It Just Won’t Go Away

Alarms are being sounded about the perils of complacency regarding the AIDS pandemic. The new warnings come from the State AIDS Leadership Committee and the National AIDS Commission during meetings in Los Angeles.

--Geographical shape of the epidemic is changing:

No end to the continuing increase in new AIDS cases in California is foreseen in studies that look as far ahead as 1993, four epidemiologists told the state committee. The epidemic is spreading from San Francisco, where new cases peaked last year, and Los Angeles, where new cases will peak later this year, to the rest of the state, where a majority of the new cases will occur commencing in 1993.

Any leveling off of new cases will depend on controlling the disease in the intravenous drug community as it has been controlled in the homosexual population. Leaders of the National AIDS Commission were skeptical about avoiding an outbreak from the drug community, pointing to New York City and Bangkok, Thailand, which have witnessed almost explosive spreads of the disease among drug users, and from them to the general population.

--Complacency is putting new populations at risk:

Heterosexual complacency is a continuing problem. In San Francisco, new infections in the gay community were quickly reduced through educational programs, but among heterosexuals in San Francisco, there has been no general behavioral change, according to health officials. Many, perhaps most, Californians take the risk of engaging in sex without using condoms. There has been a slight decline in sexually transmitted diseases, with the exception of the resistant strain of gonorrhea, which could indicate a modest increase in condom use. But the gonorrhea annual case load is still around 80,000, and syphilis has increased in two of the last three years, indicating widespread behavior that places people at risk of AIDS as well. The risk of a further spread is indicated also in an ominous increase in AIDS among women and children. While homosexual and bisexual males continue to constitute the great majority of cases, the most rapid increases have been perinatal cases, up 113%, and women, up 86% last year. Women constitute only 3% of the total AIDS cases in the state, but the risk varies by region. In San Bernardino County, 10% of the AIDS cases, and 25% of those infected with HIV, are women.

--Containment is crippled by fund shortages:

The state’s health system drew criticism from Dr. David Rogers, vice chairman of the national commission, which heard some very dismaying testimony. Los Angeles County reported that it has available only 1% of the funds required to undertake early intervention programs that can extend by years the lives of persons infected with HIV. And there are waits as long as eight weeks for the outpatient clinic at the County-USC Medical Center. San Bernardino County, which has chosen to spend no county funds on HIV programs, relying on state and federal money instead, has no outpatient clinics for the county’s more than 7,000 HIV-infected persons. San Diego, reporting 500 new AIDS cases in each of the last two years, is desperately short of funds, in part because of its limited share of state money. By 1992, more people will be living with AIDS in San Diego, Orange, Riverside and San Bernardino counties combined that in either San Francisco or Los Angeles. Orange County relies on federal grants to mount a coordinated program for the more than 14,000 thought to be HIV-infected. The epidemiologists forecast a peak in new cases this or next year in Orange County, barring an outbreak from the intravenous drug community, now accounting for 5% of cases.

The message of the hearings adds up to a warning that the worst is yet to come. But most public health facilities are unprepared. And that lack of preparedness inevitably will impair the ability of the entire health system to serve all the sick, not just those infected with HIV.