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