AIDS providers compete for shrinking funds as death rate drops

Tom Boland (wgcp@earthlink.net)
Sun, 16 May 1999 14:01:43 -0700 (PDT)


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http://www.sfgate.com/cgi-bin/article.cgi?f=/news/archive/1999/05/14/state1859ED
T0078.DTL&type=printable
FWD  Associated Press - May 14, 1999

  AS AIDS EPIDEMIC EVOLVES, SERVICE GROUPS STRUGGLE TO POSITION THEMSELVES

  JORDAN LITE, Associated Press Writer

SAN FRANCISCO (AP) -- Predictability can offer a certain comfort, even if
this is what you know: You will die young, of AIDS.

Long-term survivor Chip Supanich knows. When he learned he was HIV-positive
in 1985, the San Franciscan took his doctor's gloomy prediction to heart.
He began partying, partying, partying -- and developing a methamphetamine
habit. Three years ago, that left him homeless, 45 pounds thinner and
desperate for AIDS medications.

Now 38, Supanich says: ``I have faith that my life is not near its end.''
Yet, even as protease inhibitor drugs coax his weight back to normal, he
concedes: ``I can be certain of nothing.''

AIDS service organizations find themselves in this same dilemma,
simultaneously in transition and in limbo.

Once, these organizations focused on helping patients get their affairs in
order and keeping them comfortable as they died.

``We had a horrible certainty, and now we have a mixed-bag certainty,''
says Craig E. Thompson, executive director of AIDS Project Los Angeles, who
is HIV-positive.

Now, with more patients like Supanich living longer, just how
``exceptional'' a disease is AIDS? And what happens to the funds and
supporters -- the voluminous network of help that became a phenomenon in
itself?

They have to shift strategy, many say.

``Maybe in the long term we can't maintain that sense of crisis. Maybe it's
finding a way to manage AIDS as a decades-long health problem,'' says Tom
Metzger, spokesman for the National AIDS Fund, a nonprofit in Washington,
D.C.

Though the AIDS death rate took a nosedive beginning in 1996 and brought
public donations down with it, the Centers for Disease Control in Atlanta
reports that the number of new HIV infections has remained steady over this
decade -- some 40,000 new cases annually.

Nationwide, an estimated 15,000 groups serve patients with HIV. While some
focus narrowly on such issues as mental health counseling, others are
functioning more and more broadly -- much like welfare organizations with
clients who require housing, insurance and help with drug abuse.

``HIV is a problem in their life, but it's not the biggest,'' says Pam
Coleman, a caseworker at AIDS Project Los Angeles who has been there for 10
years.

For example, the San Francisco AIDS Foundation not only helped Supanich
decipher state insurance coverage, it also got him into subsidized housing
-- a more stable environment that proved crucial for his daily regimen of
15 medications.

To adapt to this expanding and needy population, nearly every organization
has been forced to shift money -- and priorities.

The San Francisco AIDS Foundation last year expanded its housing program
when the city gave it nearly $1.5 million more in housing grants than in
1997. At the same time, it was forced to transfer a third of its
Spanish-speaking clients and about 200 HIV-positive women out of special
case management programs when the city gave $244,671 in grants to other
agencies.

The National AIDS Fund, which has given more than $70 million to community
AIDS groups over the past decade, eliminated matching funds in five cities
last year as a handful of smaller organizations folded into others or died
altogether.

Some resent the suggestion that AIDS groups should consolidate, as is
happening in Los Angeles, or rely on umbrella social service agencies.

``I guess if you agree that the system of care and services that was built
around HIV was a remarkable thing, rather than ask, 'Why not treat AIDS
like other diseases, why not treat other diseases the way we treat HIV
disease?' '' asks Daniel Zingale, executive director of Washington,
D.C-based AIDS Action.

But others say such extensive networks can waste money. While it makes
sense for gigantic Los Angeles County to have some 100 AIDS agencies for
patients to choose from, smaller communities don't need so many options,
Thompson said.

``We don't need all those executive directors, all those people running
agencies,'' he says. ``We're keeping agencies going potentially for the
wrong reasons. People need to put their egos aside and their jobs aside and
look at what's best for patients.''

Even the big groups are struggling. Gay Men's Health Crisis -- the nation's
largest nonprofit AIDS organization -- may be hardest hit. In the past 1
1/2 years, the center slashed its staff of 300 by 25 percent and its budget
of $27 million by almost 20 percent. GMHC's caseload also has declined,
from 7,800 in New York City in 1997 to 7,500 now.

Meanwhile, many other organizations are tapping into the AIDS activists'
tradition of creative fund raising.

``Lots of other organizations have adopted the same tools very
effectively,'' says Gustavo Suarez, a spokesman for the San Francisco AIDS
Foundation. ``You've got lots of walks and lots of rides, not just for
AIDS.''

That's left veteran social workers frazzled. AIDS Project Los Angeles has
swelled from a predominantly gay caseload of 4,200 men to 8,000 diverse
clients. The 800 neediest get more intensive help -- leaving each case
manager to supervise as many as 65 people simultaneously. These days, one
has to be sicker, with more problems, to make the cut.

``It used to be when you worked with the clients you were able to take a
couple minutes to talk to them and comfort them and give them extra
attention about other things,'' Ms. Coleman says. ``You still attempt to do
that, but there's someone else behind them so there's not a lot of time.''

For Kevin Bradley, another patient who relies on the San Francisco AIDS
Foundation, the personal touches Ms. Coleman strives for are part of what
keeps him coming back to a place he believes is essential to his survival.

``Without some place like this, where does one go?'' Bradley asked. ``I
don't think it's over. I don't think we can ease up. I'm not completely
confident that what's happening now is going to last.''

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