Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
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The San Francisco Examiner; January 28, 1998
Lisa M. Krieger, Examiner Medical Writer
AIDS patients are relying less on hospitals and hospices but more on already overcrowded programs that provide food, shelter, clothing, drug treatment, mental health counseling and jobs.
While AIDS deaths have plummeted, the number of people living with the disease is higher than ever, according to statistics presented at the Mayor's Summit on AIDS and HIV, held Tuesday at Masonic Auditorium.
The City must strengthen its net of social services to care for this large - and needy - new patient population, AIDS experts said. "There is a convergence of the AIDS epidemic with poverty," said Dr. Mitch Katz, the newly appointed director of The City's Department of Health. "The epidemic is not over. . . . We need more services, not fewer services."
"There is a lot more needed'
Mayor Brown said at the conference: "Along with the opportunities presented by these promising medical treatments, many new challenges confront us as a city. I don't think you can quantify how much is actually needed. . . . We do know there is a lot more needed - and we are, in fact, trying to meet that challenge.
"We'll find a way," Brown added.
The life-prolonging combination drug therapies - often requiring up to 30 pills a day - involve strict schedules and detailed directions regarding timing of doses, fat content of meals and fluid intake.
"Without debate, these are the most complex regimens in medical history that have ever been prescribed for continuous and indefinite treatment of a large patient population," said Margaret Chesney of the UC-San Francisco Center for AIDS Prevention Studies.
Adherence to treatment is a major concern of AIDS doctors. Two new studies presented at the summit found that at least 10 percent of patients missed a dose a day; at least 20 percent of patients miss a dose every two days, Chesney reported.
An enormous challenge
To be sure, many HIV patients successfully manage their lives. But for many others, living with HIV is another enormous challenge in an already stressed existence, experts at the conference said.
Some suffer from mental illness, substance abuse or alcoholism. Others are warehoused in tenement hotels, often without facilities for cooking or even grooming.
In San Francisco, 8.5 percent of the homeless and "marginally housed" population is infected with HIV. This represents an estimated 1,000 people.
The epidemic is increasingly affecting a more disenfranchised population: women, people of color and young gay men. These groups are less likely to have private health insurance and be more dependent on public services.
New data released at the conference confirmed a recent change in the epidemic's demographics. Whites represent 75.4 percent of all AIDS cases since the beginning of the epidemic, but in 1996 they accounted for only 62.7 percent of reported cases.
Men represent 97 percent of cumulative AIDS cases but only 91 percent of AIDS cases in the past year. A larger proportion of 1996 cases were intravenous drug users, and a smaller proportion were gay and bisexual men.
Many without access to treatment
It is estimated that 9 percent of homeless people are infected with HIV and that almost 30 percent of homeless HIV-infected people are without access to either new drug therapy or the medical care necessary to begin treatment.
For instance, the city's waiting list for homes for people with HIV is currently 3,000 names long.
AIDS experts testifying at the conference called for greater funding for services that treat substance abuse, mental illness, homelessness and unemployment.
They also recommended money-management programs, flexible appointment scheduling at health clinics and convenient clinic locations.
Mark Dunlop, commissioner with the San Francisco Redevelopment Agency, said: "New strategies are needed for dealing with a growing population of people who are healthier but perhaps not ready for full employment, people who in order to survive need to be able to focus more on health issues than shelter or food."
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