Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
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San Francisco Examiner - July 23, 2009
Andrea Koskey, Examiner Staff Writer
John Conley, director of public health programs for San Mateo County, said the case-management services the county is currently providing to 40 patients as an alternative to hospitalization or nursing facility care are very expensive.
The county program provides in-home care and sends staff out to check on the health and living conditions for those living with HIV/AIDS. Patients are assigned a medical case manager as well as a social worker, according to county documents.
Additionally, the state's AIDS office will not allow municipalities to make reductions to case management activities or other requirements such as client/staff ratios, according to county officials.
"The bottom line is [the state] refused to allow us to modify or relax the program, we're locked into a rigid program and the state is paying only 50 percent of the bill," Conley said "It's becoming very, very expensive to run."
The state contributes roughly $200,000 to the county's comprehensive case-management programs for AIDS patients, according to Conley, and the county matches that more than 100 percent.
AIDS -- acquired immune deficiency syndrome -- weakens the immune system. It is caused by HIV, or human immunodeficiency virus, and is spread through sexual contact, by sharing needles, during pregnancy or through breastfeeding and, in increasingly rare cases, through blood transfusions.
The first documented case of the disease was announced by the Centers for Disease Control and Prevention in 1981. Although there is still no known cure, Conley said medical advances in the 1990s have advanced the fight against the disease and extended the life of most HIV/AIDS patients.
"One challenge we have is how to serve the population [with] HIV that is aging," Conley said. "The proportion of HIV [patients] moving into their 50s and 60s is quite significant."
But budget cuts at the state Legislature could eliminate the program and force patients to go to outpatient care.
Conley said acute illness from the disease could force a handful of patients to be admitted to hospitals for care, but the majority of those receiving in-home care will be transitioned to outpatient services.
Education efforts to prevent HIV/AIDS are also expected to be reduced as a result of state budget cuts, according to Megan O'Day, executive director of AIDS Community Research Consortium in Redwood City.
Health care costs for an HIV-positive person over 20 years is $600,000, she estimated, compared to $80,000 for a person without HIV during the same period of time.
"In the long run," O'Day said, "not supporting these programs is going to cost California a fortune."
A vicious syndrome
Facts and figures about AIDS:
* The AIDS mortality rate has significantly declined from 12.9 percent in 1990 to 3.9 percent in 2001.
* 64 percent of AIDS cases are in men who have sex with men.
* The proportion of male cases acquired through injection use increased from 9.8 percent from 1983-1992 to 19.3 percent from 1993-2002.
Sources: California Department of Public Health, San Mateo County Department of Public Health
akoskey@sfexaminer.com
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