Miami Herald - Monday, August 19 1985
Paul Anderson and Mark Silva, Herald Capital Bureau

Is Florida doing enough?

No, say doctors and gay leaders across the state. Yes, for now, say state health officials.

"I think the state has to realize the major burden we're under here," said one of the critics, Dr. Margaret Fischl, director of Jackson Memorial Hospital's AIDS task force and one of the nation's leading experts on the disease.

"I've seen my friends die because governors and presidents refuse to fund even minimal help for something that their own advisers have been screaming about as the health threat of the century," said Ed Coleman, a gay Fort Lauderdale man.

Gary Clarke, acting director of the state's health office, contends "we're doing an adequate job, given the resources that we've had available. New York and California are devoting a lot more, but they have a far greater number of cases."

In the past three years, Florida has spent an average of $665 in state funds on each AIDS victim. During the same period, California spent $8,048 per victim and New York $2,819. Florida has 866 victims, California 2,833 and New York 4,433.

Said Clarke: "I'm not saying what we're doing is good enough and that we shouldn't expand and improve as the problem grows, but I think we're doing a good job at the present time."

Unlike local governments in California and New York, local governments in Florida spend virtually nothing on AIDS-support programs.

"I'm upset about that," said Fischl.

Gov. Bob Graham declined to be interviewed about the state's response to AIDS, asking that questions be submitted in advance and issuing a response through his spokeswoman, Jill Chamberlin. She said that although Graham considers the growing crisis "very serious," he "believes we need to keep it in the perspective that there are many other serious health problems facing Florida."

AIDS has killed 437 Floridians, but cancer, heart disease, auto accidents and other causes kill far more people in the state, Chamberlin noted.

Last year, Graham vetoed a $250,000 AIDS research grant for the University of Miami that legislators had added to the 1984-85 state budget. He agreed with the Florida Department of Health and Rehabilitative Services, which argued that AIDS research should be left to the federal government.

"We had almost no money," said Dr. Robert Rubin, deputy dean for research and graduate studies at the university. He said the grant the governor vetoed "would have been, at the time, very significant."

Since then, the school has received four AIDS-related research grants but says it needs still more money.

Other groups echo the university's criticisms of state policy.

Sally Dodds, president of the Health Crisis Network, a Dade support group for AIDS victims, said the group got a $10,000 grant from the state July 15, one of four such grants. She said the state had largely ignored the AIDS crisis until then.

"This is a Southern state, and with all the stereotyping and the knee-jerk reaction to it having begun in the gay community, the state for a long time has denied the problem," Dodds said.

At the national level, gay activists repeat their criticisms of government policies, contending that the $126.3 million in proposed federal AIDS spending next year simply isn't adequate to fight a disease that, if it continued unchecked at its present rate, would wipe out a sizable segment of the U.S. population within a decade.

"I regard the government as totally two-faced in its policies," said the Rev. John Gill, gay pastor of the Metropolitan Community Church in Fort Lauderdale. "I don't know whether it's out of ignorance or a sick ordering of their priorities, but the reality is the money is not being spent. It's going to take the deaths of thousands of heterosexuals before enough pressure is applied and the money is spent."

In its $3.1 billion budget for 1985-86, which took effect July 1, HRS has just under $2 million and 17 employees for testing, tracking and informing people about AIDS. Of that, the $576,000 is state money -- the rest comes from federal grants.

That's the first state money put directly into a coordinated AIDS program.

State Sen. Frank Mann, D-Fort Myers, chairman of the Senate budget subcommittee that controls Florida's social-services spending, said that with AIDS cases and publicity growing, the Legislature probably will focus more on the problem next year. "I don't see that the politics of it are particularly difficult now that it's left the bounds of the gay community," he said.

Mann said that AIDS simply wasn't as high a priority this year as other needs, such as beefing up child-abuse investigating teams.

HRS had requested 28 new staff positions for its AIDS program, but the Legislature cut that to 17 and said the rest of the work should be spread to county health departments or private health services under contract.

Of the climate in which the funding decisions were made, a key House of Representatives staffer said: "That was before Rock Hudson."

Mann was asked if he fears getting AIDS. "It has to go through your mind. If you're in a car crash (and need blood), you start to wonder. This has happened to perfectly respectable Americans, God-fearing people who go to church every Sunday. That's a scary thing."

Dr. Jeffrey Sacks, an Atlanta-based epidemiologist for the U.S. Centers for Disease Control who began tracking AIDS while assigned to work in Florida for three years, said it's hard to judge Florida's commitment to the problem.

"It's all relative," he said. "You can say Florida is far, far behind New York, but I'm now working with the state of Georgia, and Florida is light years ahead of what the state is doing here . . . ."

New York has spent $12.5 million in the last three years on its AIDS institute, funding medical research projects, a public information campaign, antibody testing and task forces around the state to provide counseling to victims and families. California moved to create a testing, education and support-network program this year, adding a special state AIDS headquarters to the California Department of Health Services, complete with a 28-member staff.

A major part of Florida's AIDS education program centers on convincing people in high-risk categories that test results will be kept confidential. And when test results are positive, counseling is offered.

The centers are financed with a $967,000 federal grant that runs through Oct. 24 but might be extended, and with $20 testing fees charged to those who can afford it.

In one area, a state agency has been forced to deal with the problem. After a scandal involving poor health care in state prisons, the Department of Corrections last year began screening inmates for AIDS. So far, 18 cases have been confirmed, and another 40 are diagnosed with "pre-AIDS," said Department of Corrections spokesman Vernon Bradford.

Those with confirmed cases are isolated, either in the prison system's medical facility at Lake Butler or in a private hospital in Alachua. One prison doctor, Robert Simon, recently suggested that the prison system has "the possibility of seeding the southeastern United States with AIDS."

In other areas, HRS has performed well, Clarke and other officials contended. Examples:

* The CDC recently gave Florida high marks for gearing up 17 testing centers in urban areas since June 3 to check blood for traces of the antibody HTLV-III, a sign that AIDS virus could be present. * HRS published a 59-page manual more than a year ago to give guidance to workers in hospitals, nursing homes and social service agencies who must deal with AIDS cases. * HRS coordinators are working with the state Department of Education to develop, within the next month, a policy for dealing with children with AIDS in public schools, as well as a way to teach about AIDS in health and sex-education classes. Currently, the issue is left to county school boards.

A major issue AIDS activists are calling on the state to confront is how to pay the health-care costs of those AIDS victims who have no private insurance and can't qualify for either Medicaid or Medicare coverage. It has been estimated that the cost of caring for a single victim, including hospitalization, can reach $140,000.

"That's going to be a tremendous impact on the health-care system as a whole, and right now the burden is falling on hospitals like Jackson Memorial that care for indigent patients," Clarke acknowledged. "We haven't recommended that the state take on a role in that."

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