would expedite efforts to control the disease. Los Angeles County, with its own AIDS Commission and a five-year plan in preparation, has demonstrated the usefulness of doing what the framework advises.

As Kizer pointed out to the Presidential Commission on AIDS last month, one-fourth of this country’s AIDS cases have been in California. There has been innovative action in the state--and above all in San Francisco, the hardest-hit community. To the extent that there has been a lag in state coordination and in the development of local planning, Kizer’s new initiatives offer appropriate remedies.


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