Miami Herald (MH) - Thursday September 26, 1991
Paul Anderson and Elinor Burkett; Herald Staff Writers

WASHINGTON - Warning of "relentless, expanding tragedy in the decades ahead" unless America comes to grips with AIDS, a government panel demanded Wednesday that Congress and the White House devise a national plan -- the first in 10 years -- to fight the epidemic.

The National Commission on AIDS reported that 1 in 100 adult men in America is now positive for the AIDS virus. It said the disease has already killed more Americans than the Korean and Vietnam wars combined. But it declared the White House has "rarely broken its silence on the topic."

The commission, appointed by President Bush and Congress two years ago, demanded "Cabinet-level" leadership.

It called for a crash program to prevent AIDS transmission, dramatic changes in health care to ensure access to treatment, and hundreds of millions of extra dollars for care and prevention.

"The country has responded with indifference," the commission said. "It is as if the HIV crisis were a televised portrayal of someone else's troubles."

White House spokesman Marlin Fitzwater defended the administration's record.

"We believe that the government has been aggressive in responding to the AIDS crisis," Fitzwater said. "We certainly agree with the commission's report in terms of its seriousness and the fact that it is a major health problem that this nation has to deal with."

The report -- the most sweeping and sharply worded since the national commission was created by Congress -- comes as the epidemic is growing far worse. By the end of this year, more than 130,000 people will have died.

Eighty percent of all AIDS cases have occurred in six metropolitan areas, including Miami. Miami has surpassed New York, the original epicenter of the epidemic, in cases per capita. It is No. 2 in the country, behind San Francisco.

Florida reported 17,805 AIDS cases from the inception of the plague through the end of August, ranking behind two other states, New York and California.

By official government estimates, more than one million Americans carry the human immunodeficiency virus, the suspected cause of AIDS. More pessimistic outside experts put the figure at two million to three million, or 1 percent of the U.S. population.

The commission said only 12 percent those infected know they have the virus. Many remain sexually active, and the virus continues to spread. While most people who are HIV positive are not seriously ill now, experts believe they are progressing relentlessly toward AIDS.

The AIDS commission predicted the 1990s will be grimmer than the epidemic's first decade.

"If, from this day forward, there were never another instance of new infection, the upcoming decade would still certainly be much worse," the commission said.

The report was immediately endorsed by public health, patient advocacy and governmental groups.

"The federal government has been completely paralyzed in its ability to deal with this," said Boston Mayor Raymond Flynn, head of the U.S. Conference of Mayors. He insisted the need for action "is not a financial problem, it's a crisis of will, a crisis of commitment."

While the commission endorsed universal health coverage, an idea opposed by Health and Human Services Secretary Louis Sullivan, five of its 30 recommendations dealt with how to make medical care more accessible to HIV-infected people in the short term.

Commissioners said it's essential to expand Medicaid to individuals carrying the virus but not yet sick, ensuring them early access to life-prolonging treatments.

Expansion of Medicaid to 70,500 low-income people with HIV infection would cost about $345 million, or less than 1 percent of all Medicaid coverage.

Fitzwater said government spending for AIDS this budget year will exceed $4 billion. The White House said since the beginning of the epidemic, more than $17 billion has been spent on AIDS.

"Enormous resources are being put into it," Fitzwater said. "We will take this report and try to improve the system as best we can."

For five years, in increasingly urgent tones, expert panels have asked the country to respond more aggressively to AIDS. Many critics contend the recommendations have gone unheeded.

* Surgeon General C. Everett Koop's report on AIDS, October 1986: "AIDS is a life-threatening disease and a major public health issue. Its impact on our society is and will continue to be devastating."

* The Institute of Medicine of the National Academy of Sciences, October 1986: "If the spread of the virus is not checked, the present epidemic could become a catastrophe."

* Presidential Commission on AIDS, June 1988: Blamed discrimination on "fear, based on ignorance or misinformation about the transmission of the virus. We cannot afford to let such ignorance and misinformation persist."

* The Institute of Medicine, in a 1988 update: "The nation has suffered from the absence of strong federal leadership."

* National Commission on AIDS, April 1990: "All across the country, there is a cry for leadership from the federal government and partnership between different levels of government. To date, there is no national policy or plan."

* National Commission on AIDS, September 1991: "The United States, which has more people with AIDS than any country in the world, is one of the few developed nations with no national plan, even as the epidemic moves unabated into its second decade."

CAPTION: PHOTO June Osborne (AIDS)
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