Clinic Sees an AIDS ‘Second Wave’ : Health: The future spread of the disease is likely to be among mostly heterosexual IV drug users, their sexual partners and their children, experts say.

An unusual public-private clinic that offers early treatment of HIV-infected individuals is bracing for “the second wave” of AIDS--in the heterosexual population.

Thus far, AIDS victims have been mostly homosexuals. Some heterosexuals have caught the virus from intravenous drug needles, or from transfusions of blood. But they are in the minority.

The result of this circumstance, said Susan Rooney, administrator of the clinic, “is an ‘it can’t happen here’ factor in the general public. Whole communities don’t seem to accept the risks.”

Among blacks, for example, human immunodeficiency virus infections are about double the expected rate.

But doctors now think that “the second wave will come through IV drug users, who are largely heterosexual, to women and children,” Rooney said.

“It is much easier for a male to transmit the HIV to a female--four or five times more likely--than vice versa. We don’t know why,” she added.

“And from the woman, there is about a 50-50 chance of transmission of the HIV to the unborn child,” who may live two, three or four years.

“A few years ago, nobody expected AIDS to go into the heterosexual population. In other parts of the world, especially Africa, AIDS is not a gay problem. It is spread throughout the population.”

Right now, it is possible for individuals to be carrying HIV for five years and not even know it. Perhaps even 10 years, but it is unlikely that the symptoms wouldn’t have shown up by then.

This “window” between the contracting of the virus and the illness of AIDS is the business of the clinic that Rooney administers, the regional Center for AIDS Research, Education and Services, or CARES, in mid-town Sacramento.

About four years ago, death from AIDS came one or two years after diagnosis. But now, potential victims are volunteering for testing and doctors are learning to treat AIDS as a chronic disease like other chronic diseases.

“They are getting to be more sophisticated. Now you hear predictions of seven to 10 years from early diagnosis to getting sick,” Rooney said.

“Changes have been incredibly fast so far. To me, the whole face of the disease is changing,” she added, mentioning the drug AZT and “other drugs on the horizon.”

CARES opened in May after a group of hospital administrators--usually competitors--discussed the potential burden of the AIDS epidemic on all of them.

A task force of hospital administrators and physicians decided on a separate clinic specializing in early detection, treatment, education, psychological counseling and something called “behavior change support” for asymptomatic HIV-positive persons, on an outpatient basis.

Physicians could meet their AIDS patients at the clinic. Rooney said there was early concern about AIDS victims frightening other patients in a doctor’s waiting room, but that has changed. Most physicians now see their AIDS patients in their own offices.

Initial funding included $100,000 from 11 Sacramento-area hospitals, $75,000 from the Sierra Foundation, and a $156,165 state subcontract making CARES one of eight state AIDS Prevention and Follow-Up Centers, serving Amador, El Dorado, Nevada, Placer, Sacramento, Sutter, Yolo and Yuba counties.

The Sierra Foundation is a Northern California philanthropic organization that has dedicated $3 million to the fight against AIDS in the last three years.

In the first 90 days there were about 100 clients, which is not many for the 3,200-square foot facility. But more are showing up. There were about 250 visits in August. There is a part-time physician, Dr. Neil Flynn of UC Davis Medical Center in Sacramento, and a physician’s assistant, among other specialists.

With regard to “behavior change support,” a recent Gallup Poll showed that although one-fourth of all Californians are fearful of contracting AIDS, only 15% say they have changed their behavior as a result. Of those who changed, 49% said they had limited the number of sex partners, and 5% said they had abandoned sex altogether.

But only 9% of those polled said they now use condoms in response to the AIDS risks.

It appears to be the other way around at CARES. Rooney said the HIV-infected clients tell the health education specialist that they have indeed changed their behavior.

For one thing, they all volunteered for testing, which Rooney recommends for all members of the high-risk groups: homosexuals, heterosexuals with multiple sex partners, and IV drug users.

Testing can be obtained on a confidential basis at any “anonymous test site,” of which there are six or seven in the Sacramento area. They may be found under “Health” in the government pages of the telephone directory. Private physicians and blood banks also test for HIV.

But CARES has no way of reaching IV users, the anticipated spreaders of “the second wave,” who often pass unclean needles among themselves.

Rooney said, “We don’t deal with drug addiction. The least they could do is clean up their works. Use bleach. It kills the virus. We say if you can’t stop using IV drugs, then clean up your works.”