- An epidemiologist with San Francisco's Department of
Public Health sent shock waves through the various AIDS and medical communities
last year when he told reporters that San Francisco faced HIV infection
rates "comparable to sub-Saharan Africa."
-
- Although the latest report from the Centers for Disease
Control and Prevention (CDC) suggests that San Francisco infection rates
may now be lower than the national average, such grim forecasts have been
cited to push for increases in the city's annual federal AIDS subsidies
of approximately $50 million.
-
- San Francisco has long been considered the model for
other cities struggling to cope with this deadly disease. So when local
leaders like Rep. Nancy Pelosi, D-San Francisco, invoke similar scenarios
when pushing for more money, who is to argue?
-
- But there are legitimate questions about whether San
Francisco needs all that money and whether San Francisco organizations
that receive federal AIDS funding have their priorities straight.
-
- Consider:
-
- AIDS Health Project, which received $977,701 in federal
grants in 2000, features HIV bowling nights, a daytime cruise of San Francisco
Bay and "interactive workshops" that cover "flirting and
cruising . . . holding, kissing, licking, sucking, f-."
-
- Positive Force, which receives $1 million a year from
the CDC, threw a "Poz Prom" in April, inviting participants to
"dress in your most glamorous attire, from leather to feathers."
The group also offers flirting classes and in July will host a workshop
on how to have anal intercourse if you suffer from diarrhea.
-
- HIV Stops With Me (www.hivstopswithme.org), a CDC-funded
San Francisco- based Web site, features shots of muscle-torsoed male models,
profiles of project spokespersons and a commentary by Mike Shriver, Mayor
Brown's "Special Adviser on AIDS and HIV Policy." But the site,
which receives $1 million in CDC money channeled through the San Francisco
Department of Health, carries no information on safe sex, latex condoms,
water-based lubricants or needle sharing. "It's a disservice when
you think that there are people who can't even afford basic medical care
and they're wasting money on frivolous programs, " said Roland Foster,
a staff member of the House Government Reform Committee in Washington,
D.C.
-
- Foster could have been referring to the tens of thousands
of HIV/AIDS patients outside of San Francisco and California who don't
enjoy the same access to potentially life-saving medication under the AIDS
Drug Assistance Program (ADAP), financed mostly by the federally funded
$1.7 billion Ryan White CARE Act.
-
- States receiving smaller federal allocations, or which
provide little local money, like Alabama, South Carolina and West Virginia,
have waiting lists for ADAP. Those patients, such as the 400 people on
the ADAP waiting list in Alabama, are left to fend for themselves, at the
mercy of complicated "compassionate-use" programs established
by private pharmaceutical companies.
-
- Other states offer a much more limited range of drugs
covered under ADAP. Often excluded are the costly, high-powered antibiotics
for treating opportunistic infections like cryptosporidium, an intestinal
parasite deadly to HIV/AIDS patients.
-
- San Francisco, meanwhile, continues to reap the lion's
share of AIDS funding, keeping AIDS patients well supplied with the latest
drugs, not to mention boat cruises and flirting classes.
-
- To be fair, this is largely because San Francisco was,
in the early years, ground zero of the AIDS epidemic in America. But that
is no longer the case. According to the CDC, poor African Americans - outside
of affluent areas like San Francisco - now account for half of new infections.
The "explosive" increase in HIV infections the CDC announced
last week refers primarily to gay and bisexual African Americans -- but
not in San Francisco, where reports show that annual infection rates among
gay black men are substantially lower. As the Wall Street Journal pointed
out, higher rates among African Americans 'result in part from enduring
socioeconomic disparities like lack of access to medical care.'
-
- But federal funding does not respond easily to such changes.
For the past decade, money from the Ryan White CARE Act has been distributed
according to a complicated formula that counts the total number of AIDS
patients within a jurisdiction - living or dead - rather than the current
number of living HIV clients. As a result, San Francisco, which experienced
a devastating death toll early in the epidemic, receives twice the amount
per patient ($5,980) than do other cities whose actual caseload is now
comparable to San Francisco's. For example, Chicago receives $3,123 per
patient, while the heavily African American District of Columbia receives
just $2,869 per patient,
-
- according to a 2000 report from the General Accounting
Office.
-
- "The U.S. taxpayer has been funding health care
services for dead people," said a GAO official who testified at a
House Subcommittee on Health and Environment hearing on reauthorizing the
Ryan White CARE Act.
-
- AIDS officials outside of San Francisco are becoming
equally critical of the way funds are distributed. "We can't understand
the principle that says a person living with AIDS in one jurisdiction should
receive X, while a person living with AIDS in another should receive Y,"
Charles Henry, director of the Office of AIDS Programs and Policy for the
Los Angeles County Department of Health Services, told a gay community
newspaper last year.
-
- "We here in L.A. have long supported a more progressive
approach to [distributing Ryan White dollars], which endangers San Francisco's
inordinate share of Title 1 (Ryan White CARE) funds," Henry added.
Perhaps aware of the pressure, San Francisco AIDS organizations are also
spending an inordinate amount of money on lobbying - for more money. According
to the San Francisco AIDS Foundation's tax forms for 1999, the nonprofit
organization, whose annual budget is listed at more than $18 million, spent
nearly $1.7 million in lobbying campaigns. (It also paid its executive
director, Pat Christen, $214, 390 in 1999, according to the foundation's
Web site.)
-
- Much of the AIDS Foundation's "public policy and
advocacy" funding went to lobby groups in Washington, D.C., such as
the CAEAR Coalition (Cities Advocating Emergency AIDS Response). CAEAR,
in turn, hired a consulting firm called the Sheridan Group to work the
corridors of Washington. Such lobbying campaigns have paid off for San
Francisco: Last year, the city received $36 million in Ryan White CARE
Act funds, and an estimated $10 million from the CDC for HIV prevention.
Of course, questions could and should be raised about how other cities
are handling federal AIDS funds. There have been reported instances of
abuses - including outright fraud - in North Carolina, Florida, Texas,
Puerto Rico and Indiana. San Francisco appears to be free of such egregious
activities. But how much of San Francisco's money is reaching those who
need it most - and the quality of services provided - are also questions
of concern.
-
- For example, there are currently more than 3,400 men,
women, and children living with HIV/AIDS on the city's official waiting
list for housing assistance. Many others face a bewildering array of paperwork,
waiting lists and "client managers" before they receive an actual
Ryan White funded service.
-
- Critics point to the case of Tony Leone as an example
of how overlapping, overfunded, bureaucracy-heavy AIDS organizations in
San Francisco have sometimes hurt rather than helped those they are supposed
to serve.
-
- Unable to get a 95-cent adult diaper from San Francisco
General Hospital, Leone, an AIDS patient who suffered from chronic diarrhea,
traveled home from his appointment on a bus, alone, soaked in his own excrement.
Leone had four different Ryan White funds-paid client managers, all of
whom, he said, seemed unable to help him with the most basic of home needs
like shopping, laundry and washing dirty dishes. According the Bay Area
Reporter, one case management organization, Project Open Hand, insisted
that Leone fill out forms to be 'recertified' as a client. Another cared
only that the rent on Leone's apartment got paid on time. A third, according
to Leone's own testimony at an HIV Health Services Planning Council hearing
in 1999, 'spent 40 minutes out of the hour she spent with me telling me
how she met her lover and what it takes to maintain a successful lesbian
love relationship.'
-
- "Another case manager sat with her nose out my window
looking at the mess of dirty laundry, saying, 'I wish there was something
I could do,' " he said. A few months after his testimony, Leone died.
___
-
- Wayne Turner is co-founder of the Washington D.C. branch
of ACT-UP). ©2001 San Francisco Chronicle June 3, 2001 Page C-3
|
