San Francisco Chronicle (SF) - The Voice of the West, 901 Mission Street, San Francisco, CA 94119; - THURSDAY January 11, 1990 Edition: FINAL Section: NEWS Page: A1 Word Count: 1,038
Elaine Herscher, Randy Shilts, Chronicle Science Writers

The task force's detailed, 24-page report -- due to be released today -- advances the most comprehensive plan of any city to date in dealing with the AIDS epidemic. It calls for an aggressive program drawing on resources from both the public and private sector to finance its goals.

The task force report, which was obtained by The Chronicle, recommends that city-financed counselors be assigned to the estimated 30,000 San Franciscans who are infected with the AIDS virus. It also recommends that the city make sure that every infected person receives proper medical care and behavioral counseling.

To stem the tide of the epidemic among drug addicts, the plan also would set up a city-run "demonstration project" to distribute clean needles to intravenous drug users and make enrollment in drug recovery programs available whenever a drug abuser seeks it.

So-called needle-exchange programs are illegal in California, although San Francisco has the largest in the nation, run clandestinely by volunteers.

"I don't know of any city in the country that's put together this kind of detailed plan about where to go," said Dr. Donald Francis, the task force leader and an AIDS researcher with the federal Centers for Disease Control in Atlanta.

"No other city has begun to think about early intervention for infected people, that's for sure," said Francis. "This is our chance to get ahead of the epidemic, rather than just wait for the crisis to come."

PANEL'S MISSION

The 21-member task force was appointed by Mayor Art Agnos when he took office in January 1988. It includes religious leaders, AIDS community organizers and corporate executives whose firms have lost scores of employees to the epidemic.

The group's charge from the mayor was first to report on what is needed and then to take on the task of how to attain the goals, including finding the money to pay for them.

The gap between available and necessary money will not be easily filled. The panel estimated that existing resources range between $157 million and $172 million and that up to $152 million more is needed in the fiscal year beginning July 1 in three broad categories: prevention, early intervention and continuing care. For instance, $28 million to $93 million more is needed to pay for early intervention to extend the health of people who are in the early stages of AIDS but who have not yet exhibited full-blown symptoms.

Although the bulk of that money would come from private insurers rather than government, the city would still have to raise millions of dollars to implement the recommendations.

'NOT IMPOSSIBLE'

"It's not something that's impossible. We're a wealthy country. It's a small amount of money for the state of California or for the federal government," Francis said.

"If you have a new epidemic, you find new money to pay for it. If you don't, you will crush the system."

Among its 53 specific recommendations, the task force also calls for:

-- Vastly expanding confidential AIDS testing for all people at high risk for infection by the AIDS virus, particularly at sexually transmitted disease clinics, prenatal programs and drug treatment centers.

-- Creating a central coordinating system for people who want to volunteer their services to fight the epidemic.

-- Establishing more residential care facilities for infected people and innovative recruiting programs to hire and train home health aides to allow ill people to remain at home.

-- Using private sector administrators to help train the leaders of the community-based organizations in management skills.

The report is designed to be the city's blueprint for its AIDS policy. There will be a joint hearing for all city departments involved on how to implement the plan.

'MOST CRUCIAL PART'

Francis called the proposal for early treatment and counseling of people with the human immunodeficiency virus, known as HIV -- before they come down with one of the life-threatening diseases that mark an AIDS diagnosis

-- "the most crucial part" of the task force report.

"Without early intervention, it's not going to work," said Francis. "With the chaos in the life of a drug user, for example, you can't keep them from infecting other people and making sure they get to the doctor without some kind of counselor. They'll fall through the cracks."

Task force member Jim Foster, a San Francisco health commissioner, agreed that early intervention is the most significant component of the document.

"As someone who's HIV-positive, that early intervention material is extremely important to me," Foster said. "We are moving into a new era with this epidemic where people are living longer. We are going to assure the people of San Francisco who are HIV-positive that we'll do everything possible to keep them living longer and productively."

MEDICAL INSURANCE

To make sure private insurers will pay for the medical treatment, Francis said, the city will seek assurances from the insurers of all city employees that they will pay for early AIDS treatments.

Frank Alvarez, a top administrator from the city's major insurer, Kaiser-Permanente, sits on the task force and has already endorsed the recommendation, Francis said.

The task force also suggested that the city tap volunteers. "I have a whole organization of people who want to get involved," said task force member Kathleen Fisher, who is managing partner at the law office of Morrison & Foerster, with 1,000 employees.

"Every time I try to raise money for AIDS or start an education program, I can't include all the people who want to get involved," Fisher said.

Fisher and others said they also expect to help increase the number of hospital beds for AIDS patients by lobbying for higher hospital reimbursement rates from the federal government and private insurers, which pay as little as $35 a day.

Several of the task force members will help present the report today, but the absence of one of their colleagues will serve as a reminder of the epidemic. Jon Cole, the only person with AIDS to serve on the task force, is too ill to attend, Francis said.

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