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