Los Angeles Times (LT) - WEDNESDAY December 5, 1990 Edition: San Diego County Edition Section: Metro Page: 2 Pt. B Col. 1 Word Count: 847
Barry M. Horstman; Times Staff Writer

The needle exchange proposal, the most controversial of the 83 recommendations included in a report from the county's Regional Task Force on AIDS, was referred by the board to Chief Administrative Officer Norman Hickey for more study.

With little debate, the board voted unanimously to direct Hickey to report back in three months on the cost and feasibility of the recommendations in the task force report.

Used in a handful of other Western cities, including Seattle, Tacoma and Portland, government-sponsored clean-needle programs enable individuals who use illegal intravenous drugs to exchange their hypodermics for new ones.

Noting that the sharing of intravenous needles among drug users spreads the AIDS virus, supporters of needle exchange programs argue that the plans prevent transmission of the disease and can also be a mechanism for encouraging drug users to receive treatment.

Opponents, however, complain that, by dispensing the needles, the government in essence condones illegal drug use and could even increase addicts' usage by minimizing safety concerns.

"My concern is that, if we give away needles, addicts will use more drugs than they do now, and we'll just be encouraging someone who might not otherwise use drugs to try it," said Supervisor George Bailey. "I have serious doubts about that idea."

The task force's chairman, lawyer Penn Lerblance, emphasized that the needle exchange plan is only a backstop to the expanded drug treatment and recovery programs recommended in the group's 39-page report.

"This clearly is a difficult issue for many people on the street to understand," Lerblance said. "Our major objective is to stop the transmission of the virus, and the best way to do that is to get people to stop using drugs. But, until there's enough money for those programs, you have to be realistic. If you can get people to stop using dirty needles, that's a step in the right direction."

Sensitive to the political volatility of the needle-exchange idea, members of the 31-member task force emphasized Tuesday that it is only a small part of the group's overall strategy for battling a disease that has killed about 1,400 San Diegans--a bleak statistic expected to grow dramatically.

An estimated 29,000 San Diegans are infected with HIV, the AIDS virus that typically takes a decade to progress from infection to diagnosis of the deadly disease. Of those individuals, about 2,300 have reached the final stage of the disease and have been formally classified as AIDS cases. However, because that number excludes AIDS patients living in San Diego who were diagnosed elsewhere, the overall caseload probably is higher, the report said.

"Our problem in San Diego is much larger than the mere count of diagnosed cases of AIDS," Lerblance said. "The impact on hospitals, nursing homes and the health system in general . . . is equally important."

Much of the report encourages the county to assume leadership in expanding public awareness about the disease and in marshaling support from both the public and private sectors to address the growing health problem.

That task is complicated, Lerblance and others acknowledge, by the fact that AIDS today receives considerably less news coverage and public attention than it did in the mid- to late-1980s, when concern over the disease was at a peak.

"Getting less coverage is a mixed blessing," Lerblance explained. "You don't get that intense, hysterical reaction that wasn't sound to begin with. But you also get more people feeling that AIDS isn't their problem, which it is, even if they don't have it, because of its (effect) on the health system."

Recognizing that the county's severe fiscal constraints limit its ability to fund ambitious new programs, however meritorious, the task force offered many recommendations that would not significantly increase county costs.

For example, the advisory group urged the county to lobby aggressively for state and federal legislation that would increase long-term health care funding for AIDS patients and accelerate the approval of experimental drugs to treat the disease.

It also recommended that the county work with education officials and private employers to promote prevention and early detection, and press for increased charitable donations for AIDS services, which lag behind more established giving programs for other major diseases such as cancer and heart disease.

However, other proposals, including the controversial needle-exchange plan and a call for expanded hands-on oversight of AIDS cases, could increase county expenses, forcing those ideas to compete for scarce county dollars against other compelling needs both inside and outside the health-care field.

"Money's going to be a problem," conceded Dr. Donald Ramras, the county's public health officer. "But I don't think there's any way that any governmental agency could or, for that matter, should do the entire job in an area like this. It's going to take a lot of cooperation on a lot of levels to get the job done."

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