Action Alert: San Francisco AIDS Care in Jeopardy

San Francisco's budget crisis has reached a point at which
the public health department's model AIDS care program is
seriously threatened. City officials at the mayor's office have
insisted all along that preserving AIDS services was a high
priority. But even maintaining AIDS services at their current
level would be insufficient given the increasing numbers of
people living with AIDS. Needed services also are becoming more
complex as the population affected by the epidemic becomes poorer
and less educated. City officials do not seem to understand the
extent to which AIDS care is integrated with health care service
as a whole.

The city's Public Health Department has been struggling all
year to cope with first $32 million and then $57 million in lost
appropriations from the city's general fund. Last week the
department was suddenly asked to provide a plan within 24 hours
to make up for a further $32 million reduction in general fund
donation. As usual, the demand, from the city's chief
administrative officer, included a stipulation that AIDS services
were to be protected.

Even before this latest reduction, AIDS services were being
nibbled away. Two weeks ago, the staff of the well-regarded AIDS
clinic at the county hospital (San Francisco General) were
chagrined to learn that they would lose at least one part-time
doctor or full-time nurse practitioner. In considering the cut,
the head of the hospital's Department of Medicine, Merle Sande,
M. D., argued, "Hospital outpatient clinics have to reduce their
capacity by 80,000 visits a year. There are attempts to preserve
AIDS, but I can't possibly do that. Everything comes out of the
same pot. I have to cut across the board."

With the latest budget reduction, the already overcrowded
AIDS clinic is targeted for a loss of $500,000. This reduction
will mean the loss of three full-time doctors, a principal clerk,
a phlebotomist, a pharmacist's assistant, a nurse's aide, and a
clinic administrator.

The crowded nature of the AIDS clinic has meant that not all
AIDS outpatients are seen there. Many go to the hospital's
family medicine department, for example. Others go to
neighborhood health centers for early HIV care. And all patients
go to specialty clinics for conditions requiring their particular
expertise. Most of these facilities already require four to
eight week waits for appointments. In the most recent scenario,
San Francisco General's primary and specialty clinics would be
cut by a third of their capacity, and four of the eight district
health centers would close.

Two of the remaining district health centers are in
neighborhoods hard-hit by the AIDS epidemic. Their survival is
being purchased by taking $1.2 million away from such AIDS
services as home mental health counseling; home health, attendant
and hospice services, food bank aid, hospital peer counseling,
psychosocial and advocacy services; and media relations and
prevention efforts.

Then there are all the programs that help people with AIDS
or HIV even though city hall does not take them into
consideration when claiming to "maintain AIDS services."
Consider, for example, the proposed elimination of the methadone
detoxification program to help people off heroin. That program
serves about 275 HIV-positive San Franciscans per year.

Laguna Honda Hospital, the city's chronic care facility, is
slated to lose 300 beds. This will mean that some patients at
San Francisco General's in-patient AIDS ward will not be
discharged as soon as they could be, and a stay at the AIDS ward
costs $1500 per day.

Lastly, the range of mental health and addiction treatment
services administered by the department will lose $27 million in
city funds and concentrate mainly on crisis resolution. This
will deprive many people with HIV, or at risk for HIV, of the
personal resources they need to protect themselves.

Behind the city crisis is the looming state deficit of $10
billion. The state budget gap results from failure to plan for
the economic realities of the post-Cold War era, especially the
shrinkage of California's defense industry. To help bridge the
gap, Governor Wilson wants to eliminate local aid paid for by the
state sales tax, causing city governments across California to
search for ways to downsize their operations.

Dramatic trimming of state expenditures also is expected,
although last month's vote in a state Senate committee to kill
all state AIDS programs was quickly rescinded. It is now
expected that funding for AIDS will remain the same next year.
Flat-funding has been the case for the last five years; it really
amounts to a 30 percent cut because of inflation and the 60
percent growth in the number of people with AIDS. The AIDS Drug
Assistance Program, which helps people of moderate income, has
had a chronic insufficiency of funds. For this reason, the
program rejected a recommendation by its physicians' advisory
board that it add ddC, foscarnet and acyclovir to the list of
reimbursable drugs.

Other parts of Governor Wilson's proposed budget also would
affect the AIDS community. At present, about 40 percent of
Californians with AIDS receive some of their treatment through
Medi-Cal, the state's version of Medicaid. Wilson wants to
eliminate several eligibility categories for the medically needy.
He also is asking to reduce a number of optional Medi-Cal
benefits, including adult dental services, optometry and
audiology, and many medical devices. In another area of the
budget, those receiving Social Security disability payments would
receive no cost of living adjustment this year because the state
would reduce its supplemental grants to the program.

The uproar over health funding is peaking just as the US
Department of Commerce is releasing figures indicating that the
San Francisco metropolitan area has the highest per capita income
in the country ($30,550). Activist Tab Buckner noted, "The money
is there. In a practical way, business and governments have to
be more in partnership. When businesses give back to the
community, they see a return in terms of improvements in the
quality of the social environment." The sentiment is growing
that business and the well- to-do should bear their "fair share"
of California's financial problems.

Buckner is a member of San Francisco's Coalition for Public
Health Services, a broad coalition of AIDS, women's and other
grassroots groups, political clubs, and unions that has come
together to preserve health programs. The Coalition is planning
a number of actions to call public attention to the effects of
cutting the health budget. Further information on the
Coalition's activities can be obtained from Jerry Windley at
415/788-4999 between 9 and 2 on weekdays.