AIDS Overwhelming S.F. System : Surge in Cases, Other Factors May Signal Trouble Elsewhere

This city’s pioneering system of compassionate, cost-effective AIDS care is being overwhelmed by an unexpected surge in new cases, longer-living patients, dwindling charitable contributions and burnout among volunteers and staff.

The “San Francisco model,” which harnessed the altruism of thousands of volunteers to minimize the hospital stays of patients, has been widely emulated, and city officials believe its woes portend trouble elsewhere.

“I’m afraid we are showing the rest of the country where they are headed,” said Dr. Tom Peters, San Francisco’s associate health director.

Simultaneous difficulties at a number of community-based AIDS organizations, along with projections that worse times lie ahead, are forcing local officials to ask fundamental questions about the long-term viability of the much-acclaimed model.

As a result, there have been renewed calls for the state and federal governments to take on a greater share of the burden of caring for AIDS patients, a solution that proponents say might head off similar emergencies in other parts of the country--especially those that have not mobilized against the disease like San Francisco has.

In recent weeks, the AIDS Emergency Fund slashed its maximum cash grant to recipients to $100 from $1,000, the Shanti Project turned away 50 patients seeking housing, and the respected director of the San Francisco AIDS Foundation announced his resignation, citing exhaustion and funding woes.

“We are entering an era of scarcer resources,” said Timothy Wolfred, who will step down June 30 after four years as head of the agency. Earlier this year, the foundation laid off 11 of its 80 staff members.

Meanwhile, city health officials counted 193 new AIDS cases in March and an additional 207 in April. Both figures shattered records for a single month and dashed hopes that new cases would plateau at or slightly above last year’s monthly average of 133.

Officials say that about 10% of the March and April cases reflect more stringent monitoring by the Health Department. But that does not come close to accounting for the big jump, which was based on exposure to the human immunodeficiency virus that occurred years ago.

Transmission of the virus has fallen to about 1% a year among homosexual men, because of widespread adoption of safe-sex practices, and stands at about 3% a year among intravenous drug abusers. Still, about 25,000 San Franciscans are infected and without effective treatments will probably get sick over time.

Even in a city that has become numb to bad news about AIDS, the latest monthly totals were “horrifying,” said Pat Christen, director of public policy for the AIDS Foundation. “All of the city’s AIDS organizations are in crisis,” added Christen, who will become interim director of the agency July 1.

“It feels like a tidal wave,” added Eric Rofes, executive director of the Shanti Project, where private donations fell 8% during the first quarter. Shanti provides emotional and practical support to people with AIDS, and its 14 residences provide housing for 52 of the city’s 2,300 living AIDS patients.

“I could fill another 14 residences tomorrow,” Rofes added.

At the AIDS Emergency Fund, a charity funded by events in the gay and lesbian community, treasurer David Bell said “nine years into the epidemic, the community is becoming tapped out.”

Still, as AIDS patients live longer--and exhaust their savings and health insurance coverage--more of them are seeking grants from the fund to cover rent, utility bills and other necessities.

At Shanti, “we are seeing more dementia and other neurological impairments” as treatments that prevent pneumocystis carinii pneumonia, a leading killer of AIDS patients, come into wider use, Rofes said.

San Francisco health officials and AIDS leaders have been scrambling to find new sources of money to keep the system functioning. “It is important to remember that the collapse of the model would not save money in the long run,” noted Associate Health Director Peters.

Indeed, a California Department of Health Services study released earlier this year showed that the state Medi-Cal program spent about twice as much per AIDS patient in Los Angeles as in San Francisco. The average hospital stay was 9.5 days in San Francisco, compared to 13.3 days in Los Angeles.

“It is impossible to overstate the value of the contribution made by family, friends, neighbors and lovers,” Peters said. “It is now time for the federal government to explicitly assume the responsibility for patient care, as it would in any other type of natural disaster,” he added.

Rofes of Shanti has called a conference of Northern California AIDS experts next month to examine “ways in which the San Francisco model is outmoded, or how it might be buttressed.”

Volunteers Needed

“We need to develop strategies to enlist older people, students, and housewives as volunteers,” said Rofes, a veteran of AIDS service organizations in Los Angeles and Boston.

And in another effort to ensure the viability of AIDS care in San Francisco and throughout California, a group representing major AIDS services organizations met here last Friday to consider options including statewide or local ballot initiatives to fund AIDS and other health-care programs.

“We are in a tough spot,” said meeting organizer Mark Cloutier, executive director of the National Public Health Project Against AIDS, who noted that the overall state budget faces a $1.6-billion shortfall next year and that federal AIDS expenditures for patient care are only expected to grow slightly.

The group hopes to form a coalition with other “disease lobbies” and health-care providers and go directly to the voters to seek higher excise taxes, perhaps on alcoholic beverages.