Miami Herald (MH) - Sunday, June 2, 1991
Paul Anderson; Herald Washington Bureau

WASHINGTON - Ten years and more than 110,000 deaths after the AIDS epidemic began in the United States, scientists, activists and politicians still can't agree whether the government is doing enough to care for victims and find a cure.

Despite projections that the number of AIDS deaths will climb dramatically in the 1990s -- and evidence that the human immunodeficiency virus (HIV) that causes AIDS is now spreading more rapidly among heterosexuals and children -- gay leaders charge that official policies remain rooted in moralistic fears and discriminatory attitudes.

In the meantime, fear of the deadly virus has prompted profound changes in the attitudes and behavior of most Americans. In less than a decade, polls show, more than 90 percent of adult Americans have become aware of AIDS and how to avoid the exchange of bodily fluids that transmits it.

Concerns about AIDS contamination of the nation's blood supply, about AIDS-infected physicians and health care workers, about the risks of dirty needles and sloppy hospital practices have rocked the health care system.

Ten years ago, who could have imagined parents and teachers openly discussing with teen-agers the use of condoms and other "safe sex" techniques? For what was initially identified as the "gay plague" is spreading inexorably into the overall population.

Consider:

* While nearly 60 percent of all AIDS patients are gay men, 29 percent are intravenous drug users who shared needles and 6 percent were infected as the result of heterosexual intercourse -- chiefly as sexual partners of bisexuals and drug addicts.

* More than 3,000 children under age 13 have developed AIDS -- at least 1,581 have died -- and the American Academy of Pediatrics expects AIDS to become one of the top five killers of children during the 1990s.

Florida's 421 cases of AIDS in children under 13 ranks second nationally, behind only New York's 861. California reported 223 pediatric cases.

* Estimates that more than one million Americans are now HIV-infected yield projections that there will be as many AIDS cases diagnosed in the next two years, nearly 175,000, as there were in the past 10.

Florida, with 15,686 diagnosed cases by May 1, has the third highest number of AIDS cases among the 50 states, behind only New York (37,079) and California (32,864).

Internationally, the World Health Organization (WHO) estimates that eight million to 10 million people were HIV-infected as of January 1991, and that 1.5 million had developed AIDS. By the end of the decade, WHO predicts an additional 30 million cases of HIV infection.

"I don't know how we convince the people in Washington that the pain is real, the suffering is real, that people are dying," said Daniel T. Bross, director of the AIDS Action Council. He said the government's response continues to be "lackadaisical at best and, more often than not, politically motivated."

Health and Human Services Secretary Louis Sullivan defended the government's AIDS strategy. "Spending for AIDS research and prevention now is as great as for cancer, even though 10 times more people died of cancer last year," he said.

He called AIDS "a significant public health problem that has a high priority."

Indeed, increases in federal funding have been dramatic, from $5.6 million in 1982 to nearly $1.9 billion this fiscal year. But activists charge that the money hasn't kept pace with the spiraling number of victims and the need for highly specialized research.

"We are not prepared in any way to deal with the realities of the HIV epidemic in the '90s," said Pat Christen, executive director of the San Francisco AIDS Foundation.

Political leaders "are still sitting on their hands, wishing the epidemic would go away. It's not going to," said Timothy Sweeney, executive director of the Gay Men's Health Crisis in New York.

Acquired Immune Deficiency Syndrome -- while not known by that title until 1982 -- was first recognized in the June 5, 1981, issue of a weekly bulletin published by the federal Centers for Disease Control. It noted that a powerful strain of pneumonia killed five gay men in Los Angeles after each man's immune system mysteriously collapsed.

By May 1, 1991, there were at least 174,893 diagnosed cases of AIDS, of whom 110,530 had died, according to the CDC.

The early days of the epidemic were notable mostly for denial, fear and ignorance -- as much within the gay community as among politicians, public health doctors and government researchers. Valuable time was lost to debates over the political implications of closing gay bathhouses and screening blood donors.

Public awareness skyrocketed after the death of actor Rock Hudson on Oct. 2, 1985, following his desperate trips to France in search of treatment. Public sympathy increased, polls found, after children like Indiana's Ryan White and the Ray brothers in Florida began falling ill.

The hysteria that included calls to exclude such children from schools and ban HIV-infected adults from their jobs subsided with time and the passage of laws banning discrimination.

Still, every report of a new type of transmission stirs new fears.

Congress and state legislatures are debating mandatory testing of health care providers after the finding that a Florida dentist who died of AIDS infected at least one of his patients.

Equally chilling was the discovery that at least three people who received organ transplants from a Virginia man later died of AIDS. Other recipients, including an elderly Colorado woman given one of his hip joints, are now HIV positive.

The organ donor apparently was infected just days before he was killed in a 1985 gas station robbery -- before the six- to 10-week incubation period was complete -- so tests didn't detect the virus.

The Food and Drug Administration now puts the chance of contracting AIDS from a blood transfusion at one in more than 40,000. But continuing public skepticism convinced the American Red Cross to announce last month a reorganization of its blood collection and distribution system.

Public anxiety over AIDS remains high. A 1990 statewide poll by researchers at Florida International University found that Floridians ranked AIDS the second most serious problem facing the state, after crime and illegal drugs, even though over 56 percent of the respondents said they weren't worried that they or someone close to them would get AIDS.

The poll found mixed feelings toward AIDS victims.

Over 64 percent said funding for AIDS treatment and research should be increased. But vast majorities, apparently fearful, favored mandatory testing of all doctors, nurses and other health care workers (87 percent), couples applying for marriage licenses (82 percent), prison inmates (79 percent), restaurant workers (78 percent) and teachers (59 percent).

"My sense is, most people feel comfortable as long as they have been given good training and education," said Jamie Cohen, who runs an AIDS training program for the Service Employees International Union, which has 375,000 members who work in health care fields. The union is pushing for tougher federal standards for safer medical equipment, especially devices that use needles.

With no cure in sight, critics charge that research has been stymied by scientific gamesmanship and a lack of federal funding.

A bitter dispute between the National Cancer Institute and France's Pasteur Institute over who first identified the AIDS virus has been settled with an agreement to share credit, but there is a continuing feud between American and French researchers over vaccine testing.

The radical AIDS Coalition To Unleash Power, ACT-UP, stages regular demonstrations demanding quicker testing of drugs, as well as steps to make drugs cheaper and more widely available.

Last week, the National Institutes of Health announced a challenge to the exclusive patent for AZT claimed in 1988 by the drug manufacturer Burroughs Wellcome. AZT, which costs $3,000 a year per patient, is the only drug known to slow the breakdown of the immune system.

Some physicians' groups and AIDS activists complain that President Bush, much like President Reagan, has virtually ignored the epidemic.

As examples of Bush's insensitivity, they cite his 1992 budget recommendation for an increase of less than $100 million in AIDS research and treatment; and White House pressure that contributed to Sullivan's decision last week to delay dropping HIV infection as one of the criteria for barring new immigrants to the United States.

Conservatives scoff at the criticism and urge Bush to resist political pressures. If not for restrictions passed by Sen. Jesse Helms, R-N.C., they claim, gay leaders would use government money to promote immoral behavior.

"I only wish that the public health officials would . . . treat this as a public health issue and not a civil rights issue, the way we're treating it today," Rep. William Dannemeyer, R-Calif., said last week.

AIDS activists counter that lack of government support is evidence of prejudice that now extends beyond homosexuals to the drug users, blacks and Hispanics who make up the disease's "second wave."

Last summer, Congress authorized up to $881 million a year for AIDS care, including grants targeted to Miami, Fort Lauderdale and 14 other cities hardest hit by the epidemic -- then Congress put only $350 million in the 1991 budget.

Bush has recommended that same level of funding for next year, and many Democrats have expressed doubts about a substantial increase because of budget constraints.

The lack of money is "pathetic," said Stephen Bennett, from AIDS Project Los Angeles. "After 10 years of struggle, we look at our future and we get extremely worried because our numbers continue to expand and funding has stayed level.

"Meanwhile, people continue dying horrible, horrible deaths."

CAPTION: CHART AIDS: A deadly 10-year History

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