Battling the Twin Epidemics : Treatment: Two Valley programs help drug addicts infected with the AIDS virus fight a double scourge.

Three years ago, Elaine, now 41, was addicted to heroin. A prostitute with two young children, she spent her days and nights with other addicts, selling herself and stolen property, and shooting drugs.

“No one has done all the things I did,” she said recently, referring to her 21 years of drug addiction and the life she led to support that addiction. Ultimately, a friend and ex-addict talked her into seeking help at Tarzana Treatment Center. After nine tough months in the center’s drug recovery program, Elaine learned she was infected with the AIDS virus.

Elaine, who had already been struggling to beat her addiction, said she was struck with an overwhelming sense of futility. “What am I doing this for?” she asked herself. “Why?”

Elaine’s situation is not unique. According to the national Centers for Disease Control in Atlanta, of the estimated 5 million to 6 million Americans in treatment for a substance abuse addiction, about 36,900 are HIV-infected. In Los Angeles County, there are 120,000 to 160,000 intravenous drug users. Although there are no county health department figures specifically for the San Fernando Valley, health and medical experts estimate that 4% to 6% of the area’s addicts are HIV-infected.

The twin epidemics of AIDS and substance abuse have spawned programs that coordinate the treatment of both problems. According to Ken Bachrach, a clinical psychologist and clinical director of the Tarzana Treatment Center, this is the best way to address the combined problems of substance abusers who are HIV-infected. Too often, he said, programs treat either substance abuse or acquired immune deficiency syndrome, and most of the AIDS programs are unable to treat substance abusers.

“If someone has a medical problem and a psychiatric problem, you often have to deal with the whole person. If you don’t, it would be like treating heart attack victims without having them change their exercise and diet lifestyle,” Bachrach said.

Recently, the National Institute on Drug Abuse and the Health Resources and Services Administration have awarded $8 million in grants to community health centers, state health departments, universities and hospitals to support comprehensive treatment of AIDS and substance abuse. Such funding is important from a public health point of view, Bachrach said, “because without treatment, these people may be spreading the disease and may be involved in illegal activities to support their substance abuse. This population is at high risk to spread a fatal disease, and they are down and out human beings who need help.”

Elaine--who requested that only her first name be used--knows firsthand the effects of battling both diseases. She said the news that she was diagnosed as having AIDS was so devastating that she immediately returned to drugs, left the Tarzana center, and went right back to the streets.

“I was so bad, I’d get a chip in my nail polish and use it as an excuse to use drugs,” she said. One day, the reality of her situation became clear. “I was hiding in a closet, shooting heroin, with my two children and my mother at the front door, asking for me,” Elaine said. She was tired, depressed, and desperate for help. Three days later, she checked herself back into the Tarzana center--and she has been drug-free since.

Now Elaine counsels drug-addicted women and young mothers at Tarzana Treatment Center’s program in Long Beach. She said many of her clients are also HIV-infected.

“I tell them what I tell myself: You still have something to live for. You have children, you want to learn to play tennis, to swim,” she said. “It’s one addict helping another. And once you have a concept of recovery, using drugs isn’t the same.”

Tarzana Treatment Center and El Proyecto del Barrio in Panorama City are the only programs in the San Fernando Valley that offer specific programs for substance abusers who are HIV-infected.

Tarzana’s services include inpatient medical detoxification, residential drug-free treatment, a residential program for women and children, adult outpatient services and AIDS education, prevention and counseling services.

According to Albert Senella, administrator at Tarzana, many of the clients arrive at the facility unaware that they are HIV-infected. “And for others, AIDS is the final straw,” he said, explaining that getting a positive AIDS test sometimes motivates people to finally seek treatment for their substance abuse.

That was the case for Mike, 33, of Van Nuys, who now works in Tarzana’s HIV/AIDS Counseling and Consultation Project. Mike, who also requested that only his first name be used, grew up in New York and started using drugs at 18. “I wanted to be a gangster when I grew up. I didn’t want to be a victim,” he said. “I wanted to victimize.”

After being convicted for a drug-related crime, Mike saw a poster on a prison wall that detailed the typical symptoms of HIV infection: fever, weakness and night sweats. It scared him, he said, “because I had all the symptoms.” Afraid of what would happen if he tested HIV-positive while incarcerated, he waited until his release a few years later to enter a drug program. Initially, after learning he was HIV-infected, he, like Elaine, returned to drugs.

Later, while he was back in jail on a parole violation, he decided to make some changes in his life. He was miserable, he said, and “the drugs weren’t working.”

He moved to Van Nuys to be near his father and other family members and ultimately decided he had to quit the drug habit and get involved in something positive. With one relapse, Mike has been drug-free for two years, supported by a 12-step program, his girlfriend and his job at Tarzana Treatment Center.

He educates clients about AIDS, and tries, he said, to instill hope. “I tell them to focus on quality rather than quantity of life,” he said.

Getting off drugs can extend the lives of HIV-infected addicts, said Tarzana administrator Senella. Once off the streets and into treatment, they can get proper medical attention, boost their immune systems and learn how to prevent the spread of AIDS to others.

The center offers a 12-step program, individual therapy and group therapy to help clients learn to deal effectively with those who are important to them. Tarzana also teaches the clients basic coping skills--how to set up a bank account, how to write a check, how to write a resume--and some clients are referred to literacy programs to learn to read.

Senella said he could double the center’s $3.5-million annual budget and still not have room for all the people who request treatment. Of the county’s 38 inpatient detoxification beds, Tarzana, which has a contract with the county, has 12--the other beds are at American Hospital in Pomona. For privately paying patients, the cost for the intensive medical detoxification, which lasts about a month, is about $300 a day, including all professional services. The average length of stay in the residential program that follows is six months, at a cost of about $70 a day.

The center has a minimum 30- to 60-day waiting list, although federal policy demands that the HIV-infected and pregnant women go to the top of the list, Bachrach said. Federal waiting list guidelines also require that inquiring clients give their phone number and address, and call the center every two weeks--something that he said is virtually impossible for many.

“Addicts don’t usually keep an appointment calendar; it’s insane. This population is not very good at long-term planning. They call when they’re ripe, in crisis, and if they can’t get help then, they may be lost,” he said.

All the county’s drug treatment waiting lists are long, said Dick Browne, an administrator with the county’s Alcohol and Drug Program. As of November, there were 2,162 people on waiting lists for drug treatment programs in Los Angeles County. And that number, said Browne, will likely increase when a federal waiting list reduction grant runs out June 30. Some agencies don’t even keep lists, said Rene Topalian, assistant director of the county’s Drug Abuse Program Office, so the numbers in need are probably higher than the lists indicate.

El Proyecto del Barrio, the Panorama City-based program, offers AIDS education and outreach along with drug treatment. The program started 20 years ago as an outpatient drug treatment center. Later, job training and placement services and a family health-care clinic were added and, in 1988, the AIDS program began.

The program involves not only basic AIDS education, which is offered to community organizations and schools, but also a street outreach project that sends workers to bars, parks, street corners and parking lots in high-risk drug use areas.

Staff members, dressed in polo shirts with logos and trained to avoid conflict in tough, gang-ridden areas, go out five days a week to talk to people on the streets of North Hollywood, Panorama City, Van Nuys, Sylmar, Granada Hills, Sunland, Pacoima, Lake View Terrace and Northridge. They teach AIDS prevention--how to clean needles properly with bleach, how to use condoms--answer questions and refer interested people to treatment.

In a typical month, the center’s staff talks to about 200 people about AIDS prevention. About 22% of those are intravenous drug users. The program receives about $250,000 a year from the state Office of AIDS, the county’s Drug Abuse Program Office and AIDS Program Office, and the city’s Emergency AIDS Intervention Project, according to John Palomo, program coordinator for the AIDS Outreach Project at El Proyecto.

Palomo, 37, a former addict and intravenous drug user, started with El Proyecto working on the streets in AIDS outreach after graduating from a recovery house in 1985 and working with the National Council of Alcoholism. Getting back to the streets was exhilarating, he said.

“I felt at home working with the drug addicts, like returning to what I knew best, but with a positive light,” he said. “My life had turned around so much, but I always found the streets exciting.” Employees are required to be drug-free for two years before working in the outreach project, Palomo said.

What’s tough, he said, is that most of the people the outreach workers talk to are not going to change. Palomo tells his staff not to expect too much. “They may save a couple of people. They’re out there to give out information,” he said. “They’ll go up to someone and say, ‘Yeah, man, how do you clean your outfit?’ ” referring the syringe and needle addicts use. “Sometimes people will be interested; sometimes they’ll tell them to go away.”

Palomo said the victories are small. He recalled one case, about a year ago, of a man who called to him from his truck in the parking lot of a shopping center near the border of San Fernando and Pacoima. “The man proudly told me he’d been cleaning his outfits with bleach--he showed me the bottle of bleach--and I knew we had made a difference,” Palomo said.

Outreach workers refer people either to El Proyecto’s outpatient drug program in Pacoima or to its Panorama City counseling program, staffed by five counselors. “We get them on the waiting list for inpatient treatment but enroll them in outpatient in the meantime,” Palomo said.

What’s especially difficult, said Mike at Tarzana Treatment Center, is that addicts with AIDS carry a double stigma of two problems that most of society associates with deviance. “To most people, it’s a situation where bad people have got a bad disease.” For an addict who is already miserable, he said, “AIDS is an additional curse and it tears down any self-esteem you’ve developed.”

But there’s still a bright side, Mike said. “I could never be here mentally, physically and spiritually without this disease. I’ve learned this world is about love and compassion, not about money and possessions. And now I have another chance at life.”