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About Just out. (Portland, OR) 1983-2013 | View Entire Issue (April 1, 1986)
by Michael Helquist (MEW YORK) The A m erican response to the AIDS epidem ic has m oved into a new phase of awareness and concern, according to speak ers at a conference held in Mew York last m onth, and governm ent officials m ust assum e m ore responsibility in AIDS public policy issues. Several health experts targeted the expense o f AIDS m edical care as the m ost vexing problem ; they advised that only the federal governm ent can bring about the changes required to provide adequate health care. Gay com m entators at the two-day forum charged that lesbians and gay men have failed to hold the Reagan adm inistration account able fo r its am bivalent approach to funding AIDS research and patient care services. “ In 1986 there is no m ore pressing an issue fo r the governm ent to face than AIDS public policy,” claim ed Philip Lee, MD, director o f the Institute o f Health Policy Studies at the Universty o f C alifornia/S an Francisco. Lee said AIDS appeared at a tim e when the federal governm ent had forced the states to assume new responsibilities and in creased costs in health care. Yet the states are ill prepared to m eet the m edical expenses and to develop the necessary AIDS preven tio n program s. Lee allowed that hom ophobia kept m any state health departm ents and legislatures from m eeting the needs of people w ith AIDS. “ Cost containm ent has becom e the national public health policy,” Lee com m ented. "The discussion about AIDS policies occurs w ithin the context of econom ic issues rather than one o f hum an services' needs.” Lee asserted that the failure o f the federal governm ent to assume its re sponsibilities fo r funding AIDS program s sim ply shifts the burden to states, cities, and to people with AIDS themselves. "A strong federal role is required," Lee noted, “ and the m ost pressing issue is health care financing." Lee, president o f the San Francisco Health C om m ission and a form er assistant secretary fo r the federal Health, E ducation and Welfare D epartm ent (HEW ) — since reorganized and nam ed Health and H um an Services — said it is critical that the issue o f funding AIDS expenses be faced openly at all governm ent levels. Under the curren t "hodgepodge o f financing m echa nism s," Lee suggested that Mew York and other cities w ill soon be hard pressed to meet AIDS costs. “ W here w ill the m oney com e from to meet these future expenses?" Lee asked. "If it com es at all, it w ill likely com e from the hides o f other poor people.” He added, "Mo other cou ntry w ith people with AIDS has the same problem s that the United States does because other countries have a m ore rational system o f health care.” M ore than 250 public health officials, hos pital adm inistrators, and representatives fro m m ajor foundations attended the "AIDS and Public Policy” forum held in Mew York C ity January 16-18. The forum was spon sored by Dr. Lee’s Institute fo r Health Policy Studies and by the United Hospital Fund, an influential organization involved in public pol icy questions facing Mew York City. M ichael Grieco, MD, JD , an im m unologist and infectious disease expert at S t Luke’s- Roosevelt Hospital Center in Mew York City, to ld the audience that his hospital had al ready begun to experience severe financial constraints with its treatm ent o f AIDS patients. The Mew York hospital has treated 552 poeople with AIDS since the onset o f the epidem ic. “ We have 60 AIDS patients hospitalized rig h t now, but we do n 't have enough private 10 “White gay males affected by AIDS were taken by surprise “ Westmoreland observed. “Somehow they thought that an administration that cuts back on nutri tion services for children and that forces elderly patients out o f the hospital before they are well would embrace adequate health care for gay men with AIDS.” room s fo r them even now,” com m ented G rieco, “ and we expect to have 100 patients by 1987.” G rieco said that a recent study o f AIDS patient care at S t Luke’s-Roosevelt revealed that only 61 o f 552 patients had been seen by a social worker, and there was proportion ately less use o f dietary services and dis charge planning by the AIDS patients. Grieco also noted that one quarter o f their AIDS patients had neurological problem s, and four o u t o f five exhibited behavior problem s; yet only 14 patients had received a psychiatric consultation with a m ental health profes sional. G rieco observed that m any o f these service problem s resulted frorri lack of re im bu rsem ent “ We need Mew York State to reim burse us not only fo r what we are providing but also for what we should be providing," Grieco asserted. He concluded, “ The responsibility to provide care is not the hospital’s alone; the co m m itm e n t m ust com e from the city and state also. The state essentially controls the ability o f hospitals to function." B ruce C. Vladeck, PhD, President o f the U nited H ospital Fund, noted that AIDS public policy questions tend to “ get shoved aside" by new advances in m edicine and research. However, Peter W. A. Mansell, MD, cancer specialist at M.D. Anderson Hospital in H ouston, suggested that the hospital adm in istrators and health officials at the conference had been slow to respond to the problem s broug ht on by AIDS. “ I’m distressed that it’s taken this am ount o f tim e fo r a group like this to get together and discuss the issues," Mansell said. "We should have been looking at these problem s three years ago." A lthough representatives from such m ajor corporations as D uP ont the Rand C orpora tion, the March of Dimes, Travelers Insurance, and E quitable Life Insurance attended the conference, a few o f them noted in private that the ir participation was somewhat per functory. Conference organizer Lee has been critical in the past o f the failure o f American foundations and corporations to finance needed AIDS research. W hile the politics o f AIDS and acute m edi cal services attracted the m ost attention from the participants at the conference, other ses sions dealt with com m unity care services, public school policies, and the im pact of AIDS on the blood system. Challenge to the Gay C om m unity "T he federal governm ent refuses to recog nize the gay com m unity as legitim ate, and yet it expects gay people to take care o f AIDS them selves,” charged gay political com m entator and author Dennis Altman. Altm an called the Reagan adm inistration’s response to AIDS "a patchwork o f neglect and panic.” "A lm ost nobody in governm ent is pre pared to deal with education," Altm an noted. "T hey are far too scared to be seen as sup po rtin g hom osexuality and drug use." A ltm an, who is Australian, noted that the problem extended beyond the federal gov ernm ent to state and local officials as well. “ There is less inform ation about transm is sion o f AIDS in Mew York than there is in my hom e city o f Melbourne, which has only 19 cases o f AIDS.” A ltm an especially criticized Mayor Edward Koch, w ho had opened the forum with an aggressive denial that San Francisco had done m ore about AIDS than had Mew York. “ D o n 't let the Mayor’s lies fool you," warned A ltm an, "AIDS program s in this city have flourished in spite o f the abject failure o f City Hall." Given the governm ent’s tardy and inade quate response, Altm an questioned why the m edia and the gay com m unity found it so d iffic u lt to criticize the governm ent’s track record. A ltm an, whose book about AIDS has ju s t been published (AIDS in the Mind of America, Doubleday), noted that the media has undertaken few in-depth reports on the ad m inistration’s funding o f AIDS program s. T im oth y W estm oreland, aide to Represen tative Henry W axman (D -C A) and assistant counsel to the subcom m ittee on Health and the E n viro n m e n t echoed sim ilar com plaints about the media. "W e are losing the war against AIDS be cause the Reagan adm inistration is allowing us to lose and because the m edia has al lowed the governm ent to get away w ith it” W estm oreland charged. He noted that the m edia failed to even ask President Reagan anything about AIDS until 1985. W estm oreland added that the efforts to deal w ith AIDS are ham pered by “ the politics o f the b u d g e t The epidem ic w ill go up as the dollars go down,” he explained. B oth A ltm an and W estm oreland charged th a t the gay com m un ity had allowed the Reagan A dm inistration to fail to respond. W estm oreland cited “ a failure o f synthesis of th o u g h t” am ong gay people. "W hite gay males affected by AIDS were taken by surprise,” W estm oreland observed. “ S om ehow they tho ug ht that an adm inistra tio n that cuts back on nu trition services for childre n and that forces elderly patients out o f the hospital before they are well w ould em brace adequate health care fo r gay men w ith AIDS.” W estm oreland further noted that gay people who continue to call fo r AIDS funding w hile supporting Reagan’s m ilitary spending “ are not paying attention.” A ltm an stated the case m ore bluntly: “ It is tim e to say th t there is no longer room in the gay political m ove m ent fo r rig h t w ing gay people.” W hile A ltm an questioned the lack o f p o liti cal leadership in the gay com m unity, he noted th a t AIDS organizations in m ajor Am erican cities have assum ed the m ost prom inent leadership role. “And yet these organizations have m oved m ore into the m ainstream ; they have becom e m ore bureaucratic, and their leaders have fewer insights into m ovem ent politics.” C ongressional aide W estm oreland con cluded, “ The m edical M cCarthyites are already gearing up; the politics will only get worse.” David Rothm an, PhD, professor o f social m edicine at C olum bia University, called for coa litio n building am ong groups w ho are disenfranchised” from adequate health care. R othm an said that the hom eless, the elderly, and ex-m ental patients as well as people w ith AIDS are not receiving adequate pu blic health care. “ M oving across boundaries is now very im portant,” R othm an advised. A lthough discouraged by the current realities o f the A m erican public health system , Dr. Lee said he found som e hope in the exam ples set by people w ith AIDS and the thousands o f volunteers across the country w ho w ork in AIDS program s. Lee suggested th a t “ they represent a rebirth o f the concept o f ou r com m unity responsibilities as citizens." Michael Helquist recently received a spe cial Board of Directors Cable Car Award for Outstanding Journalist o f the Year. Mr. Hel quist lives in San Francisco; his articles appear regularly in C om ing Up! and The Advocate. The above article originally eippeared in Coming (Jp! Just O ut, April. 1986