San Francisco Chronicle - Thursday December 7, 1989
Randy Shilts

In sending its first report to President Bush eight months before it was due, the commission said the issues are "so compelling we felt it vital to write to you now" rather than wait.

In unusually strong language, the commission expressed "surprise and disappointment" at the lack of attention to the problem of HIV among drug addicts in the White House's war on drugs.

"The link between drug use and HIV infection must be acknowledged and addressed in any national drug strategy," the report by the 15-member commission said.

The commission called for expanded recovery programs for drug abusers, particularly those who are HIV-infected and therefore likely to further spread the infection.

"The availability of drug treatment on request is essential for responding to the combined HIV and drug epidemic that imperils not only drug users but also their sexual partners and children," the report said.

'ALARMING INCREASE'

The "alarming increase" of AIDS among drug users, most of whom live in the impoverished inner cities of the Northeast, has thrust tens of thousands into a "health care system singularly unresponsive to the needs of HIV-infected people," the report said.

"For the medically disenfranchised, there is no access to a system of care," the commission concluded.

Low Medicaid reimbursement rates have limited the numbers of physicians willing to treat the growing numbers of poor HIV-infected patients, the report said. Throughout the country, the commission found a lack of comprehensive care systems that link hospital, residential and home-health services into a cost-effective patient care system.

Recent breakthroughs in treating HIV-infected patients "mean little unless the health care system can incorporate them and make them accessible to people in need," the report said. "It is essential that everyone be afforded early intervention and access to care."

THE COMMISSION

The national commission was created last year to advise the White House and congressional leaders on federal AIDS policy. The panel's 12 voting members were appointed by Bush and the Democratic and Republican congressional leadership. The secretaries of defense, veterans affairs and health and human services serve as non-voting members.

"All 12 voting members signed off on this report," commission spokesman Tom Brandt said last night. "The (cabinet) secretaries voiced no objection to it, either."

The report called for the creation of regional treatment centers to coordinate care for HIV patients along the model of the regional hemophilia treatment centers. The centers would link out-patient care with in-patient wards and other social services.

The commission also said there needs to be a "frank recognition that a crisis situation exists in many cities that will require extraordinary measures to overcome."

'DANGEROUS COMPLACENCY'

The report warned that "there is a dangerous, perhaps even growing, complacency in our country toward an epidemic that many people want to believe is over. Far from over, the epidemic is reaching crisis proportions. . . . In fact, the 1990s will be much worse than the 1980s."

Representative Roy Rowland, D-Ga., a member of the commission and author of the bill that created it, said he is "pretty well satisfied" with the report. He added that the commission still has not "gotten to the really difficult work that we have to do" on such issues as AIDS testing and confidentiality. According to new figures from the federal Centers for Disease Control, 112,241 cases of AIDS have been reported in the United States, and 66,493 people have died from the disease.

Yesterday, the San Francisco Department of Public Health reported that 148 new AIDS cases were reported in November. Altogether, AIDS has been diagnosed in 7,562 San Franciscans since the epidemic was detected in June 1981, and 4,941 people have died.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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