Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
San Francisco Chronicle (SF) - FRIDAY August 9, 1991
Sabin Russell, Chronicle Staff Writer
The national Centers for Disease Control has informed health departments throughout the nation that it plans to adopt a new definition of the disease on January 1 that could add 150,000 to 200,000 people nationwide to the ranks of those said to be living with AIDS.
Currently, for an AIDS diagnosis, a patient must be infected by the human immunodeficiency virus, which causes AIDS, and have a so-called opportunistic infection, which attacks patients with weakened immune systems. Under the new definition, a person infected with HIV whose measure of infection-fighting T-cells in the blood falls below 200 will be considered to have AIDS. A T-cell count of 1,000 is considered healthy.
In San Francisco, where there is a high concentration of people infected with HIV, the expanded definition is expected to have a greater effect than in the rest of the country. In addition to broadening the eligibility of those patients for costly social services, the change may have profound psychological consequences for thousands of people who are infected by the virus but have eluded the gut-wrenching diagnosis of AIDS.
"It is an incredible shock to have an AIDS diagnosis where you didn't have it the day before," said Chuck Frutchey, education director for the San Francisco AIDS Foundation.
Dr. Sandra Hernandez, director of the San Francisco AIDS office, said the new CDC definition will probably increase the number of San Franciscans with AIDS to between 7,500 and 8,500 from the current 3,250. An estimated 24,000 city residents are infected with HIV, according to the city health department.
Hernandez said she expects the major impact of the change will occur in mental health services such as suicide hotlines, crisis intervention and mental health counseling -- programs already facing budget cuts. She noted that the definition is to take effect during the Christmas holiday season, a time that is particularly hard for those infected by HIV to deal with their illness.
Hernandez said city officials are trying to determine how the change will affect eligibility for health services and for federal money used to pay for such services. "The CDC is handicapping us a bit," said Hernandez. "They have not released to anyone a plan for implementing the changes."
The greatest concern is whether federal entitlement programs such as Medicare and Medicaid will provide additional funds to pay for the services sought by newly eligible AIDS patients.
Health experts say the change in the federal definition is overdue. "It more accurately reflects the situation than the existing definition," said Dr. Mervyn Silverman, president of the American Foundation for AIDS Research. "The existing standard was designed for surveillence purposes, but it has been used as a standard for reimbursement, access to (AIDS drug) trials and access to care."
Women's groups have been campaigning for an expansion of the AIDS definition because the current one does not cover many of the infections endured by HIV- infected women. That has left many women without access to health services that are available to infected men.
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