PRESIDENTIAL COMMISSION ON THE
HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC
HEARING ON THE WESTERN STATES RESPONSE

The Hearing was held at the
San Francisco Department of Public Health
101 Grove Street, Room 300
San Francisco, California

Friday, March 25, 1988

COMMISSION MEMBERS PRESENT:
ADMIRAL JAMES D. WATKINS (Ret.), CHAIRMAN
KRISTINE M. GEBBIE, R.N., M.N.
FRANK LILLY, PH.D.
BENY J. PRIMM, M.D.
CORY SERVAAS, M.D.
WILLIAM B. WALSH, M.D.
POLLY L. GAULT, EXECUTIVE DIRECTOR
COMMISSION MEMBERS NOT ATTENDING:
COLLEEN CONWAY-WELCH, PH.D.
JOHN J. CREEDON
RICHARD M. DEVOS

PENNY PULLEN

 

 
 

 

I-N-D-E-X

WELCOME
Admiral Watkins, Chairman

PANEL FOUR

CALIFORNIA AIDS-RELATED HEALTH POLICYMAKERS
David Werdegar, M.D., M.P.H., Director
of Health, City and County of San Francisco
Philip Lee, M.D., Director, Institute for Health
Policy Studies, University of California, San
Francisco; PResident, Public Health Commission,
city and County of San Francisco

Honorable Dianne Feinstein, Former Mayor of
San Francisco

Honorable Ann Rudin, Mayor of Sacramento
Honorable Maureen O'Connor, Mayor of San Diego

Honorable Art Agnos, Mayor of San Francisco

APPENDIX - SUBMITTED TESTIMONY

PAGE

131

132

137

140

150
160

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PROCEEDINGS

MS. GAULT: Good morning, ladies and gentlemen,
distinguished guests, members of the Presidential Commission. My
name is Polly Gault. I am the designated federal official here,
and in that capacity it is my privilege to declare this meeting
open. Mr. Chairman.

CHAIRMAN WATKINS: Good morning. Today the
Presidential Commission on the HIV Epidemic begins its second and
final day of formal hearings in the city of San Francisco.
Yesterday, the Commission heard diverse and impassioned testimony
from several of San Francisco’s minority communities regarding
their struggle to confront the epidemic within their populations.
We also heard witnesses from community-based organizations from
five western states with different population and funding bases,
each with a unique message that helps the Commission understand
local response in many different areas. These are organizations
on the front lines of this epidemic, fighting it within different
cultures and in many community settings on a day-to-day basis.

In the afternoon, representatives from several leading
corporations and business organizations that have developed sound
AIDS-related corporate policies encompassing employee education,
employment practice and support of community-based organizations,
all presented their testimony. That so many of the corporations
demonstrating early leadership in the Bay Area is something for
which San Francisco can be justifiably proud. Following
yesterday’s formal testimony, the Commission made site visit to
the Shanti Project where we saw a success story in action. This
visit was also helpful to the Commission as it allowed us to see
individuals with many talents for many backgrounds working
together to provide compassion and support for those in need.

Our brainstorming session there led to several
recommendations that will assist the Commission as it continues
to prepare a recommended national strategy to the President to
deal with this epidemic. Site visits such as these are extremely
valuable to the Commission, and this afternoon we are looking
forward to visiting the San Francisco AIDS Foundation, San
Francisco General Hospital, and Bayview Hunter’s Point
Foundation, all highly esteemed for their role in shaping a
positive response to the epidemic.

Today, we are fortunate to have testimony from several
individuals who have been responsible for developing AIDS-related
health policy, and putting it to work in our cities. We asked to
have this testimony presented to us here today because no city
is more closely associated with an active municipal response to
the epidemic than this one. The Commission is honored that
Mayors from so many major California cities were able to bend
their schedules to be with us today. We are particularly pleased

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to have the former and current mayors of San Francisco, the Mayor
of San Diego, and the Mayor of the state’s capital, Sacramento.

So as we begin this final day in what has been a most
interesting and successful visit for us, the Commission expresses
its gratitude to the city of San Francisco and its people for
their effective and aggressive response to the epidemic. All of
us have studied and learned a great deal from the San Francisco
model but the San Francisco model is really San Francisco people,
and we salute all of you for your efforts.

For our first panel this morning, we have Dr. David
Werdegar, Director of Health, City and County of San Francisco
and Dr. Philip Lee, Director, Institute for Health Policy
Studies, University of California, San Francisco. He is also
President of the Public Health Commission, City and County of San
Francisco. We have a little different sequence this morning in
testimony from witnesses and I would like to try to adhere as
closely to the time constraints as possible so that we can
adjourn on schedule and proceed with our site visits. I do want
to give deference to the time constraints placed on the Mayors
that will be coming, so let those of us on the Commission try to
restrict our questions accordingly. If necessary, we can
correspond in writing with some of the witnesses. With that, we
will start with opening remarks from Dr. Werdegar.

DR. WERDEGAR: Admiral Watkins, members of the
Commission, thank you for your kind remarks about our community.

Those of us battling the AIDS epidemic in our local
communities have been urging a cogent national response for too
long it seems, to no avail. This dangerous epidemic requires a
national response, guided by an organized plan of action, funded
as we would a national emergency and benefited by the continuous
oversight of a wise and representative Presidential Commission.

We have been greatly encouraged by the Preliminary
Report of the Presidential Commission issued last December, and
its interim report of February 24. We appreciate the earnest,
open hearing process, and the sense of urgent national purpose
conveyed by the Commission. We note particularly the attention
in your February report to health care system issues, the need of
accelerated research and clinical trials, and the call for
substantial federal support for substance abuse intervention.

The theme of your two-day hearings here in San
Francisco is, I believe, community response to the epidemic. In
San Francisco, we have sought to develop an organized community
response that involved public, private and volunteer sectors:
health workers and health institutions, community based
organizations, advocacy groups, schools, churches, labor and
industry. We took the view that the epidemic involved all

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segments of our population, gay and straight, minority and
majority, friends, neighbors, families, lovers, AIDS affected us
all and we would fight it on a united front. That was the theme
of our community response.

The AIDS problem extends to our neighboring counties,
and regional planning is therefore necessary. Our Health
Departments are indeed engaged together in regional planning.
Our community efforts have been remarkably helped by an informed
media and enlightened political leaders. The Health Department,
this building here and all of its parts, has been the focal
point, the center of gravity for convening, planning,
coordinating, and monitoring the city’s AIDS program. It has
worked closely with community hospitals and community-based
organizations, and practitioners in the community, in all of our
education prevention efforts as well as in the provision of
health services. I would say an unrelenting community-based
educational program has been the hallmark of the San Francisco
progran.

The Health Department itself is a major provider of
services to those most in need. We have coordinated AIDS efforts
in neighborhood health centers, maternal-child health care
programs, substance abuse programs, mental health programs, jail
health services which we provide, and services in the youth
guidance center and many other health programs. The Health
Department’s acute care facility, the San Francisco General
Hospital, has, of course, been a major center for AIDS care,
teaching and research. We have never accomplished all that we
could have or should have, or wished we had.

Nevertheless, we have been constantly motivated by our
tragedy to develop a model program, an ideal program that would
not only benefit our own community, but by way of example and
through shared experience, other communities as well. This
community resolve has been the foundation for the intensity and
generosity and creativity which has characterized the San
Francisco response. I say this to the Commission out of the
personal conviction that the best of programs and plans will not
reach fruition unless we can reach into the collective psyche of
the nation to summon for, similarly, a national will and resolve.
A call for collective dedication was a phrase in your preliminary
report that caught my eye.

Only 10 days ago, the Health Department of San

Francisco submitted to its seven member Health Commission a
detailed report on the current status of AIDS in our community
with estimates of needs over the next five years, and I have left
this approximately 200 page document on your desk. In estimated
needs through 1993, authoritative epidemiological studies portray
the epidemic and provide carefully considered projections for the
next five years. I submit this document for whatever help it may

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be in your own endeavors. I believe it is a document that could
well be emulated by other agencies.

No city in the United States has suffered the AIDS
epidemic so severely as San Francisco, where 10 percent of the
nation’s epidemic has been centered. The number of cases since
the epidemic began seven years ago now approaches 5,000; the
number of deaths close to 3,000. The number of cases in racial
and ethnic minority groups, now 16 percent of the total, is
climbing more rapidly than in the white population.

We believe the epidemic will peak in the mid-1990’s,
and then mercifully decline. The intervening years will be
enormously difficult. We foresee by 1993, barring major medical
breakthroughs, a three to fourfold increase in the number of
cases. By 1993, we shall have 6,000 with AIDS under care in San
Francisco, as compared to 1,700 at present. While we plan
diligently so as to be prepared, it must be stated that our
health service system is under severe strain now, and without
substantial federal assistance, it will be overwhelmed in the
years soon ahead.

One interesting analysis in the report depicts spending
on AIDS in our community from all sources. It is now running at
a rate close to $100 million annually, and it is projected to
rise to $400 million by 1993. These figures exclude all
volunteer services and social support, disability insurance and
the like. AIDS is now the third leading cause of death in San
Francisco, after heart disease and cancer, far and away the
leading cause of death in terms of years of life lost.

I would like to mention some bright spots in a bleak
picture. In reviewing this AIDS report, one of our Commissioners
asked, are there any bright spots in it all? Let me suggest a
few. Startling as it might seem, the AIDS epidemic in San
Francisco has largely been arrested, which is to say, and without
suggesting any sense of complacency or ignoring population groups
where it is not altogether the case, the rate of new HIV
infections has been remarkably lowered, both in the gay community
and in the IV substance abusing community. We ascribe this
success to a vigorous educational program, ready availability of
anonymous and confidential testing, prohibition of mandatory
testing, and policies locally at least to prevent discrimination
against persons who are HIV positive.

A second bright spot is the lengthening duration of
life of persons with AIDS. A third is that we have demonstrated
that the cost of AIDS care can be contained by sparing the use of
the acute hospital, and developing an extensive network of
out-of-hospital services. Fourth, organizational structures are
developing in racial and ethnic minority communities as they have
in the gay community, effective in education, prevention and

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support services. They greatly need funding support. The Health
Department has teamed up with the school system for education of
our youth. We have a conceptual framework, we believe, an
organized plan, a network of services, and a community resolve to
bring us through the difficult years ahead. We will need help.

There are significant gaps in our continuum of
services, largely owing to problems of resources, and I will
mention just a few that seem to me most important. One that
looms large to me because of its expense is the very serious
impending shortage in funding for various aspects of the longer-
term care of persons with AIDS. That is not just funding, but
personnel and facilities. We need appropriate skilled nursing
care facilities, psychiatric facilities, day care programs. We
have a growing population of persons with AIDS who are severely
debilitated, cannot be cared for at home, and need help with all
activities of daily living. The problems of AIDS dementia and
AIDS psychoses, our clinicians tell us, is growing, and we need
the facilities in which to provide the care. We also need
facilities or supervised residential care facilities for those
who have concurrent substance abuse problems.

We have virtually no skilled nursing care beds.
Period. We have a growing problem of homeless persons with AIDS,
often individuals who have substance abuse or behavioral
problems. Many of the supportive services such as those of
Shanti, which you saw, have generously been provided by
volunteers. The residential part of Shanti is subsidized by the
Health Department, but meals at home, transportation, help with
activities of daily living, psychosocial support, are all
provided by volunteers. We are reaching the point where these
supports cannot be maintained through volunteer efforts alone.

I believe Dr. Lee will discuss some of the aspects of
federal health services, financing, and how they affect us in the
AIDS epidemic. We have prospective of obtaining a Public Health
Service Hospital which is now vacant in the city for use as a
skilled nursing care, day care, ambulatory care facility. It
would be a Godsend to us, and we are hoping the Congress will
provide us that facility and the necessary federal subsidy to
operate it.

Another gap is the care for asymptomatic individuals
who are HIV positive of which we have some 30,000 in our
community. Many of these now recognize that medical supervision
has something to offer, and there will be a surge in the demand
for care. We need, in the substance abuse field, massive
assistance at all levels: education, especially in schools in
minority communities; early family oriented intervention;
outreach services; methadone treatment slots; demonstration
programs; research. It is the most poorly funded program of all.

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I will skip ahead in my written testimony and move to
some brief recommendations. I offer these knowing that some of
these have been said before, and some have actually been
incorporated in your reports. I think most important for the
nation is a comprehensive plan, implemented with executive
leadership, and benefited by the continuous oversight of a
Commission like your own with scientific advisory panels. Of
course, the plan and the Commission will be of no help unless it
is backed by resources that are commensurate with the magnitude
of the epidemic. We would greatly benefit by federal block
grants directly to cities that are severely impacted by the
epidemic, that would come to the Department, that could be used
flexibly for education, prevention, surveillance, treatment. We
subsidize many aspects of education and treatment by our
Department, usually with city dollars which have been the most
flexible. The city dollars are no longer there.

I mentioned the problem of long term care services, and
the need for governmental help with regard to this issue. I
believe we need greatly accelerated clinical trials. When you
look at our projections to 1993 you can see that the clock is
ticking. The current national cooperative drug trial system is
cumbersome, and unduly long. It just will not produce the
results fast enough, and there are other approaches. We could do
community based trials in high prevalence areas. We would be
perfectly happy to do it here in San Francisco under Health
Department auspices. We could get clinical trials in a large
scale with controls going tomorrow. The current clinical trials,
I am afraid, are just leaden-footed.

I would like to see commitment to continuous support of
anonymous and confidential testing. These have been a very
important part of our educational progran. They have clinical
value as well. We have the sense that support is apt to be
waning just at the time when we are expanding the use throughout
the community.

Lastly, we need legislation to prevent discrimination.
I am sure you have heard this before, but the importance of
discrimination laws at the national level, strong ones, to
prevent discrimination in jobs, housing, health insurance. This
legislation is important from a public health point of view
because that will allow people to come, seek care, be tested,
receive counselling. It is all part of our work in public
health.

I have just a final observation before I run over my
time. The preliminary report of the Commission describes
creating a national climate, and I quote from you, "setting aside
prejudice and fear in favor of compassion and a sense of
community responsibility." If the reports of the Presidential
Commission can help create such a national climate, we will all

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have reason to be grateful. The next several years, all our
projections indicate, will be exceedingly difficult and will
require our best effort. I believe the AIDS epidemic, for all
its tragedy, has things to teach us about the bonds that bring
our diverse community together as in about education of our
children, about our health care system, the many research aspects
that will benefit, all of these may one day allow us to view the
epidemic in some ways as having repaid our society for the many
precious lives lost. Thank you.

CHAIRMAN WATKINS: Thank you very much, Dr. Werdegar.
Dr. Lee?

DR. LEE: Thank you, Mr. Chairman. I am delighted to
join with Dr. Werdegar in welcoming the Commission. I do have a
fairly detailed statement which I am submitting to you that I
will not recite in detail.

I do, at the outset, want to commend those who have
gone before us here, and particularly note former Mayor
Feinstein; members of the Board of Supervisors, who provided the
political leadership; and Dr. Mervyn Silverman who was the
Director of Public Health in San Francisco from 1978 to 1985 when
the San Francisco model took shape and, who provided very strong
and effective leadership. The media has been critically
important in San Francisco, underappreciated. The business
community, the community organizations, and especially the gay
community in San Francisco, and whose participation in research
has helped us identify risk factors, modes of transmission,
behavior change needed to prevent the spread of infection, and
what a community must do to sustain that behavior change. More
importantly, they have taught us a lesson we must never forget,
and that is how to care for one another. For that lesson, we all
owe a great debt of gratitude to the gay community, particularly
in San Francisco, but also in other communities.

I want to briefly summarize my statement, Mr. Chairman.
First of all, the AIDS epidemic is occurring at a time of a
growing crisis in health care financing and in the health care
delivery system. We have a growing number of uninsured. At the
same time, we have an increasing number of health insurance
companies that are shifting from providing health insurance to
other activities. We are in very serious condition in terms of
health care financing. We also have a second epidemic that may,
in fact, be worse than the AIDS epidemic, and that is the cocaine
and drug abuse epidemic. You have touched upon that in your
previous report, but I think you cannot underestimate the
intersection of those two epidemics for the future because I
believe, as Dr. Werdegar does, that in the gay and bisexual
community, we have largely controlled or developed a means to
control the epidemic, but we have not done that with respect to
the IV drug user community.

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Second, AIDS health care costs are not disproportionate
to other high cost illnesses, and this is documented in
background materials in my testimony. We have estimated in
studies we have done here in San Francisco that the lifetime cost
of care for an AIDS patient is about $45,000. Some others have
estimated costs slightly higher than that. If you project costs
to 1991, as has been done by Anne Scitovsky and Dorothy Rice who
work with us at U.C. San Francisco, it is estimated that between
$8 billion and $16 billion will be expended nationally in 1991--
about one to two percent of our total health care spending. That
could easily be handled if we bear it nationally and bear it
equitably. If it has to be borne by the communities, that burden
is intolerable as shown by the evidence in the report that Dr.
Werdegar and the Department of Public Health presented to the
San Francisco Health Commission--$90 million this year, $350
million by 1993. We cannot afford, in San Francisco, to increase
the local tax monies that have been the glue holding the whole
thing together so far. That glue is being spread very, very thin
today, and we cannot sustain the effort without more adequate
state support, private sector support, and federal support.

You have addressed two, I would say, the two most
critical issues in your previous report, and I hope you will
develop those recommendations more fully, one, with respect to IV
drug abuse, and the other, that Dr. Werdegar has mentioned, the
long term care services, including social services, housing,
practical support, and other services that nobody pays for, with
the result that the individuals are paying out of pocket.
Donations are supporting those services, or local tax dollars in
San Francisco are supporting those services, but that cannot be
sustained without a much broader base of support, and without a
national policy.

Third, in addition to the financing issues, there are
critical issues in housing, and again you identified these in
your last report. We have a number of homeless in San Francisco,
who are sick with AIDS, and that is true in every other major
city where the AIDS epidemic has been particularly explosive.
This is an area of social services, practical supports, again,
those things that are not supported by traditional private health
insurance dollars or Medicaid dollars, where funds are short.

And then of course, there is the funding needed for research, for
education, the various other activities that are funded at the
federal and state leveis.

However, it is not enough to just provide money. There
needs to be a national plan. I think this Commission is moving
towards that and developing the framework for a national plan.
There is not a single state that has developed a state plan.
California does not have a state plan for AIDS. Most of the
counties in California are moving towards developing plans, and

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San Francisco is the first county to develop a comprehensive and
detailed plan. We need adequate resources for planning. We also
need adequate resources for the administration of grant funds.
We are finding prolonged delays in the administration of federal
funds and state funds because the staffing has not kept up with
the funding, either at the federal level or at the state level.
There are delays of months in implementing contracts and in
working through the signing of those contracts, and the problem
is compounded when there is an attempt to limit personnel. I
know, Admiral, you are very familiar with this kind of problen.
At the federal level, at the state level, it is seriously
impairing the capacity of country to respond to the epidemic.

Finally, this is not just a public sector
responsibility. We have to have a public-private partnership at
every level. You heard from the business community and the
community organizations yesterday. We have, I think, moved very
well to develop that kind of partnership in San Francisco, but we
need to strengthen it here, we need to strengthen it at the state
level, and certainly we need to strengthen it at the federal
level.

There needs to be cooperative planning around
financing. What is the role of private health insurance?
Increasingly, the burden of financing care for persons with AIDS
is moving from private health insurance to Medicaid. In
California, we have seen that go up from 10 percent in 1984-85,
to 20 percent in 1986-87, to 30 percent today. An increasing
burden is being placed on the local taxpayers, not only in San
Francisco, but in Atlanta, in New Orleans, in Dallas, in
communities around the country where the local public hospitals
are picking up the tab. That cannot continue. We cannot say
that this is a local problem. Private insurance has to play a
very substantial role, and it is going to take cooperative
planning at the highest levels to achieve that. Thank you very
much.

CHAIRMAN WATKINS: Thank you very much, Dr. Lee. We
thank both you and Dr. Werdegar for appearing before us this
morning. We are going to be following a different protocol this
morning. We normally would like to spend a lot of time chatting
with you, but it is impossible with this schedule. We have to
keep moving right along. On the other hand, Dr. Werdegar and Dr.
Lee, both of you, we would like to keep this door open and
dialogue between us and we will find your submitted documents, I
think, very valuable, particularly if we go into our cost
analysis and financial section which is going to be an important
part of our report. We are chartered to keep a close eye on
that, and I think you have given us some opportunities to
demonstrate cost effectiveness in care that not only is
beneficial for those afflicted with the epidemic, but also for
all health care delivery for the future of the nation. I think

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your broadened view is one that the Commission shares is an
opportunity, a unique opportunity we have to take advantage of,
not only addressing in a compassionate way the care and handling
of the epidemic, but also, importantly, we are exposing
significant flaws in the health care delivery system as you
mentioned, and it is very clear to us as we watch it, and as we
evolve in our deliberations.

So thank you for appearing before us. Thank you for
your written testimony and your oral testimony, and we will be
communicating with you. I know that the Commissioners will have
questions, and if you will be willing to respond to those in
writing, you can be assured that they will get close attention in
our final report. Thanks very much for coming today.

DR. LEE: Thank you, and we would be delighted to work
with your staff and with the Commission. Thank you very, very
much.

CHAIRMAN WATKINS: Our next witness coming before the
Commission today is the Honorable Dianne Feinstein, former Mayor
of San Francisco. Mayor Feinstein and I got to know each other
Many years ago as we brought the fleet back to San Francisco
together. The only disagreement we ever had was that Dianne
wanted to paint the fleet white and I asked her to give me the
paint and she would not do it. She said that the budget would
not permit it in San Francisco. So at any rate, we are honored
to have you with us, Mayor. You have a reputation among all of
your people here as being a courageous, involved and sensitive
leader in dealing with this epidemic. You were here at a tough
time, and we were particularly pleased that you would be willing
to take time off of vacation to come and chat with the Commission
this morning so let us have your statement.

MAYOR FEINSTEIN: Thank you very much, Mr. Chairman and
members of the Commission. The first point that I would like to
make is that your interim report is truly a giant step forward.
The 60 pages, the 180 recommendations, I think are thoughtful,
considered, very acceptable, and necessary. If I were to look
back at what the past has typified since San Francisco’s
beginning with AIDS in 1981 when the first 50 or 60 cases were
discovered and San Francisco expended its first $184,000 until
today, we have expended cumulatively more than $50 million and
are expending about $20 million this year. We saw the community,
particularly at that time the gay and lesbian community,
obviously overwhelmed and struck by the terrible lethal nature of
this disease, really come together in a positive way, and I think
that was the beginning of what has become a model program for the
nation. Dr. Werdegar, Dr. Lee, I think described it to you, and
we have been very proud to be in the forefront of compassionate
care for AIDS.

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But there is one thing that has really struck me
increasingly, and initially I did not really believe it was going
to be the case, but that is the really profound need for
protection against discrimination. Every day we see the stories
and every day we personally know the cases. Housing, employment,
and insurance; there is an overwhelming need. I think one of the
problems in effectively approaching a prevention and education
program is that people really are frightened. Leave the
mythology aside. They are frightened to know what might happen
to them, and they do lose housing and they do lose their job.

I know of somebody, even in this city, just last week, was
diagnosed as having AIDS, was up front about it, told their
employer and they found an excuse not to have him employed.

And perhaps the worse thing is the insurance. We now
have drugs that can prolong life, namely, AZT. The cost of AZT
runs about $10,000 a year. There is a one-time federal pot to
pick up some of this, but in many states, the individual has to
spend down to the poverty level before they qualify for the
drug. That seems to me to be grossly unfair. And then, of
course, insurance can be cancelled, even on the remotest
possibility that somebody has AIDS or a friend of someone has
AIDS, and I think there is a very real need for strong federal
action. As you know, Congressman Waxman has a bill, HR-3051
which takes care of many of these problems. I would hope that in
this Commission’s final report, there would be definitive
statements on the need for the Federal Government to take this
kind of action. I think that once people are secure in the
workplace, in their homes and with insurance, that removes a
great deal of the fear that the AIDS patient has himself.

On another point, testing, I think most of us who have
dealt with the disease for a long time believe that the most
important part is mandatory education, education beginning early,
beginning in the public school system, appropriately presented
based on the grade, that deals with the- high school youngster in
an era of certainly liberalized sexual habits and opportunities.
The true facts are very important to get across. It is very
difficult because everybody believes it is going to happen to
somebody else, and I think this is particularly true in the
heterosexual population. People believe it is not going to
happen to my child, and it is not going to happen to me, and
whoever I am with is not going to give me the disease. Of
course, that is not true. So getting the appropriate education
out there is extraordinarily important.

Today, testing in America is really only available in
the major urban centers. What we know of this disease indicates
that its great spread and increase is going to take place outside
of the major centers of New York and Los Angeles and San
Francisco. Therefore, having the appropriate medical care,
enabling people get counselling and education in their own

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communities, it seems to me should be a number one priority of
this Commission.

I just had, and I would like to submit to you, someone
send me through the mail something that I thought was rather
interesting. There is a laboratory here in California that is
putting forward a mail test. I would like to submit the
original of the letter to me that describes the test, and also
the kit that is sent to you by mail. I would be interested in
knowing, frankly, the Commission’s evaluation. This is now
before the FDA for approval, and essentially what it consists of
is rather interesting. It has the alcohol swab, the gauze, a
cold pack, and it is all coded so all the individual does is use
a small device which is capable of pricking the skin and there is
a small collection vial with the code number, in this case it is
197. You put this back in the styrofoam next to the cool pack,
and you send it in. There is telephone counseling required,
both before and after, and this kit could be made available in
areas where people do not have access to testing. I think your
evaluation of this kind of thing could be most useful and so I
would just like to leave this with you.

CHAIRMAN WATKINS: Thank you. I will accept that for
the record, and we will be pleased to take a look at that.

MAYOR FEINSTEIN: I understand a number of laboratories
are in the process of producing this kind of mail order kit.
The important part in testing, as you know, is confidentiality.
Because of discrimination, people are so afraid. They are afraid
to get the results because there may be a breach in the
confidential processing and therefore they lose whatever they
have: home, job, insurance, etc. If I had to assess something
that is really necessary to overcome, to move to the next steps
in dealing with AIDS, I would have to say it is the fear of
discrimination.

This city has been very proud of its large
public-private effort. In dollars, it totals about $89 million.
Every private hospital in the city does take AIDS patients as
well as the very large direct care commitment that the city has
made. We have detailed in the written testimony which we will
leave for you every program that the city sponsors, and a
chronology of effort. I was privileged, while I was Mayor, to be
the chairman of the AIDS Task Force of the United States
Conference of Mayors, and I found that it was a very important
effort because it was an opportunity to bring together mayors
across the nation to trade information and notes, and, frankly,
to ask questions. One of the things that became very evident in
the early days was how little people knew about the disease. I
think a very necessary national, well, attribute if you will, is
an information sharing device that perhaps this Commission may be
able to continue.

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San Francisco took the lead in information sharing
through the Conference of Mayors and through our health
officials. Our health officials played a major role in terms of
transmitting information to other cities, and, of course, San
Francisco has been in the forefront of doing some of the
controlled studies. But of very deep concern to all of us is the
lengthening period of incubation and therefore people are
substantially in jeopardy. That exists for the gay comnunity,
and it will also exist, we believe, for the heterosexual
community. The next great challenge is to begin to work with
the minority communities, the at-risk communities and be able to
get past the discrimination fear, into an area where people
periodically are willing to test themselves, and are willing to
make the lifestyle changes that are necessary to prevent the
spread of the disease. As Dr. Lee said, the cities have really
been hampered by the absence of money with which to deal with
this, and what we find is that people have to travel to get help.
They do not have it in their own community. They are afraid in
their own community, they have to leave families and friends and
support mechanisms. This Commission can see to it that there is
an effective transmittal of funds. I know you have spoken about
a 50-50 match; I frankly think that that match will not work. I
think it has to be something like 80-20 because of the way costs
are.

As you know, San Francisco was able to obtain the
Public Health hospital. It is going to be impossible, in my
opinion, to operate it. The proposal that we have made to the
Federal Government is an 80-20 percent match with 20 percent
coming from the local jurisdiction and 80 percent from the
Federal Government. I really believe that that is the only way
it is going to be effective.

I would also urge the Federal Government to develop
direct relationships with the cities and the communities.
Federal matches are fine, but very often we see that the state
matches get siphoned off, and do not really reach the communities
that need the help. In sum, I think the number one issue is
removal of anti-discrimination; secondly, the building of the
kind of education and prevention campaign which can permeate the
rural hamlets and the more isolated areas of this country; and
then, thirdly, the kind of federal commitment of dollars which
can enable people to get treatment and care, information and
counselling and not have to go hundreds of miles to do that
wherever they live in America.

I would just like to say thank you very much for taking
such a positive position. I know when this Commission was first
put forward, many people did not believe it would be able to come
up with the kind of work that you have come up in your interim
report and I think you are to be very much complimented. It is a

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major step forward, and I know that all of us that care very
deeply about the people afflicted by this disease and by what it
is doing to people, would like to help establish this partnership
in any way we possibly can. Thank you.

CHAIRMAN WATKINS: Thank you very much, Mayor. I would
like to at least take the 15 minutes, if it is satisfactory with
you, to allow Commissioners to ask questions. So, Dr. Lilly,
would you like to begin?

DR. LILLY: I am just wandering about your
recommendation about adding discrimination legislation. If you
can expand a little bit on that, and perhaps tell us why local
measures would not be sufficient, have not been sufficient.

MAYOR FEINSTEIN: Well, I think it is a national
problem. There are not just, AIDS is not restricted to New York
and Los Angeles and San Francisco. AIDS is going to hit in
Kansas and Texas and virtually every state in the Union. I think
when one talks about discrimination, and the fact that people in
their homes, when they find they have AIDS, very often want to
come to a city for care where they are going to be protected, and
we find that that is the case. Therefore, I think it is very
important to have a national overlay of protection for people in
the workplace, for people in their housing as well as the
overwhelming insurance problen.

DR. LILLY: Thank you.
CHAIRMAN WATKINS: Mrs. Gebbie?

MRS. GEBBIE: First, just the comment that I hope will
give you some encouragement, working as I do with states all
across the country. I think there is a growing network of
services available, even in very small counties and localities
that has come a long way in the last couple of years so some of
that is starting to happen. I would be interested in hearing you
discuss a little more this issue of what size match is necessary
to get people at state and local government levels to
participate. To some people, an 80-20 federal match sounds
exorbitantly high on the federal side. To others, the 50-50
sounds like no local government could ever come up with their
half of it. Can you just talk a little more about how you got to
where you did on thinking 80-20 might be what would work?

MAYOR FEINSTEIN: Well, largely because of the dollars
that are involved, the minute you open a facility, as you know,
you are into several million dollars. Most communities, and
communities particularly in California, which is a Proposition 13
state, as well as others that have restrictions, do not really
have the ability to raise local revenues to handle great new
programs, and because it is not enough just to have a hospital,

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because hospital care is so high, you also have to have community
care so I think then when you look at, for example, if you are
going to open a regional center, and you are going to find that
the cost of operating that regional center runs anywhere fron,
dependent upon how you look at it, from $1 million-to $4 million
dollars a year, that is a difficult amount of money for a
community to come up with for a new program, even 50 percent of
that is difficult to come up with.

MRS. GEBBIE: Thank you.
CHAIRMAN WATKINS: Dr. Lee?

DR. LEE: Mayor Feinstein, may I congratulate you and
Dr. Werdegar and Dr. Philip Lee? You are constructive, you are
nice, you are unified in your approach to this. Where I come
from, New York City, everything is confrontational, and this
really hampers progress. A specific question on the insurance.
It is my observation that confidentiality in the insurance
industry is fiction, complete fiction, but they do have a
problem, and what is your idea of how they are going to solve it?
If you want the private insurers to pick up the costs, how should
they do it? Should they distribute it? Should they not test for
the HIV? Should they put in higher premiums? How do you think
that they should handle it?

MAYOR FEINSTEIN: I suppose you would say that the
correct way is not to test for HIV, to take the person as a whole
person when you are granting insurance. You see, I happen to
philosophically believe that people should be entitled to
catastrophic health insurance as a national standard, that one of
the great tragedies is that we are all susceptible to
catastrophic diseases that go on and on, and very often people
get cancelled from their insurance when they come down with that
disease, and I think that is a kind of basic protection that has
to be afforded people. I think what is complicating here is the
fact that you have a young, healthy population, generally a good
risk otherwise for health insurance, and therefore what companies
have done is the minute they hear about the problem, the
individual loses their health insurance unless the individual is
able to become so secretive about it that the company does not
know, and that undermines education and testing. I really
believe that people should be entitled to health insurance. Now,
I know that is probably going to mean some premium jump, but it
is certainly better than having to take on costs that exceed many
times $10,000 a year in your own personal care.

DR. LEE: What do you feel about Medicare funding for
this problem?

MAYOR FEINSTEIN: I think Medicare funding would be
excellent if it would be consistent and if it would provide the

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amount that is necessary. One of the problems with Medi-Cal, we
have been finding in other areas is that the rates are not enough
to handle the problem, and therefore there is a gap that needs to
be filled.

DR. LEE: Thank you.
CHAIRMAN WATKINS: Dr. Walsh?

DR. WALSH: I do want to commend you for your
leadership and especially for your candor on facing what the
federal responsibility should indeed be. Now, my question is
directed to you, and I would welcome, if you have no objection,
if Dr. Philip Lee also may want to comment because of his long
years in Washington, he understands the system very well. That
is that in the strategy that the Commission must follow in its
final report, about recommendations for federal assistance,
whether in urging this assistance that we should in some way
consider broadening the base of the problem in order to get
positive action, particularly from those states which are just
like, the Senators are just like the Mayors you met, in states
that do not have the problem, it is very difficult to get those
Senators excited, into broadening the base whereby using AIDS as
an example and as a wedge, whether we could not address the
broader base of the problems, of the shortage of nursing care,
the problem of home health care, the problems that have to be
addressed by the nation as a whole, and AIDS as an example of how
our health care system has been strained by just one disease, and
that we are long overdue in addressing the needs, not only of
this group, but the general problem.

I have a gut feeling, living in Washington, that we
have a better chance of getting legislation passed that way than
an isolated way, and I would welcome your thoughts on it as well
as if Dr. Lee wants to comment.

MAYOR FEINSTEIN: Maybe Phil ought to comment on that,
Dr. Walsh. I am not sure I understand your point.

DR. WALSH: Well, the thing is that I am fearful that
if we press firmly and directly for a specific legislation, I am
not worrying about discriminatory legislation. That is, the
discriminatory legislation is fine. That you have no problem
with. But I am worrying about funding legislation. If we try to
press it for one disease, is that going to be the wise strategy
or should we in some way take a broader strategy which will
benefit, which will achieve what you want, but will also force
the Congress to face the problem of the uninsured, face the
problem of what the states can do in Medicaid and Medicare. They
are just not facing it. That is what I am getting at.

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; MAYOR FEINSTEIN: I would be very frank with you. I
would probably take it any way I could get it but I think the
concern I have is that if money is not earmarked for AIDS, that
it will not go to AIDS, that others will find other priorities.
I think in some communities, with a problem like this, it is much
easier to hide it than in other communities and that is a deep
concern I have. Dr. Lee was part, when I was Mayor, I had what
was called an AIDS Task Force, and every couple of weeks, all of
the doctors as well as some of the community people came in and
kind of brought me up to date on everything that was happening
with respect to AIDS and it proved to be a very valuable vehicle
to address concerns as they happened, and also to watch the
changing statistics.

Essentially, there has been very little federal help as
you know, virtually none, and consequently, and I believe this is
going to happen in every city. I think a city has to identify a
problem, submit a plan and then the Federal Government, as part
of a national or health emergency, ought to be willing to put x
dollars of what it is estimated to take care of that, just as I
believe very strongly the Federal Government ought to pick up the
cost of AZT. I know it cost Burroughs about $80 million, well,
maybe they should be recompensed for their costs and in some way
a system devised that people have access to a life prolonging
drug.

DR. PHILIP LEE: Bill, to comment further, I think that
the Mayor, when she responded to Dr. Lee’s question about
insurance, put her finger on the problem because we have a
generic problem with health insurance, growing numbers of
uninsured, and, as she pointed out, many people with catastrophic
illness, including the elderly who have Medicare but with certain
high cost illnesses, they are now paying as much out of pocket as
they did before Medicare was enacted.

DR. WALSH: That is what I am getting at.

DR. PHILIP LEE: And some of them are paying 40 percent
of their income for their medical care. If any of us were paying
40 percent of our income for medical care, there would be a
revolution in this country, but if it is poor old people, they
can, we will let them do that. So we have a generic problem on
financing, and it is particularly with respect to high cost
illness. A very small percentage of the population accounts for
40, 50, 60 percent of medical care costs. That population is not
protected and I think we need policies to protect persons with
AIDS as well as to protect others with high cost illness.

The second problem that she pointed out that is a
generic problem is the intergovernmental relationship problem.
We do not have a clearly sorted out set of relationships between
federal, state and local government. The 80-20 match I think is

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an absolutely necessity if we are going to do something with the
AIDS epidemic. Local government, you look at Texas, you look at
Louisiana, $800 million deficit they are facing. They cannot
come up with that kind of money so that is a second.

The third is organization at the local level, the
public-private partnership that has developed here that
unfortunately, as Dr. Lee pointed out, has not been achieved in
New York, unless you achieve that, and that takes a
transformation in the health care system, a much more open
system, a much greater willingness to work with community groups,
to create organized systems so that we have three generic
problems, and I would agree with you, Bill, and I think this
Commission has to be looking at the total context as it makes its
recommendations or as you make your recommendations.
Particularly, I think, AIDS is a wedge that is pointing out these
very, very serious problems.

DR. WALSH: Why I asked that, Mayor, was that the worst
thing we could do is to get into a fight, say, with the Gray
Panthers, and everyone else about where the dollars are going to
go, and that is why I think Phil’s thoughts on it will affect it,
and you can still earmark funding for AIDS. If the legislation
is worded properly, you can earmark it if you will.

DR. PHILIP LEE: But an even higher priority ought to
go to prenatal care.

DR. WALSH: That is right, absolutely.

DR. PHILIP LEE: We have millions of women who do not
have any health insurance, pregnant women, and they do not get
care until they go to deliver.

MAYOR FEINSTEIN: Doctor, if I might say, I think there
is one overwhelming thing that has to be guarded against, and
that is setting group against group.

DR. WALSH: That is right. That is what I am afraid
of.

MAYOR FEINSTEIN: You know, you do not want the elderly
fighting AIDS victims, and I think that that is a very important
thing because it could conceivably happen, and that is one of the
reasons, I think, clearly stated, AIDS is the nation’s number one
public health emergency, and therefore it really has to be
addressed as that.

DR. WALSH: Okay. Thank you.

DR. PRIMM: Mayor Feinstein and Dr. Lee and Dr.
Werdegar, I, too, want to join the Commission’s sort of symphony

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of certainly admiration for what has been done here in San
Francisco, and also to congratulate a very sympathetic and
dedicated staff of Commissioners and others who have helped to
make that possible, and I have often suggested to other cities in
the nation that I visit, that they ought to take a book out of
the page of San Francisco’s chronicled successes, and begin to
duplicate them in other cities around the nation.

I do have some concern about do-it-yourself testing.
My concern is that San Francisco has proven that as long as there
are support systems that are there and personal support systems,
we have visited some projects, for example, the Shanti Project,
where people who have diseases that lead to death or are
supported by individuals and maybe post-test these personal
involvements with individuals have a tendency to do more good
than if they were alone by themselves when they heard or got back
in the mail or whatever, the results, say, of a do-it-yourself
test. I know in the past that hotlines have been certainly
effective in aiding people who were at the point of committing
suicide or had other kinds of crises. I am concerned greatly
about this particular one, that I think one needs a more personal
kind of contact with individuals at the time that results may be
become known. It is a concern that probably could be worked out
with a little bit more thinking, although you had indicated that
this particular manufacturer would have counselling were a
telephone available. I feel that we ought to have something
personal.

Again, I commend you and commend your staff and I have
no questions for you. I just thank you for your pioneering work
in this field.

MAYOR FEINSTEIN: Thank you, Doctor. I do not want you
to misunderstand me. I do not know whether this is a good idea
or not. It is an idea that I think has to be looked at. You
know, people, I think, said that at one point about pregnancy
tests, too, particularly for young people, and yet now you can
get a home pregnancy test. I think that the important thing is
because the way drugs seem to be going, the earlier you can catch
the disease, the better the opportunity you have of prolonging
the life of the individual. Therefore, everything we do as a
society ought to be to get people to help themselves and have
access to something that will prolong their life and help then.

DR. PRIMM: One other mention here. I have often
visited the Tenderloin District when I come to San Francisco. I
have a friend there who runs the Cadillac Hotel. Leroy is a
former New Yorker, as you may know.

MAYOR FEINSTEIN: My friend, too.

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DR. PRIMM: I was there last night and visited the park
very close by that hotel, and saw in another block a number of
obvious intravenous drug abusers who obviously could possibly be
infected with HIV. I am concerned about those homeless IVDAs
here in San Francisco, and would like to see somehow, something
that could be developed in terms of housing which I know is
terribly difficult, I mean, I am concerned about it in my own
city, too, believe me. But he has done some very innovative
things, as you very well know, and I thought maybe something in
that form of the thing that he is doing with the developmentally
disabled, the mentally disabled, could be duplicated for housing
for some of these people who are infected with the virus who will
just die in the streets, and it is sort of pitiful in a town as
wonderful as this. So I was hoping that to bring this to fore
and maybe Dr. Werdegar or Dr. Evans or Dr. Lee could suggest
something.

MAYOR FEINSTEIN: You do know, Doctor, that as part of
the homeless program, and maybe Dr. Werdegar would like to
address that, there is an effort made, and a major effort made by
the Department of Public Health to find special placement for
people who are homeless with AIDS and then also to provide them
with medical services at the same time. Doctor, do you want to
address that?

DR. WERDEGAR: Thank you. Commissioners, let me
introduce Dr. Patricia Evans who is the Associate Medical
Director of our AIDS office who I think is best informed on this.

DR. EVANS: Dr. Primm, I would like to address what you
have just talked about in terms of the IV drug using community.
In the plan that you were given, you will see in there that we do
have a number of programs that we are trying to institute, and
some of these have actually been put into place. We do have
Baker Places which is housing for IV drug users who are HIV
infected, who have AIDS and ARC. There is also a hotel for the
homeless who are IV drug users and have AIDS, and Catholic
Charities has just purchased a building and is in the process of
renovation and will have spaces available for this particular
population here in San Francisco. So there are things which are
being done here in the city and county. Again, this does cost
money and we do need more in terms of providing more services to
this community, though.

DR. PRIMM: Thank you.

CHAIRMAN WATKINS: Thank you very much. We are going
to move on to our next Mayor, the Mayor of Sacramento, the
Honorable Anne Rudin. Thank you very much, Mayor Feinstein, for
coming today, and thank you, Dr. Werdegar and Dr. Lee, for
staying with us. As you know, Mayor Agnos will be here later on,
and perhaps he will need you also. Welcome, Mayor Rudin, to the

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es |
 

panel. We would like very much to hear your statement this
morning.

MAYOR RUDIN: Good morning, Admiral. Thank you very
much for giving me the opportunity to speak before you. Good
morning, Commissioners. I am Anne Rudin, Mayor of Sacramento,
and I want to say that I have reviewed your interim report. It
is a very comprehensive and well written report, very thorough,
and I want to commend the Commission on its thoroughness in
investigating and exploring the implications of AIDS and the HIV
epidemic. I do not know if my comments will present anything new
to you because you have covered an awful lot of ground, but
perhaps they will reinforce your findings, validate your
conclusion and let you know that Sacramento has the same problems
that other cities have. If not to as great an extent, at least
the potential is there.

Sacramento, as you know, is the capital of the largest
state in the United States, and we are facing the most serious
health problem of our nation, human immunodeficiency virus
infection is something we are taking very, very seriously. The
population of the Sacramento area is close to one million. HIV
is a threat to over 10 percent or approximately 100,000 of our
people. According to the Sacramento County Health Department, to
date, 182 individuals have been diagnosed with HIV infection, 72
have died. Statistics from that department show that there will
be over 600 people with AIDS by 1991. Ordinarily, municipal
governments would not be expected to take more than a modest role
in addressing a public health issue because we do not have that
responsibility. It has been given to the county in most places
in California except for unique situations like San Francisco’s
because we have overlapping city and county here. We do not have
a direct health care role in our city, but the AIDS crisis has
forced a shift in the usual patterns of responsibility and cities
all over now are awakening to a new role of leadership in the
coordination of service delivery and in the funding and lobbying
for program support from the private sector and other levels of
government.

The people of Sacramento have addressed this need for
involvement. Volunteers, health care providers, and political
leaders have developed a well-integrated community that provides
services for those with HIV, their families and their partners.
Our first AIDS cases were diagnosed early in 1983, at which time
the AIDS Foundation was formed in Sacramento, and which today
provides a variety of services, including education to high risk
individuals and to health care workers and to the general public.
It also operated an AIDS information hotline and is establishing
minority outreach programs and gay outreach programs.

The Sacramento County Health Department administers a
variety of programs including condom distribution which costs

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$11,000 a year, education at adult detention facilities, HIV
testing at alternative sites, and a variety of social services.
We also have the Stop AIDS project, the Clinic for AIDS-Related
Disorders, Home Health Care program, and a program called Hand to
Hand. These are just a few of other community services that are
available in California.

In 1985, I organized the Mayor’s Task Force on AIDS to
gather information to enable us to formulate public policies to
address the problems associated with AIDS and ARC. Many of these
recommendations have been implemented in Sacramento, and an
ordinance has been enacted which prohibits discrimination against
those with HIV infection with regards to employment and housing.
Training has been provided to all our emergency response
employees and police officers. Sacramento County has established
an ongoing AIDS Education Prevention Task Force to help solve the
AIDS crisis, and it has recommended an AIDS prevention unit be
formed to implement these recommendations, and this unit has been
funded and it active.

Although we believe the programs and services we
provide in Sacramento are having a positive effect in deterring
the spread of AIDS, they are not enough. Prevention programs and
services are underfunded, and it is time now for other sources of
funding, and we, of course, look to the Federal Government as we
do in so many programs that are nationwide, to help us provide
adequate funding. We need only look ahead to see that the money
we spend today will save money in the future. I know that we all
have priorities that may vary, and other things that take as high
priority but we have to look at what we can save in the future by
spending money on AIDS prevention today. For each HIV infection
that occurs in Sacramento during this year, we figure that
government will spend approximately $15,000 for health care for
each person over the next ten years.

The Sacramento AIDS Foundation has estimated that it is
seeing 18 new clients a month, and the University of California
Medical Center clinic is seeing nine new patients a week. There
is overwhelming evidence that education is the key to prevention.
According to Dr. Neil Flynn, who is the Associate Professor of
Clinical Medicine and the Director of the AIDS Clinic and
AIDS-related disorders at the University of California Medical
Center, in New York City, 60 to 70 percent of IV drug users are
infected with HIV. It is not the same proportion in California.
We understand that in San Francisco, 15 to 20 percent of IV drug
users are infected, 10 percent in Los Angeles, but only 5 percent
in Sacramento.

So we still have time to arrest this. If HIV infection
is allowed to spread rapidly among IV drug users on the West
Coast, we will be setting ourselves up for an enormous financial
burden as well as needless loss of human lives. We know the role

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of education, that education can play here. It is clear that
once IV drug users become affected, we know what happens. The
virus spreads to their sexual contacts, who might not be IV drug
users, and to their children. It is estimated that if Sacramento
had a million dollars for prevention programs for IV drug users,
we could arrest the spread. Currently, we have about $150,000
available for this year, and it is totally inadequate.

We need to better fund education programs for members
of other high risk groups, and the general public. And target
groups for education and prevention should include gay men,
adolescent gay men, IV drug users, their potential sexual
partners, and multi-partnered heterosexuals. We think it is
still manageable because we can still find the people who are
infected, and trace their contacts, especially the heterosexual
contacts of high risk individuals.

We also look at the need for the development of a
vaccine, and I know that there are many considerations. Your
report pointed that out. The question of liability, legal
liability in the development and the use of a vaccine, the
economics of developing a vaccine, competition between companies
and so forth, and the secrecy that they engage in, but Dr. Flynn
has told me that some of the simpler vaccines have not been
tested because they are not patentable because they do not use a
new technology. They are simply a killed whole virus vaccine
which is not profitable for the companies to produce so his
feeling is that these are not being tested. They could be
tested, they could be used, and they could be used to advantage.

We would like to see the National Institute of Health
overcome the obstacles toward finding new vaccines which might be
tested immediately. We have a population for which such a test
could be used, and it is an ideal population because we know many
of the IV drug users, who they are and who share drug
paraphernalia without using disinfectants, and who are at high
risk.

I want to say something about the services that are
needed. The major problems with services in Sacramento at this
time revolve around reimbursement issues for care. Since
approximately half of the people with AIDS are on Medi-Cal, which
reimburses at a very low rate, close to 44 percent of actual
charges in our city, hospitals and health care providers have
been reluctant to provide care for people with AIDS. At this
rate, a considerable amount of money is lost in the care of
people with AIDS, and as a result, the pressures are tremendous
to constrict and restrict the AIDS clinics or cut financial
losses.

This problem can be addressed in two ways. First,
Medi-Cal reimbursements must be increased. Secondly, a regional

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center for AIDS should be established, and in the model proposed
by Dr. Flynn, this center would bring together AIDS physicians,
social services, case managers and home nursing personnel. The
center would house a clinic facility, transcription services for
physicians who use the facility, a special billing system which
allows private physicians to bill from the center through their
own private offices so using resources they already are paying
for. It could provide an AIDS library and social services to
coordinate lower cost home care. Private physicians could come
to the center to see their patients instead of seeing them in
their own offices, and they could pay a use-of-facility fee which
could be slightly lower than their overhead for their own
offices. The supplemental funds to run the center would be
provided by grants from federal, state, local and private grants
and donations, and all administrative and support services then
could be provided at one center.

Another urgent problem in Sacramento is the lack of
beds in skilled nursing facilities for people with AIDS who are
unable to care for themselves. As a result, they are staying
unnecessarily at acute care hospitals and taking up those beds
instead of the skilled nursing facilities because of the low
reimbursement rate. So precious acute hospital beds are lost,
the cost of care was double or triple what it could have been had
skilled nursing facilities been available. So we must raise that
cost, the reimbursable cost of Medi-Cal needs from the $44 a day
that is being paid.

Sacramento has also some special problems in providing
services to people with HIV infection due to its high military
populations, the rapid growth of the metropolitan area, and the
low cost of living. On the first item, the high military
population, civilian health and social services in Sacramento
have no formal ties to the military establishment. Now that the
military is screening troops who live in Sacramento for HIV
antibodies, it is important that these patients receive
information and referrals to local providers who can assist them
and their family members with health care delivery with emotional
support with health care planning information and resettlement
information should they be discharged to the Sacramento area.

The population of Sacramento is increasing at a brisk
pace. This also enlarges the population at risk for HIV
infection and those currently infected. This increase in numbers
is going te cause heavy demands on existing and newly created
services. It is also a less expensive place to live than other
cities in the metropolitan areas of California, like San
Francisco and Los Angeles. Therefore, people with HIV infection
who are symptomatic move to Sacramento when their incomes are
reduced because they can live more economically there.

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Specifically, I want to just list some current services
that need expanding that we see the need to expand and a list of
new programs and services which need to be developed in
Sacramento. The current services that need to be expanded are
acute hospital beds, unless other forms of facilities are
provided; non-ambulance patient transportation services like
paratransit or some auxiliary form; home delivered meal services;
social work case management services; clinical social work for
assessment, patient, and patient family therapy; IV drug use
prevention and education; volunteer buddy services for both
emotional and practical support; people to look in on patients to
cook and clean and shop for them; a network of support groups for
patients, for patient families and children, especially for women
IV drug users with children; home health nursing and attendant
care; legal defense and advocacy services; and legal assistance
and planning.

New programs that we would like to see develop, new
services include residential skilled nursing facilities; licensed
board and care and group homes; residential intermediate care
facilities; an AIDS outpatient service with mobile outreach;
street outreach for IV drug users; inpatient psychiatric
services; 24-hour AIDS patient emergency services; outreach in
minority communities for IV drug users; development of
ethnic-specific education; and outreach and prevention
information services for minority patients, especially in their
languages.

We think Sacramento has done exceedingly well to meet
the demands of the HIV epidemic. We believe that we know
everything there is to know about the HIV to halt its spread. We
must be able to apply that knowledge for education and
prevention. More must be done, but the financial support is
needed to meet the crisis head on. We must educate the high risk
individuals and the general population. We must provide funding
for this now so that we can end the spread of this deadly
disease. What will the next generation think about those of us
who had the knowledge in the 1980’s to virtually stop the HIV
epidemic dead in its tracks but did not apply that knowledge?
They are going to wonder what kinds of irresponsible fools we
were to let this virus spread to the point where the next
generation will not be able to eradicate it. Thank you very
much.

CHAIRMAN WATKINS: Thank you very much, Mayor. We will
open the questions with Dr. Crenshaw.

DR. CRENSHAW: I will just thank you for that comment.
I think that we all need to have a thorn under our saddle to get
moving a little faster and use the resources that we have got.
No questions.

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MAYOR RUDIN: Thank you, Dr. Crenshaw.

CHAIRMAN WATKINS: Mayor Rudin, would you please
provide us with your Sacramento ordinance on discrimination? You
probably do not have it with you, but if you could forward it to
the Commission, I would like to review it and look at its words.
I am sure it was sensitively arrived at and sometimes when we
average those across the nation, it might be useful in our own
deliberations as we close in our final report.

MAYOR RUDIN: I will be happy to send it to you. We
used the U.S. Conference of Mayors’ model, adapted it to
Sacramento, I will be happy to send you a copy.

CHAIRMAN WATKINS: Fine, thank you. Would you tell me
what happens to the potential recruit for the military in your
region who is examined at the military entrance point, found HIV
positive. I would like to know how the military transfers that
knowledge back to competent counselling and other authorities in
the private sector back in the Sacramento area. Are you familiar
enough with that to know what the process it, and if it is a good
process, if it is a sensitive process or is it one that is rather
casually done?

MAYOR RUDIN: I had a, I reviewed the process. I am not
able to repeat step by step what happens. My impression is that
it is not thorough enough. There is not enough follow through.
It is casually done. There is not the follow through to the
source of help, both the emotional support and medical care.
Often people are transferred out of the area before they are able
to follow through on their medical care so there is not a
continuity for each one of these, for every person who is
identified as carrying the HIV.

CHAIRMAN WATKINS: Has the military attempted to come to
you as the Mayor or your community-based organizations to find
the proper networking and the proper referral, both for pre-test
counselling and post-test counselling?

MAYOR RUDIN: There is a person on the staff of the AIDS
Foundation who is a social worker who has made the effort. He
has made the outreach effort to the military because he knows
people in the military just through social contacts who have
turned out to be carrying the HIV and has learned from them that
the process is really very sketchy, not as reliable in following
through on each person. No, the military has not come to me.

CHAIRMAN WATKINS: Would you be willing to ask your
social worker to prepare some sort of a review of how you view
the military’s response, and I am particularly interested to know
not the ones that are in the military, those ones that have
attempted to come into the recruiting office and then found in

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their medical exam at the entrance point that they are HIV
positive and are now rejected back to society. How, then, does
that transition take place back into the Sacramento society?

MAYOR RUDIN: Yes, and to whom are they referred for
treatment.

CHAIRMAN WATKINS: Right, and how well is it done. We
are going to be talking with some of the Defense people, and it
would be good to have some specific information so that we can
ask the same questions when we go to those in the Department of
Defense.

MAYOR RUDIN: I will be happy to provide that
information to you.

CHAIRMAN WATKINS: Thank you very much. Dr. Lilly, do
you have questions?

DR. LILLY: No questions.
CHAIRMAN WATKINS: Ms. Gebbie?

MRS. GEBBIE: Yes, and this is one, too, where you
probably will want to consult with some additional people. Your
comments highlight what is an issue for lots of us, and that is
the mobility of patients. With much funding currently being
based on the number of patients reported to CDC which means it is
their point of original diagnosis, often the funding does not
match to where the patients are, in addition some people have
raised the question about basing prevention money distribution on
currently diagnosed patients because, in fact, it may be those
areas with low prevalence that could benefit the most from a big
bubble of education money. If you and your staff have done any
thinking about what would be a logical basis for distribution of
increased funding, what formula or system ought to be used that
would make certain the money got out appropriately and where it
could be well used, I would appreciate receiving that or hearing
some comments today if you have thought about it.

MAYOR RUDIN: I cannot give you that today, but I can
get that information to you also. I do not work directly with
the programs but I am in contact with them. I am not working
with them but I am in contact and I get information and I am sure
that Dr. Flynn, the epidemiologist who has done widespread work
on this, will be happy to provide that information. Thank you.

MRS. GEBBIE: Thank you.

CHAIRMAN WATKINS: Dr. Lee?

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DR. LEE: First of all, a question about your
constituency. Sacramento sits right in the middle of maybe our
finest farming area in the United States of America. We went to
Belglade in Florida where they have terrific problems with the
migrant workers, very high HIV rates and drug addition. Do you
have that problem in Sacramento?

MAYOR RUDIN: It has not been identified as a problem.
In California, what used to be the migrant workers are not as
migrant as they used to be. They are tending to stay in one
Place to find jobs. Sacramento’s agriculture has declined
somewhat as urbanization has increased. We still have farming in
the central valley, but we do not see the migrancy that we used
to see so that has not been identified as a major problem.

DR. LEE: Some specific questions. When you said Medi-
Cal, $44 a day, for what? Is that for outpatient services?

MAYOR RUDIN: Oh.

DR. LEE: You could not possibly be talking about
inpatient. It must be outpatient services. Is that what they

pay?
MRS. GEBBIE: I think she said long term care.

DR. LEE: Anyway, if you do not know, I was interested
because it certainly is spectacularly low figure.

MAYOR RUDIN: I am sorry, I do not know. It is very
low. I think it inpatient, Doctor.

DR. LEE: It is inpatient?
MAYOR RUDIN: Yes.

DR. LEE: That speaks for itself. One of the issues
that I am personally very interested in is these residences for
PWA’s because they are so necessary for people who have been
kicked out of their houses or are too sick to work but do not
have to be hospitalized. These are so cost effective, and the
models we have seen elsewhere in the country are so excellent.
Two other people here in San Francisco have made the comment,
one that there was some kind of residential support by the local
Health Department here in San Francisco. That was told to us
this morning, I think by Dr. Werdegar. I mean, how does that
happen? Do you have that? Do you have funds for that?

MAYOR RUDIN: We do not have funds for that. We have
lost much of our housing subsidies. But a private, non-profit
organization has established a house. Someone donated an old,
large Victorian house that can accommodate about 12 or 13 people.

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This is a group associated with the Catholic Church, and the
Lutheran Church is joining them in providing services to the
homeless, but this one is particularly geared toward people with
AIDS. They do not get any medical care there. People do go in
as volunteers, and it is fully occupied now. It is called the
Hope House.

DR. LEE: But you have no public or county or funds of
any kind that apparently they have in San Francisco.

MAYOR RUDIN: No. We do not have the money for it.

DR. LEE: AAAnother thing I did not have time to track
down is what the witness from Hawaii mentioned, that there was
Medicare funding for the same kind of residential housing there.
You certainly do not have any Medicare funding for that.

MAYOR RUDIN: I am not aware of it.

DR. LEE: And no Medicaid stream there at all.

MAYOR RUDIN: No.

DR. LEE: Thanks.

CHAIRMAN WATKINS: Dr. Walsh, do you have any questions?

DR. WALSH: I just need a one-word answer. May we
assume that you would subscribe to the recommendation of Mayor
Feinstein that the ratio, if we recommend federal funding, be
80-20 as a realistic ratio for, you will recall in our interim
report we felt, we at first felt 50-50 between states and Federal
Government. She suggested that because of the laws and like that
your ability to raise that much revenue is impossible. Can we
assume that you would subscribe therefor?

MAYOR RUDIN: I agree with that. I am assuming you are
saying that the 80 percent on the part of the Federal Government.

DR. WALSH: Yes, of course.
MAYOR RUDIN: Yes, Doctor, I do subscribe to that.

DR. WALSH: It is important for us to know that
legislation prevents you from it, even if you wanted to do 50,
you cannot get it.

CHAIRMAN WATKINS: Thank you very much, Mayor Rudin, for
being with us this morning. We have the Mayor of San Diego with
us so we are going to proceed with our next panel. Thank you
very much.

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MAYOR RUDIN: Thank you.

CHAIRMAN WATKINS: We are pleased to have the Mayor of
San Diego, the Honorable Maureen O’Connor with us this morning,
and Mayor, welcome to the Commission and we look forward to your
statement.

MAYOR O’CONNOR: Thank you, Admiral Watkins. I
understand you are a fellow admirer of San Diego.

CHAIRMAN WATKINS: Yes, I spent many, many wonderful
years there. It is, well, it is not my hometown, but it is so
close to it in my professional career. I have the greatest
admiration for the city and what you have done there, and not
only that, I think you have a unique county in this state that
has been in the forefront of aggressive education and other
programs, integrated programs, and a variety of partnerships in
your region that have almost been a model for the nation. I know
we are leaning on San Diego County, for example, to set the tone
in so many areas where we are running major national pilot
efforts for education programs for the handicapped or the youth
at risk groups and all others, so we applaud what you are doing
there. It is a great city, and we are honored to have you with
us.

MAYOR O’CONNOR: Thank you. Unfortunately, I do not
think it is enough. Admiral Watkins and members of the
Presidential Commission, I am Maureen O’Connor, Mayor of the
City of San Diego. I am grateful for this opportunity to discuss
the AIDS epidemic as it impacts San Diego. Our area is ill
prepared to deal with the scope of the impending crisis, lacking
a coordinated effort and realistic funding to deal with the
mounting tide of AIDS and ARC cases which are estimated to number
around 10,000 today and will approach 50,000 according to
projections by 1991. As AIDS raises national and social concerns
and has caused profound local and individual impact, we applaud
the steps outlined in your interim report as necessary in
addressing the whole fabric that must constitute the national
effort. We must have a national approach to AIDS which stops
the spread of the disease, protects the civil rights of the
afflicted, provides for medical care, (PWA’s and PW-ARC’s, should
be given expedited coverage under Medicare and be provided with
hospitalization, outpatient and prescription services), addresses
the medical concerns of medical insurers and those who need
insurance, provides for the social service requirements of PWA’s
and PW-ARC’s, and communicates effectively to all segments of the
population about risk and behavior.

States and localities need clear direction. In
California, for example, we face over 120 bills on AIDS pending
before the legislature going in every conceivable direction, and
the citizenry must address proposition 69, the LaRoche initiative

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on the June ballot. Let me now briefly speak to immediate local
needs from a Mayor’s perspective in coming to grips with the AIDS
problem.

city and county governments are separate entities in
San Diego. Responsibility for health issues rests with the
county. As Mayor of the city, I have no control beyond
persuasion over the marshalling of resources to combat this
disease. Because AIDS has significant impact on only one of
the five county supervisorial districts, the county is
unresponsive to the burgeoning crisis. Dr. Cox, the County
Health Director, recently, as of Tuesday, flatly declared there
was no AIDS emergency in San Diego and that AIDS merited no
special consideration in relation to other health issues.

Due to a lack of resources, there is no action plan
in place for dealing with this disease, no prioritization of
programs, and no caseload projections beyond 1991. While state
and federal programs provide for basic medical care and
educational programs, the major burden for social services and
outreach continues to be carried by the private sector, which
by and large means the gay community in San Diego.

The city has begun to assist the various social
organizations in providing AIDS and ARC sufferers with the
most essential food, shelter and counselling needs as the
demand overwhelms the ability of the private donations to keep
pace. The city subsidizes approximately 60 percent of the food
bank costs for PWA’s and PW-ARC’s earning less than $850 a month.
The city funds a van for transportation. Through its Housing
Commission, the city is providing a house to PWA’s and PW-ARC’s,
for low cost housing. The city subsidizes the rent on another
house used for low income housing by AIDS agencies. The city
assists in providing education-counseling for those at risk and
who test HIV positive.

The city funds its very modest effort, assisting
perhaps five percent of the PWA’s and PW-ARC’s, through
allocation of 10 percent of the Community Development Block Grant
Funds available for social services. Only $1.5 million of such
funds were available to the city in 1988 for all city social
service programs. CDBG funds were fully subscribed before the
addition of AIDS programs. The rapid growth of AIDS requirements
will quickly displace all other social programs, every one of
which is essential to some segment of the community. Compounding
the problem is the fact that the Federal Government is reducing
CDBG funding to the cities each year. Federal cuts are also
threatened in other areas, such as public transportation. Such
cuts have a direct impact on the services needed by the AIDS and
ARC populations. Cities cannot compensate for diminished federal
programs and fund an increasing AIDS progran.

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Cities such as San Diego are jurisdictionally
constrained in their ability to respond to a health crisis and
are fiscally powerless to address needs. Where the population
affected is currently concentrated in the major urban areas, the
tools must be provided to the city governments to act where
others fail to step in, and where the private sector’s
willingness to participate is overcome by the need for services.

The requirements of various urban areas will vary based
on the make-up and size of the immediately at risk population,
and existing local, medical, and social agency resources and
various peculiarities in the local, political and social
environments. San Diego, for instance, must deal with the Navy
and Marine Corps recruits discharged as HIV positive. We urge
the immediate enactment of federal legislation such as Senate
Bill 1220, Senator Kennedy’s AIDS Research Care and Treatment
Bill, which will give direction, scope, and funding in sufficient
scale to formulate a national AIDS policy. Funding provided
should go directly to the level of government best positioned to
administer prograns.

Specifically, we need direct assistance to the cities
through programs such as those contained in Senate Bill 1220, the
increase in social service funds available to existing programs
such as CDBG or other pass-through mechanisms, San Diego needs
such funds now to provide for the fundamental structure to
sustain human existence within the bounds of decency. Examples
of our specific requirements are: a PWA; PWA-ARC licensed adult
socialization facility; low income housing; facility for AIDS
agencies to allow for adequate client servicing; meals on wheels
programs; food bank funding; visiting nurse and health care
capability; counseling services and clean needle programs.

Admiral Watkins, members of the Commission, these are
just our minimal requirements. We would like a lot more funding
to address what we consider is a serious problem in our community
and I want to thank you for the opportunity and courtesy extended
to me today to address you.

CHAIRMAN WATKINS: Thank you very much, Mayor. I
would like to open the questions from the Commissioners with
Dr. Crenshaw.

DR. CRENSHAW: Not only as a Commission member, but as
a resident of San Diego, I have a real special interest in our
town, and you have mentioned many of the rather unique problems
that we have which include the second highest incidence rate in
the nation of new AIDS cases, and you mentioned the military.
Not the military recruits, but the people in the military who are
triaged through Balboa Naval Hospital which is equal in numbers
approximately to our public health count, and then we have people
who come there to be close to the Mexican border to get drugs.

162

 

 
 

MAYOR O’CONNOR: That is correct. Our population, those
coming across through Mexico and the number of drug users, that
is correct.

DR. CRENSHAW: Well, that is also true, and what I was
thinking of but I did not express very well is the people who
could not get certain drugs in the United States to treat their
disease who go down there and go back and forth across the
Mexican border in order to get drugs to save their lives and give
them hope, and then we have got the drug traffic on top of that.

MAYOR O’CONNOR: I am sorry, as Mayor I always think of
drug traffic.

DR. CRENSHAW: No, it is all true.

MAYOR O’CONNOR: It is always coming this way and not
going that way in my mind.

DR. CRENSHAW: It is all true, and then on top of that,
we have got an unknown number of illegal aliens about whom we do
not have a clue as to what is going on so the concerns that I
have are severalfold.

I think we have got a volatile and largely unrecognized
problem in the sense that they are all separate pieces of the
puzzle, that when they come together could make San Diego one of
the most serious areas in the entire nation for this problem, and
in the area of prevention and education, I think we are making
headway there as far as treatment and care is concerned, and you
mention facilities, but we just heard three individuals from the
San Francisco Bay area demonstrate the incredible work that has
been done by the city itself up here, with a budget of $50
million and another $20 million to come this year. How much
money has the city of San Diego allotted to AIDS education?

MAYOR O/CONNOR: Okay, you have to understand that with
San Francisco, the city and county are one, so they receive all
health care funds, and you also have to understand that the city
of San Francisco is $170 million in deficit right now. The city
of San Diego is not allowed the luxury of running a deficit. We
have to balance our budget and we receive none of the monies
available for health services under that. We do through our
program, I cannot give you the specific number, but the city,
through its print shop, we have released our own educational
pamphlets, and have distributed them throughout the city as it
relates to the AIDS education program, in conjunction with the
county.

DR. CRENSHAW: So we have got the pamphlets, but
basically the city has no funding as yet.

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MAYOR O’CONNOR: No, the city has no funding, and I will
tell you, if you want to get a little quick synopsis of the
problem with all cities in California, we are constrained by the
Gann Initiative, we are constrained by proposition 13, we have to
cut out of our budget $30 million this year just to balance, and
basically the money that we use for social service programs is
funded through CDBG which is continually being cut back by the
Federal Government. So our modest contribution to the AIDS
overall project is in the roughly $200,000 category, not counting
the money that we are giving to provide for the housing
facilities through our Housing Commission.

DR. CRENSHAW: So basically what I am understanding from
you is that alone, you cannot spring things loose in San Diego to
address a problem that you see as really serious from what you
have obviously described and what can we do to help, short of a
large check of federal funding that we would love to make
available tomorrow, but in the interim, what can we do to get the
powers that be, and the people running policy in San Diego to
commit funds and energy and effort in a big way to educational
prevention?

MAYOR O’CONNOR: Well, the first thing you can do is
under the Gann Initiative if they would declare, the county would
declare AIDS an emergency, they can lift the Gann waiver and
spend money that they have that they cannot spend under the law
so if you could convince them, to this point they have not been
convinced to declare an emergency in San Diego, that would be a
big step forward that would give them the opportunity to spend
some of their unallocated reserve which is roughly $6 million and
focus that on AIDS education but if you, ma’am, really think that
the local government, whether it is city or county, have the
resources to address this problem, even minimally, and I am
talking about minimally, I have to tell you that is not the case.
The city’s budget never anticipated the epidemic, we do not have
the responsibility, but we do have the moral responsibility, but
we do not have the means based on our limited finances, nor the
authority because we are not the health agency, to address it.

So that is one specific example of where you could really help us
in the community because to this point, we have not been able to
convince the Health Director and the Board of Supervisors to
declare an emergency.

DR. CRENSHAW: All right. That is very helpful, and I
will say it is a terrible dilemma because you have a balanced
budget and little money for AIDS, and San Francisco is pouring
their heart and their soul and their money into it, but they have
got an enormous deficit to confront so I-am glad we have got the
Admiral leading us over there.

164

 

 
 

 

MAYOR O'CONNOR: And I am glad the Admiral is here
because I think it is a prioritization on the federal level. You
know, they could take a look at their budgets and re-prioritize
because I am sure if the Federal Government had to act like
cities, we just cannot keep having the cities become the
scapegoat for all the budget balancing in Washington because our
cities are having some severe problems. I do not care whether it
is the issue of AIDS or just the survival of our infrastructure.
We need help. I have often thought about declaring us a foreign
country so we could get loans. I mean, it is a serious problem
that we are facing, and then we get the addition of the AIDS
emergency, which it is throughout the country, and then we have
to address that, too, with our limited resources, plus we are
getting cut back at the federal and state level. We are in an
untenable position.

DR. CRENSHAW: Well, I agree that the Federal Government
is obviously going to have to pitch in in a lot of different
areas, but I do think that your point of the $6 million
available, given emergency declaration is really a good one, and
all of the cities have to suffer financially in some way if they
are contending with this AIDS epidemic.

MAYOR O’CONNOR: And we are doing that in that we are
taking from existing programs, other social programs, ma’am, we
are taking it from them to address this crisis and now I am down
to, in the next year’s budget, do I fund my after school
recreation program for children at $650,000 a year? What it
addresses is our problem with drugs and juvenile delinquencies.
Do I take that money and put it into the AIDS emergency? That is
a tough call for a Mayor to make, and I am saying we need some
support nationally, and that is why this Commission is, frankly
in my opinion, our only hope.

CHAIRMAN WATKINS: In follow up, Mayor, could you tell
us a little bit more about the county’s reticence. Do they also
have the same problem and therefore they cannot come to grips
with it? They are sympathetic with the issue but they simply do
not have the dollars or what is the obstacle? Is it local or is
it federal?

MAYOR O’CONNOR: Well, I think it is a little bit of
policy. It takes three votes to do anything on the Board of
Supervisors. There is only one supervisorial district that
encompasses the city itself so the other supervisors, rightly or
wrongly, they understand that the problem is out there, but it is
technically not in their district, they also are under a lot of
financial constraints, and I am not here to tell you that they
are not, but they are the lead agency. They are the health
agency responsible to try to address this problem so I think it
is a combination of both.

165

 
 

 

CHAIRMAN WATKINS: Is there any technical element in the
existing statutes in the county that talk about the emergency,
the medical emergency that would preclude the HIV epidemic from
falling under that if a decision were made in that direction?

MAYOR O’CONNOR: No, I do not think so. I think the
county mayors in 1987 requested the regional task force on AIDS,
that is, a combination of city and county representatives, they
addressed the Board of Supervisors in their program to declare it
an emergency and frankly, it is just on somebody’s desk and the
Gesire is not there at this point.

CHAIRMAN WATKINS: If, at the national level, advantage
was taken of the existing law that deals with medical emergencies
in the nation, giving the Secretary of Health and Human Services
certain powers under that Act. It has not been enacted, but were
it to be enacted, would that be a trigger mechanism at all for
the county to move out more aggressively and declare it?

MAYOR O’CONNOR: I would think so. It would certainly
help us in the city to then move to the county and assert the
position that it is declared an emergency and therefore we must
go along with the national policy.

CHAIRMAN WATKINS: Thank you. Dr. Crenshaw?

DR. CRENSHAW: Thank you, no. That covers it, and I
just hope that if any other ideas occur to you where we as a
Commission can help bring some support and pressure to bear to
accelerate the process in San Diego, I would really appreciate
receiving it in writing or getting a call.

MAYOR O’CONNOR: I appreciate that, Dr. Crenshaw. I do
think San Diego, as far as a community, we have a lot of good
programs that are addressing the issue of AIDS, a lot of
volunteers, a lot of church organizations, but they are running
out of funds.

Where, in other cities, there are problems about putting
the homes in neighborhoods, we have a very good program where we
go out and we talk to the community first, we get a lot of
community support. Our first home basically is going in without
opposition from the neighborhood. We take a lot of time and care
in selecting the facilities. We do have a lot of volunteers, but
there is what is called burn-out. We have the Owen Clinic, Dr.
Crenshaw, that you are well aware of, at U.C.S.D., that is doing
an excellent job. For example, they are just stretched to the
point where a computer that costs $6,000 would really help them
doing their patient caseloads so they are constantly one step

166

 

 
 

 

ahead of, I do not want to say financial bankruptcy, but it is
kind of emotional bankruptcy because there is a lot of good
people out there addressing this, that they need some support
from our government.

DR. CRENSHAW: Thank you.
CHAIRMAN WATKINS: Dr. Primm? Dr. Walsh?

DR. WALSH: I think any Mayor with the name Maureen
O’Connor is going to solve all the problems.

MAYOR O'CONNOR: Oh, that is what my constituency
thinks. They keep telling me that.

DR. WALSH: Now, Mayor, may I just ask one question? We
have had much advocacy for giving or recommending direct federal
grants to cities. Give me just a brief technical answer. We
know, in some states, the grants go to the state, then to the
county, then down, by the time you get it, everyone, the crisis
is either past or become so magnified that you need twice as much
as you asked for in the first place. If such a recommendation
were made and accepted on the part of the Federal Government,
does this in any way, would you be prevented from making an
application for such a grant without violating some kind of state
law or state rule or county rule or would it destroy the
discipline of the county health system or public health system?
It seems to me it would be a ridiculous rule, that is why, but
yet there are organizational reasons. Can you apply if there is
money available for direct city grants?

MAYOR O’CONNOR: If it is community specific in that if
it is health care, I mean, that obviously is the direction of and
jurisdiction of the county, but if it is social service
programming, transportation, housing, outpatient care, food
programs, yes. I mean, I think we can, through the U.S.
Conference of Mayors and the National League of Cities, we could
help carve legislation that will be more specific and the dollars
can get directly to the source and can be expedited.

DR. WALSH: That is what I meant. Do you actually need
new legislation to do that? In other words, I think we have all
been appealed to and understand the less bureaucracy, the better,
and if you could deal directly with the affected cities, it makes
sense, but will you have to frame legislation to make our
recommendations possible or is the existing legislation on the
federal level good enough?

MAYOR O’CONNOR: Senator Kennedy’s Senate bill, I think,
with a few modifications would satisfy everybody’s needs, yes,
sir. I think there is existing legislation that is going through
the process that can be worked on from the mayor’s standpoint.

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DR. WALSH: Thank you.

CHAIRMAN WATKINS: Would you be willing to give us those
modifications, mark up a copy and send it to us?

MAYOR O’CONNOR: Yes, Admiral, be glad to.

DR. WALSH: It is very important. We would like to
respond to this. We do not know how.

MAYOR O’CONNOR: Okay, I will be glad to send you --

CHAIRMAN WATKINS: It will be very helpful, I think,
Mayor, if you could do that, take that bill and then bring it in
line with what you and your colleagues in the mayoral business
believe is right for the cities and is worded in the right way
that makes the sense, and any additional information you have
surrounding that to justify that would be very helpful to us.

MAYOR O’CONNOR: Okay, that is fine. Our city as a
whole, the city council, has actually adopted a resolution in
support of the Senate bill with the modifications that we are
discussing so I would be happy to do that for you.

CHAIRMAN WATKINS: I would like to know if you have
the detailed knowledge of what happens to the aspirant for the
military that goes to the local military entrance command, is
examined medically and found to be HIV positive. How is that
individual returned to San Diego and properly counselled and
worked into your social service network to deal with the AIDS
epidemic? If you know that, I would like to have any details.

MAYOR O’CONNOR: I do know that, Admiral, and I think we
handle it very sensitively. The military works very well with
the organizations, the regional task force, AIDS projects, AIDS
assistance. We give them assistance through the mayor’s office
in that once they are identified, they are told that there is
help on its way, and we do integrate them into the system so it
is a very quiet, coordinated effort. We work very closely with
the military.

CHAIRMAN WATKINS: We received information from Mayor
Rudin of Sacramento that she felt it was not sensitively handled
in her region, and I am trying to build up enough information to
know because it has been raised to me on a number of occasions
that where sometimes it is plus and sometimes it is very minus
where there is less sensitivity to the transitional mode and make
sure that the pre- and post-test counselling and transition is
sensitively handled. So you are saying it is in San Diego.

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MAYOR O’CONNOR: It is, and I can send you, how we
handle it.

CHAIRMAN WATKINS: I would like to have that. If you
could include that in your letter to us with the other
recommendation, it would be very helpful to know exactly how it
is handled and that may be something that I can chat with the
Department of Defense officials on.

MAYOR O’CONNOR: That would be wonderful.
CHAIRMAN WATKINS: Mrs. Gebbie?

MRS. GEBBIE: I am tempted to ask you to reread that
quote from your County Health Director, except I think I would
get too embarrassed to listen to it again, and do have some
concerned about a County Health Director in a major metropolitan
area who does not seem to understand what is going on, and I
guess I wish if I had a chance to talk directly with him, I would
find out there was some other dynamic operating that could
explain it because in general, County Health Directors, at least
in metropolitan areas have grasped the need to get ahead of this
problem and to react.

A couple of questions, first related directly to that.
Has your county established any kind of a task force or group
that is in a position to work with the county level government to
try and break this log jam?

MAYOR O’CONNOR: We have a regional task force on AIDS
that was established before I was mayor. We have been very
effective in getting an anti-discrimination ordinance. Just as
recently as last Tuesday, the city adopted an ordinance to
control and regulate bath houses. I felt they should be closed.
The County Health Director said no, they should be regulated and
that is when we got into the dialogue that AIDS is not an
emergency. The regional task force is somewhat successful but it
is not at all as successful as it would like to be in explaining
their position to the Board of Supervisors.

MRS. GEBBIE: Is it an official body in the sense that
it was appointed and has legitimacy on account of government or
is it a more spontaneous thing that happened?

MAYOR O’CONNOR: It is an official body but it is
advisory in nature and you know how that goes.

MRS. GEBBIE: Yes, and people do not always take the
wise advice that is given to them. We are struggling to do that
here. The other piece relates to what you have already been
asked about several times, and that is this structuring of
grants. The piece that tends to worry me about grants directly

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to cities is that it will end up like a giant federal bureaucracy
to monitor lots of grants to small and medium-sized cities.

Money going to 50 states might be more manageable if there were a
way to explode it through the system so that it worked, and
obviously you do not think that is a workable model.

MAYOR O'CONNOR: Can I just give you an example, and it
is not related to AIDS, it is related to drugs. I was elected
Mayor of the city of San Diego about 20 or 21 months ago. Mayor
Koch called me two weeks after I was sworn in and said, you have
to come back to Washington, we have a war on drugs. We need the
Administration to start helping us. We went back to Washington
and we fought real hard to get $1.5 billion legislation passed to
address the drug problem, and the war that we are losing in our
streets and our cities.

We just now received the funds in city of San Diego. I
think we are now the sixth largest city in the country. We just
received our first allocation. The Justice Department had to
take care of it, and then it had to go to the state, and then
from the state it gets to the city. We just now received roughly
$400,000, 22 months later. AIDS patients are going to die by the
time you start getting the funds to the source in which it is
needed. And every time you go through a governmental layer, you
are adding on administrative costs to that dollar that has to be
taken off before it gets to the patient in this case.

MRS. GEBBIE: Do you have a good trail of that money and
that decision that could highlight the spots at which it stopped
along the way?

MAYOR O’CONNOR: Oh, certainly. I can get it for you.
MRS. GEBBIE: I think that would be very helpful.

MAYOR O’CONNOR: Just do not attach my name to it. I
have to get more money out of Washington.

MRS. GEBBIE: However you want to get it, send it ina
plain brown wrapper but I think it would be helpful as we
struggle because there will be forces that do not like that
direct local funding idea.

MAYOR O’CONNOR: Well, you have to understand, and I am
in politics and this is not a disparaging remark to my colleagues
in politics, but everybody at every level feels that they are the
only ones that can protect the taxpayer’s dollar to make sure it
is well spent, and I have been in the business long enough to
know that the dollar is better spent by the people who know the
problem and how to address it than the farther removed it is.

The further the decision makers are removed from the problem the
more waste you have. So if there is some way you can get it down

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to the cities, you are going to be more cost effective in the
long run.

MRS. GEBBIE: Thank you.

CHAIRMAN WATKINS: It would be very useful, and we have
just described enclosure three to your good letter to us that we
need because we have run into this many times before, and I think
if we put enough of these together, we may see a pattern of
sluggishness in the bureaucracy that we can attack, and certainly
I think when we have what really is a national health emergency,
this is a time when we should perhaps put in new processes into
effect, and allow that kind of direct application where we have
the highest density of health problems so it would be useful to
us. We are getting this from other sources as well, that I think
we will probably come up with some kind of recommendation to
facilitate the process under these kinds of conditions.

MAYOR O'CONNOR: And, Admiral, I think we mayors stand
ready to help. this Commission in any way possible because I think
you are our united hope that we will have a responsive ear in
Washington because if we do not, people are not going to realize
the epidemic proportions that this thing can lead to in the next
five to ten years without proper planning so I, the Mayor of San
Diego, would be more than willing to go back and support your
cause in Washington because I think we need everybody because
there is not a sense of emergency in Washington.

I mean, they do not have to see the mother coming in to
the mayor’s office that has a hemophilic child that is subject to
AIDS that was just released from the day care center because the
other parents do not understand that you cannot get it from hand
shaking. I had a meet-the-mayor session to just talk to anybody
that wants to talk to the Mayor of San Diego, and Wednesday night
a woman was convinced that someone put AIDS in her coffee. You
know, the education that everybody thinks is going on that
everybody understands we have a long way to go. We have come a
long way, but we have a long way to go, and we cannot afford to
wait for a five year, six year, seven year, long term plan. It
will be too late.

CHAIRMAN WATKINS: Dr. Lee?

DR. LEE: Let me persist with that line of thought. By
the way, your County Health officer reminds me of our New York
State Health Officer who says that HIV infection is not an
infectious disease. Clearly, he has some political agenda there
which is completely unrelated to the problen.

Let me ask you to think a little bit theoretically here.
You have painted a beautiful picture about the cities. Now, as I
remember, and please correct me if I am wrong, when some seven to

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eight years ago, there was a program where there was direct
federal grants down to the cities.

MAYOR O’CONNOR: Model Cities program.

DR. LEE: Yes, and so that instead of going through the
process that we have been talking about, there was a system where
federal tax dollars, everybody realized the cities had to handle
their problems, they are the ones that know their problems. They
get the dollars up front and forget about it. Now, that went sour
someplace, did it not? That dried up. What happened to that
program or is it operating?

MAYOR O’CONNOR: No, Model Cities, I was on the City
Council of the city of San Diego when it was implemented. I
think it went sour, like all programs, some people saw some
abuses and the Federal Government got tired of it and they wanted
to take back control. You know, the politicians for whatever
reasons, decided that we were allocating the funds, that they
wanted to have another, different kind of program so it just fell
out of favor but it was a very good program.

DR. LEE: It seems to me that this type of program would
be an incredibly good way to rectify it. Because, in my
reflection here, listening to you talk, the way monies are
handled in the United States, goes back to the way they were
handled a long time ago when we were sort of rural societies and
non-mobile, etc., etc. Now you have these terrific
concentrations of populations in the cities, and terrific
concentrations of needy populations going to the cities, and the
system just does not seem to be working any more.

MAYOR O’CONNOR: It is not.

DR. LEE: So maybe if you got a really good idea and it
seems like you have your finger on it, could you let me or
Admiral Watkins know? Do you have a recommendation on putting
that direct federal funding back to local government?

MAYOR O’CONNOR: I think that you will be hearing from
Mayor Agnos, and I know he is talking along the same lines, and I
think he has a proposal that he will be presenting to you that I
can give you from our perspective in San Diego what we need, and
we can give you a dollar amount, and I can check my record. I am
a woman of my word. I keep within the budget. I will spend it
for exactly for what I need it for. I am convinced that every
mayor in this country can come up with a program and stick with
it, if given the opportunity, but our problem is we are stagnated
by all of the layers that we have to go through to get permission
to do what is important in the first place. We have all of the
responsibility for this problem because we are on the firing line
on the cities and we have none of the authority.

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DR. LEE: Thank you.

CHAIRMAN WATKINS: Thank you very much, Mayor. We are
going to close this particular panel out and take a short recess.
I would like the Commissioners to stay in the general vicinity
here so aS soon as Mayor Agnos arrives, we can proceed with these
hearings. Thank you very much, Mayor, for coming before us
today. We appreciate very much your testimony.

I want to thank again Mr. Allan Harris and George
Seegers of the U.S. Public Health Service for the wonderful
support they have given us here. Dr. David Werdegar and Ann
Schlegel, San Francisco Department of Public Health who have
given us so much support, and particularly the host of our site
visits to the Shanti Project, to the San Francisco AIDS
Foundation, San Francisco General Hospital, Bayview-Hunter’s
Point Foundation and the Mid City Consortium. We thank you again
for all of the courtesies you have extended to this Commission.
It has been very informative for us. Thank you.

( BREAK} )

CHAIRMAN WATKINS: The Commission members will now come
back in. We will commence our final panel this morning before we
adjourn to the site visits. We have with us this morning the
Honorable Art Agnos, Mayor of San Francisco. We are very
pleased, Mr. Mayor, that you take time out of your schedule here
to come and chat with us today. This is an important city. We
have learned a great deal here. We have had your predecessor
here talking a little bit about her experiences prior to your
arrival on the scene as Mayor and we look forward to your
statement, sir.

MAYOR AGNOS: Thank you very much, Admiral, and members
of the Commission. Welcome to San Francisco. We want you to
know, I feel like I am back in the legislature here. I have not
done this in a few months. It feels good.

CHAIRMAN WATKINS: We are much more friendly, Mr. Mayor.

MAYOR AGNOS: We want you to know about AIDS and San
Francisco and what we think needs to be done. You have already
heard from our fine Public Health Director as well as the
President of our Health Commission and former Mayor of San
Francisco who has lived through most of the entire history of
what you have been hearing about in our city so I think you have
gotten a good handle, and I hope that we can add a little bit to
what I am sure has been some outstanding presentations not only
from our local officials here in the city but also from around
California.

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San Francisco has already lost more young men to AIDS
than all San Franciscans who died in World War I, World War II,
Korea, and Vietnam combined and doubled, to give you some sense
of what the proportions are. The word decimate means literally
one out of ten, and in San Francisco, by the end of this year,
one out of ten gay men in our city will have died of AIDS or be
diagnosed as having AIDS, and within five years, it will be one
out of four in our city. They are San Franciscans in the prime
of their lives, hard working, good citizens, whose contribution
to our city is without question.

But the pain and suffering you hear from those of us who
have lost friends and loved ones in this city to AIDS is not just
a San Francisco story, and if you remember nothing else from this
Mayor today, please remember that. AIDS is not a San Francisco
story, it is a California story, it is an American story, and it
is a world story. Today, there are perhaps 30 American cities
who have the same level of AIDS cases that San Francisco had just
three years ago, and while the level of new infections is almost
levelling off here in our city, in the gay community, that has
not been the same experience elsewhere. The results for those
cities are inevitable and indisputable, and what our city has to
offer them and to offer you is not a picture of what the epidemic
in their city is going to be like five years from now. What we
offer is a model of how to meet the epidemic in ways that involve
people which are cost effective and which care about people.

I want to particularly single out to you the important
role that people with AIDS and ARC themselves have played in San
Francisco. They are not AIDS victims. They are people who are
living with AIDS and who are fighting to see more of us alive.
They staff the hotlines that guide people who are newly
diagnosed, they help counsel families trying to deal with grief,
and they educate in every part of our city, including our high
schools, to wage war against new infections. I commend them to
you, and I strongly recommend that you consider their
contribution when others urge you to treat people with AIDS as a
danger to our society or as helpless victims who have no role in
determining their own needs.

My own involvement with AIDS public policy includes my
work as a member of the California State Assembly before coming
into the Mayor’s office. It dates back to 1982 when California
had fewer than 100 cases statewide. I sponsored an AIDS
education forum in San Francisco and sent mailers to communities
in Fresno and Modesto, and I did it because no one else would.
No state money, and no federal money. In 1983, as Chairman of
the state legislature’s Ways and Means Subcommittee on Health, I
provided the first state funding for AIDS education. We did it
alone in California at that time because there was no federal
help, and in 1984 I doubled the funding to $1 million, and we
still had no federal AIDS education funding. In 1985, I authored

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the first law here in California, setting public health standards
for the use of the AIDS antibody test within months after it was
released by the federal Food and Drug Administration, including

consent and confidentiality provisions. The Federal Government

did not provide that leadership, they left it to the states and

we were the first to respond.

Finally, in March of 1987 I requested and won approval
for a special joint session of the California state legislature,
a very rare occurrence in our state capital, on the AIDS
epidemic. The Surgeon General of the United States, Dr. C.
Everett Koop, and a Nobel Laureate, Dr. David Baltimore, the
co-chair of the National Academy of Science Institute of Medicine
panel on AIDS came to the California State Capitol and spoke in a
highly unusual session. I was dismayed then that Dr. Koop, our
nation’s top Public Health officer, had not been invited to bring
his message directly and personally to the President of the
United States who has appointed him, and I am still dismayed, a
year later, that Dr. Koop has not been invited to fully brief the
President of the United States on our nation’s most serious
health crisis, nor has he been invited to play a lead role in
setting our nation’s policy, and I respectfully urge this
Commission, without delay, to recommend to the President as part
of your recommendations, that he meet personally with his Surgeon
General and that they appear publicly to end the impasse that
public health officials face from those who hold political
office.

I understand and have experienced that impasse. As a
state legislator, I worked with Public Health Officials on every
AIDS bill that I authored, and there was never one that was not
supported by them and the medical community. Without exception,
those bills had the support of the public health community with
AIDS care providers and the entire coalition of health
professionals and consumers. But time after time, what the
public saw was a political, partisan line being drawn. I think
that was an artificial line drawn for artificial reasons, but the
delay results in deaths which are not artificial.

Working with the United States Surgeon General, I
drafted an omnibus AIDS bill that incorporated the
recommendations from his 1986 report to the people of America.
I also worked with the National Academy of Sciences Institute
of Medicine. The bill was hailed as a model for the nation, a
measure that could save lives. While Dr. Koop does not endorse
state legislation, he confirmed that he had worked on each draft
and we prepared it and said the bill was the most compassionate
he had ever had presented to him, and in the California State
Assembly, only one Republican voted for it, and he was the only
physician in the legislature. In the California State Senate,
not even one Republican would vote for the bill.

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The centerpiece of that legislation was the creation of
a California Commission on AIDS. It would bring together the
public sector and the private sector, the many agencies of state
and local governments and a range of individuals who are affected
as employers, police, insurance executives, physicians, nurses
and people with AIDS themselves. The same approach has been
recommended by every public health association for the nation,
but it has yet to happen. This Commission is a temporary
stopgap, not the national body that we need to oversee all parts
of our policy on AIDS. It is overdue, and it should not have to
wait for an election to happen. In the interim, I urge you as a
Commission to call for the establishment of a powerful body that
can review existing programs of every kind to see whether they
might be put to work to help us combat AIDS and to provide the
assistance we need for demonstration programs and rule changes
where the need is already evident.

In San Francisco, we have a model program called Open
Hand. Volunteers, including professional chefs from some of our
city’s finest restaurants prepare meals that are taken to people
with AIDS who are still able to live at home, but unable to
prepare nutritious meals for themselves. It is very much like an
older, more established program called Meals on Wheels except
that Meals on Wheels is barred from helping people who are under
the age of 65.

We have no nursing facility for people with AIDS in
San Francisco. Indeed, we have virtually no facility in all of
northern California. The reimbursements rates simply are too
low for the cost of care. The fear of other patients and their
families is too high. We are seeking to have the Public Health
Service Hospital in San Francisco converted into a facility that
can help meet that need, particularly those that face the dual
diagnosis of AIDS dementia. But the process of winning federal
approvals for such an innovation and the help that we need for
the operating costs will take years before the project is
complete. Those who need it this year and the next likely will
not live long enough to find it of service.

Too often, federal rules prohibit demonstration project
funds from going to programs that have already been launched.
We call that here the San Francisco penalty. Our city begins a
program, proves its effectiveness, uses our own funds, and then a
federal demonstration program is created but only for new efforts
that come after it, using us as the model. When the Commission
proposed a $1.5 billion program for AIDS and substance abuse, you
called for local and federal match.

San Francisco wants and needs such a program. We have
less than a dozen beds for women who have child care needs who
require residential substance abuse programs. We have an
aggressive street outreach program to meet IV needle users,

176

 

 
 

informing them of detox programs, counselling programs, and how
to clean needles with bleach.. I helped start those programs with
a state pilot that is now being expanded statewide. But the
federal component comes from a block grant that was a one-time
appropriation from the War on Drugs. Your proposal could help us
put in the residential treatment program we need while keeping
families intact. We could continue our model street outreach
programs but unless you make it clear that there will be no
penalty for programs like ours that are already started, the
announcement you made intending to encourage us all will be an
incentive for further delay.

Cities simply will stop innovations, stop bridging the
gap, and wait for the pipeline which may never open. San
Francisco will not do that, but you can remove the issue from the
table by simply including an ability for programs like ours to be
grandfathered in. The burden on cities such as ours in San
Francisco is going to grow greater, even though the new
infections level off. The incubation period guarantees that the
pipeline will continue to bring new cases.

But, beyond that, a major shift is taking place in
meeting AIDS costs. Two years ago, about 30 percent of San
Francisco’s caseload were publicly funded cases, including
through our state Medical program. Today, there is almost 50
percent whose costs must be borne by the public sector. As
insurance redlining increases, as employers feel free to limit
health benefits so that AIDS is not covered, or worse,
discriminate against those with AIDS, the costs are going to fall
straight on the cities. This will continue to be a particularly
true situation in states like California, and about 35 others
where a no-risk pool program exists for those unable to help
obtain health care. They drop straight on to the public roles.
The Federal Government has an opportunity to play a major role in
creating federal incentives to states to create risk pool or stop
loss programs including case management that can spread the cost
of AIDS care sensibly and equitably between employers, insurance
and the public sector.

I particularly want to call to your attention to the
fact that one out of every two dollars paid for by California
employers for health care comes from a self-insured plan that
they underwrite on their own. The state and cities have no
authority over such programs. The conditions of benefits,
whether home care and hospice, is reimbursable, even whether
certain diseases, such as AIDS, could be redlined out, are issues
to be reviewed by the U.S. Department of Labor. I have yet to
see policy guidelines to employers on AIDS in ERISA plans. The
federal-state share of AIDS care, according to the Health Care
Financing Administration, is only 53 cents on the dollar. The
other 47 cents is absorbed by the doctors, hospitals, and
charities. For us that means San Francisco taxpayers because our

177

 

 
 

major hospital, San Francisco General, is a part of our city’s
health department.

The specifics of our needs are long. We need help for
homelessness with AIDS. In San Francisco, we estimate that
number at somewhere between 200 and 600 people. We have fewer
than 80 beds. We need significant funding for case management,
including money management, and eligibility workers for those who
should receive veterans’ benefits or SSI. We need to create
health centers capable of monitoring and possibly providing early
intervention for those who are antibody positive, something many
San Franciscans with independent incomes are doing through the
private sector but which is still out of reach for those who rely
on the public sector for help.

We need better coordination of new drugs, and better
access to investigational drug opportunities. We need a federal
consumer protection program to halt AIDS fraud, just as we are
doing through the Attorney General of California and his AIDS
fraud task force, which John Van de Kamp created last year. Most
of all, we need committed leadership in the White House itself.
Cities like San Francisco have shown what can be done. I cannot
tell you how many visitors I get through City Hall from all parts
of the world as well as all parts of the country who are coming
to see what we have created with our own unique enterprising
public-private sector cooperation.

What threatens to overwhelm San Francisco is not the
increased caseload of AIDS but the continued lack of leadership
from the Federal Government, and we hope that you will provide
that with your recommendations to the government. Thank you very
much.

CHAIRMAN WATKINS: Thank you very much, Mr. Mayor. I
would like to open our questioning with Dr. Lilly.

DR. LILLY: Good morning, Mayor Agnos. I would like to
ask for a little clarification of what types of
anti-discrimination measures for people with AIDS exist in San
Francisco on any level, federal, state and local. Do they work,
and what do you, what role have they, have they helped in the
crisis? Do we need more?

MAYOR AGNOS: Yes, we have a city ordinance that
prohibits discrimination against people with AIDS in employment,
housing, I believe, and public accommodations. At the state
level, I have tried to include a similar provision in employment,
and that has not been signed into law by the Governor even though
his own Fair Employment and Practices Commission has decided that
AIDS is a handicap, someone with AIDS has a handicap and is
protected under the existing law so the Governor has used the
rationale since it is already protected under existing law, we

178

 

 
 

 

do not need to specify AIDS and single that out. So at the
state level, people can apply for the Fair Employment Practices
Commission if they have AIDS and are the subject of
discrimination in employment and housing I believe. Right?

And housing.

Yes, I think they do help because if people are
discriminated against, and people do not feel protected,
obviously they are going to go underground with their illness
and I think that that simply adds to the possibility that the
infection will be spread.

DR. LILLY: Do you think that the current laws are
adequate to prevent discrimination? Do you think that there
is residual discrimination?

MAYOR AGNOS: I think here in San Francisco they are,
and at the state I would like a little stronger statement. In
fact, when I was pursuing the legislation that I was describing
that I worked up under the, with the cooperation and assistance
of the Surgeon General of the United States, part of that was
AIDS discrimination. We were supported by that by the business
community, by people who traditionally are not seen as civil
rights advocates because they wanted a clear statement from the
government that would spell out just what the ground rules are.
Today, we do not have that. We have kind of a patchwork of local
ordinances that make it confusing for business in particular and
employers to know what the law is and to be guided by that, so I
think it would be helpful, yes, sir.

DR. LILLY: Okay, and I am a little surprised to hear
you say that you really do think that your measures are adequate
in San Francisco. I suspect you are, perhaps, better off than
many other parts of the community but we have heard that there
are problems.

MAYOR AGNOS: Well, of course there are always problems
when you have laws that protect people, but the laws are in place
here. They are not elsewhere so people have a remedy that they
can seek in San Francisco that does not exist elsewhere.

DR. LILLY: The 20 percent increase, increase from 30
percent to 50 percent in the number of cases that fall on the
public role then for support, is that in any sense related to
discrimination perhaps with respect to availability of insurance,
medical insurance.

MAYOR AGNOS: I have no doubt that is part of it.

CHAIRMAN WATKINS: Mrs. Gebbie?

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MRS. GEBBIE: ‘Two different areas I would like to ask

quest! ons on. The first is related to what Dr. Lilly was just

asking. In discussions around this whole issue of discrimination
and how we should define the groups to be protected, generally
people are pretty clear that they mean people with AIDS,
diagnosed patients, and that seems to be where everybody rallies
to very quickly, and people who are HIV positive, that is, test
positive. Another group that is at times included are people who
may be discriminated against because they are thought to be at
risk of the disease. That then would often extend to protection
against discrimination for somebody who might lose their housing
because a man looked like he was gay and therefore was at risk of
AIDS and got thrown out, not fitting into one of the earlier
categories because he may or may not be gay, may or may not be
HIV positive, but just kind of looked that way. How far along
that list would you carry the anti-discrimination protections?
Do you see that last group as appropriate to include, and how
would you word that protection if you did?

MAYOR AGNOS: Well, certainly the first part should be
included. The second part, and I think the federal legislation
which Congressman Waxman has introduced and is moving through the
Congress, is worthy of your attention and support. It has mine.
As to the second part of your question, I am not sure if it is,
if I would limit it to someone who looks gay, whatever that
means, or I think it is all human beings who are at risk so I
think that we have to define the law in a way that anyone who is
discriminated against because they are thought to have AIDS, be
they man, woman or child of any race, creed or color, are the
ones that have to be protected so I would think that I would
draft the law in a way that just speaks to the illness that is at
risk rather than --

MRS. GEBBIE: Have or thought to have.

MAYOR AGNOS: --rather than a particular type of
individual that we originally may have thought was the person who
was at risk because clearly you know, as a Commission, that that
no longer is the case.

MRS. GEBBIE: But the thought to be at risk or thought
to be in there is something that you would --

MAYOR AGNOS: I think that I would try to, my brain is
ever here whispering to me. Mr. Bush, Larry Bush, who is one of
my advisors on this tells me that the California law says that
people are protected if they are perceived to be at risk. That
might be one way of dealing with it.

MRS. GEBBIE: I think receiving a full copy of that
language would be helpful to us.

180

 

 
 

MAYOR AGNOS: I will see to that.

MRS. GEBBIE: Good. The other area that I have a
question about is the issue of regional needs. We have heard a
lot today about cities, but in an urban area like this, as in
many parts of the country, people’s daily lives are carried out
almost in ignorance of where city boundaries stop and start.

MAYOR AGNOS: Absolutely.

MRS. GEBBIE: They live, work, play in several different
areas. Concentrating funding solutions on cities, therefore, may
not be right because a city might be surrounded by some
relatively small areas that would not ever qualify as a city but
which are a part of that area’s pattern. How would you suggest
we tackle that or how have you tackled that here in the Bay Area?

MAYOR AGNOS: I agree with you. I do think we need a
regional approach. I think that especially in our region, San
Francisco is seen as the city to come to if you have AIDS. In
fact, in our country it is seen as the city to come to because of
our very extraordinary programs to help people with that, and I
think giving the kind of regional help that you are suggesting in
your comments would go a long way to equalizing the kind of
services that are out there. As I said, our services have been
developed internally and/or originate with our own community and
we need your help to spread them out by funding out by funding
ours as well as those regionally. San Francisco has already got
a regional approach to this. Our Public Health Director meets on
a regular basis with other Public Health Directors and people who
are concerned around this problem to develop regional responses
to the AIDS issue so we are doing that here, and I think we are
going to move further down that road under my administration

MRS. GEBBIE: Would you, in looking at the economic side
of that, recommend finding a way to channel funds to that sort of
central city to reach out and define its region or would you do
both separately or how would you start with that?

MAYOR AGNOS: I would like to see us do both. I would
like to see us fund some programs that are up and running. I
hope you will remember the San Francisco penalty.

MRS. GEBBIE: Yes, that was a well made point.

MAYOR AGNOS: And we need to fund our programs that are
up because we are truly educating the world. We have had members
of the West German Parliament here, I have had the British
Secretary of State for Health and Welfare here. People come from
different parts of the world because they have heard, and are
directed by Washington, by the way. They send them to San
Francisco from Washington to see what we are doing so that they

181

 

 
 

can learn and take that back to their respective countries and we
also have, as I said, people coming from other states and cities
to see what we are doing so we are educating the country and the
world on what a good response is in terms of care as well as
compassion for AIDS victims, and I think we need to be recognized
and supported in those efforts.

At the same time, I think we have to create a track that
encourages your correct point of approaching this on a regional
basis rather than a kind of patchwork basis that occurs now if
you only look at cities in desperate need. I think your funding
stream could make that happen by saying we will fund this kind of
overall approach through a regional kind of task force, and leave
it up to us to create it or not be eligible.

MRS. GEBBIE: Thank you.
CHAIRMAN WATKINS: Dr. Lee?

DR. LEE: Mayor Agnos, this Commission has made every
effort to approach this problem on a non-partisan basis. You
have had difficulties with partisan politics which comes through
in your talk. If there is one thing that I want to send you, the
message is that we are not going to approach this problem on a
partisan basis. We are going to approach it as we see and so
please do not except us as part of the problem. We are going to
be part of the solution.

I have two ideas which I would like to run through you.
The first is an idea that we talked about with Mayor O’Connor.
What do you think about the original Model Cities federal grants?
I understand from one of my associates here that one of the major
reasons it went sour was corruption, local corruption. What did
go wrong with that program, and why is it not a good idea?

MAYOR AGNOS: You are talking about Model Cities in
housing?

DR. LEE: I am talking about direct federal grants to
localities rather than going through this process that currently
we seem to be going through where you apply for something and
three years later, you start getting part of the money.

MAYOR AGNOS: I would have to go back and study the
history of what happened under Model Cities. That was about 20
years ago, was it not?

DR. LEE: No, it is not 20 years ago.

MAYOR AGNOS: Fifteen years ago? You are talking about
Model Cities that was proposed under the Johnson Administration I
think.

182

 
 

 

DR. LEE: And they had direct federal grants.

MAYOR AGNOS: Yes, I understand. I remember the
concept. What I am trying to say is I do not remember what went
wrong, and I do not think it was corruption in our city although
that may have occurred in other cities. I am very open to that
suggestion and would welcome pursuing that idea. I think our
city should be a Model City in how to provide compassionate care,
and I do not think we can afford to go through this laborious
process that now exists in terms of getting the funding because
we got the programs working. We just need the help to expand
them, and use them to show the rest of the country and, as I have
said, the world, how to do it so I would welcome that suggestion
and would be anxious to work with the Commission or whomever you
deem appropriate to try and develop it.

DR. LEE: I notice in your report and from your comments
that you are an admirer of Surgeon General Koop.

MAYOR AGNOS: I think he is terrific.

DR. LEE: We share that admiration. One of the crazy
thoughts that I have had that I would like to put across to you
is if there was a national effort and a national community drive
on this problem, would not he be the logical, or the Surgeon
General be the logical head of that, number one, and number two,
what would you think about bringing health out of HHS and making
the Secretary of Health a Cabinet position. Would not that
enormously strengthen the health industry and the hand of the
Surgeon General?

MAYOR AGNOS: Absolutely. I think they are both
outstanding ideas.

DR. LEE: We have a bipartisan position, sir.
MAYOR AGNOS: I was known for that in the legislature.
DR. LEE: The other guys did not --

MAYOR AGNOS: The other guys did not like it, that is

all.
CHAIRMAN WATKINS: Dr. Walsh?
DR. WALSH: Mayor Agnew, Agnos, again -~
MAYOR AGNOS: That was the Republican.
. DR. WALSH: Mayor Agnos, on the -- he was Greek, though,
CO --

183

 

 
 

 

MAYOR AGNOS: Yes.

DR. WALSH: Again, we find ourselves commending the city
of San Francisco for what it has done and the foresight that it
has had. I just have a couple of very brief questions. First,
in regard to your suggestion about a permanent oversight
commission at the federal level, I find myself very concerned
about this because I wonder if you would not be recreating the
ogre that you are trying to get rid of which would namely be a
permanent body that would have extreme difficulty in staying
non-partisan. One of the strengths that this Commission has is
that we can be very free and totally non-partisan and recommend
with a flair if we wish because none of us have permanent
ambitions.

Having lived in Washington as long as I have, I find
permanent oversight commissions are something that states wish
they had never heard of once they got them but I just wanted to
comment on that.

MAYOR AGNOS: Well, I think that is a thoughtful idea
that I see at the city level. When you talk about commissions,
you see people, even ongoing commissions, people get on the
commission and sort of invest themselves in those, and try to
become the very embodiment. I think you can handle those kinds
of problems by limiting the term in the creation of the
commission saying no one will serve more than two terms or four
years or two years or whatever you set. I think you can also put
a sunset on the commission itself and say it will have to be
renewed in four years or eight years or ten years. With AIDS, we
know that this is going to be with us for the foreseeable future.
We have no cure, we have no answers, and I think a commission
would depoliticize to a much greater extent this disease which
has become so politicized.

In the state legislature today, there are some 100, in
the California state legislature, there are some 170 different
bills introduced by politicians from all parts of the spectrum
politically. I want to tell you, with all due respect to my
colleagues, they do not know a hell of a lot about AIDS. They
are listening to various special interest groups, be they police
officers, firemen, consumers, doctors, nurses, religious figures
and they all introduce their very narrow, special interest. I do
not think that is the best way to form public policy in this
state or in this country. We need to depoliticize that process,
and we need to put it in the hands of people who will use one
single criteria, and that is a public health approach. Every
single piece of legislation that I introduced and passed always
used that criteria. It was not political, it was not consumer
oriented. It was what is in the best interests of public health.
That must be the only criteria, and I think a balanced commission

184

 

 
 

would depoliticize to that extent that that is possible in a much
greater way the current situation that we have where we have
everybody from the left to the right proposing their solutions to
the AIDS crisis and I do not think they have a public health
orientation.

DR. WALSH: I understand that, and you know we have 45
bills alone before the Congress written by the same type of
people in most part that you are talking about.

MAYOR AGNOS: That is right. I think we also help the
legislature --

DR. WALSH: My only concern is, you know, the concern I
have raised was, we have seen and heard amply before this
Commission the problems even that we have an Interagency Advisory
Group in the Federal Government headed by the Assistant Secretary
of Health and so on. Basically, they are career people. They
are theoretically apolitical and so on, and we have found, at
least, I cannot speak for the whole Commission, I certainly have
found in my experience that this has slowed progress rather than
advanced it. This is my personal feeling, and that is why I
raise that concern.

Just a quick question that I want to ask you is several
of the mayors who have been before us today pointed out that our
recommendation of the 50-50 state-federal division in our interim
report simply would be impossible for most states or cities to
cover, and they seem to come out with a ratio of 80 percent
federal, 20 percent state as something more realistic. Do you
subscribe to the fact that, we know that you have a terrible
deficit here.

MAYOR AGNOS: I was just going to say, Dr. Walsh, I am
looking at $172 million deficit in our city.

DR. WALSH: I know, but again I mean it would help us
because I think we recommended what we did, I think, in good
faith thinking it was a very realistic division. We do not want
to go in with our final report than less than a realistic
recommendation if it is going to have any impact. Would you want
to comment on that?

MAYOR AGNOS: I do not want to, I think that at least
75-25, if not 80-20 kind of ratio would be the kind of thing that
would make it workable for us, 50-50 simply we just cannot handle
it. We are going broke right now, and part of our deficit is
because of the increased caseloads that we have, and the programs
that we have right now dealing with AIDS so I would subscribe in
general with the same idea.

185

 

 
 

 

 

DR. WALSH: And the other thing that has been raised, I
would like your opinion on, is a mechanism to get grants directly
to cities without going to counties or states. Do you subscribe
to that?

MAYOR AGNOS: Yes, I think that is what Dr. Lee was
suggesting with his Model Cities approach. I think that our city
would be an extraordinary Model City. We already are, we are
just not being compensated for it, and we are looking at cutbacks
in some of those model programs or at least stopping their growth
simply because we cannot afford it and that would be a tragedy.

DR. WALSH: Thank you.

CHAIRMAN WATKINS: Dr. Primm? Excuse me, Mr. Mayor, we
have used up a lot of time, but if you can stay just a little bit
longer, I think we will have a few more questions. Do you have a
cutoff time?

MAYOR AGNOS: No, sir.
CHAIRMAN WATKINS: Good. Dr. Primm?

DR. PRIMM: Yes, you had indicated this before in your
testimony that when you sponsored a bill in the legislature it
always had a public health benefit to it. Currently we have been
notified that there was such a bill sponsored where you would
forbid physicians from telling another physician the HIV antibody
status of a patient and also that you would forbid a physician to
tell a spouse or a significant other of the HIV antibody status
of a patient. Can you comment on that?

MAYOR AGNOS: Sure. That was March of 1985, when the
Federal Drug Administration issued the HIV test prematurely
because there was a kind of hysteria in our state, in our
country, around contaminated blood, where people had in good
faith earlier donated blood that we then were realizing was
contaminated with the AIDS virus. We needed a response to stem
the hysteria around blood banks and all of the implications with
that.

The FDA rushed this test which they admitted and
acknowledged publicly was imperfect, had a high false positive
rate, but nevertheless, it was worth throwing out the good blood
with the bad blood in a high proportion in order to protect the
nation’s blood supply. They recognized those weaknesses in this
early test, and recommended that procedures be put in place that
would protect the people who were taking the test or who were the
subjects of the test at that time. So I jumped on it very
quickly because we were having the problem here to protect the
confidentiality and the security of those people who were the
subjects of the tests. It was done with the full knowledge,

186

 
 

support and cooperation of the medical community, both public and
private. There was no opposition. In fact, it rolled through
the legislation almost unanimously and was signed by the Governor
who has not signed many pieces of AIDS legislation in this state
so there was no controversy at that time. As I said, it was
supported by public health officials, private groups, blood
banks, American Red Cross, you name it, they were there. I think
only Jerry Falwell opposed it, that type of person but I think he
more opposed whatever I did rather than the issue.

So at that time, there was no controversy around it. As
the test was refined and improved a little bit and the medical
community became aware of some of the uses of it that we
discovered there were not the kinds of problems that we initially
anticipated which the FDA concurred in, by the way. So over the
last two years, I have introduced several pieces of legislation,
including one that is right now in the final step of the
legislative process waiting to go to the Governor that would
loosen up those confidentiality procedures, that would allow for
the medical team to discuss among themselves without getting a
written permission from each person that was affected by the HIV
tests so that a doctor could talk to another doctor or to a nurse
or to someone while retaining the information in a separate part
of the medical jacket so we have been trying to loosen that up.
However, since that legislation also included a restatement of
the anti-discrimination portion, the Governor has not seen fit to
support it in the past. I am hoping, this year, as the more
information is made known to him about discrimination, that he
will sign it.

There are other pieces of legislation that are going
through now in the legislature since I have left to loosen this
up but I just want you to know that over the last two years, as
we have become more knowledgeable, this is a disease, as you have
learned, we are learning something new every week, every month
and so initially, you are correct. We were very restrictive
because we just did not know what was going to happen with this
imperfect test. As we have seen it put into use, we have learned
that we can loosen up those restrictions and I have proposed
doing that.

However,-let me say in saying that, I do not think that
we ought to treat this test like a blood pressure test. I have
great faith in the doctors but I do not think they are the gods
that they would have us believe they are. We are mandating and
seeking to give AIDS education in our high schools as a way of
preventing this disease, yet we do not mandate that for doctors
who are administering these tests. They are going back on what
they learned in medical school in 1952, and certainly we are
learning things about AIDS every week that doctors are not
mandated to learn but we are saying our high school kids should.
I think we ought to balance that before we give the-doctor carte

187

 

 
 

 

blanche with this kind of information that has so many
implications in the social well being, the professional well
being, of the patients that they are working with.

DR. PRIMM: I appreciate your forthright response and
certainly your candor.

MAYOR AGNOS: Thank you, sir.
CHAIRMAN WATKINS: Dr. Crenshaw?

DR. CRENSHAW: I would appreciate a little further
clarification perhaps on some of the bills that are before the
legislature to amend the original law because as I recall, when
attempts were made to amend it so that spouses could be told,
that you were not in favor of that, and eventually it was amended
and I do not recall whether you supported that or not.

MAYOR AGNOS: We did.

DR. CRENSHAW: What is your current point of view since
the law is still on the books that does not allow a physician to
warn a sexual partner? On contact notification, do you still
hold the original position that sexual partners should not be
told, or are you proposing an amendment and supporting a change
in that so that sexual partners can be warned?

MAYOR AGNOS: I am sorry, I have had a few other things
on my mind in the last three months, and I am not up to date on
what the current status of those bills are in the legislature.

A colleague of mine, I think it was Assemblywoman Teresa Hughes,
was pursuing that spousal notification bill. There was some
controversy around that because people were afraid that if it
was freely given without the kind of information that should
accompany that kind of notification on the part of the doctor,
that people would be afraid to go to their doctors. I wanted to
see us mandate certain AIDS educational components for doctors
who were going to use this test and then inform the spouse about
it because right now they can do a lot of damage if they are not
properly informed and well educated about AIDS and this test.

So I was opposing it because we were not building in the kind of
informational educational protections that I think the consumer
needs in that kind of circumstance.

You were talking about contact, I am sorry.

DR. CRENSHAW: The second part was what is your current
opinion or position on duty to warn the sexual partners because
the spousal part is being treated separately from sexual
partners. What is your current position on notifying sexual
partners and duty to warn there?

188

 

 

 
 

MAYOR AGNOS: Well, I think we ought to use the Public
Health model and in using, in informing people, and I think
whatever protects the public health, as public health defines
those procedures is what we have to follow, and as a politician,
I do not want to tell them how to do it. I think they have to
tell us.

DR. CRENSHAW: But you would not oppose or object to
contact notification if it were thought wise by the Public Health
Department?

MAYOR AGNOS: You know, Dr. Werdegar, who testified
earlier, could give you a more specific answer to that because we
do have a very good contact model, tracing model in this city,
and it is working well, and I am sure he could give you the
specifics of it.

DR. CRENSHAW: For heterosexuals primarily I believe,
but perhaps I need to be updated on that. And then after this, I
have one quick bit of advice I need from you. Yes.

DR. WERDEGAR: We do contact notification in San
Francisco, but it is of a limited nature. We provide contact
notification, this is all voluntary of course, as you do not get
the information in any other way, to the opposite sex partners of
those identified as HIV positive who indicate to us that they
would like this information conveyed. It is usually in the
circumstance of a man who is HIV positive who either through
a@rugs or through homosexual exposure to the virus has also had
female heterosexual contact.

Our view is that the female heterosexual contacts may
not have been aware, through educational programs and so forth,
that they might be exposed in this way so we provide the
notification. We mainly think that, to summarize it briefly,
that contact notification, at least in our community, is mainly
of value in preventing perinatal transmission of AIDS, and we use
it for that purpose.

There is one important point to be made about contact
notification to distinguish it from that which is used for other
venereal diseases, syphilis, over the years, in the public health
context. Those were usually for illnesses that had a short
incubation period, and where you could trace and do contact
notification over the last weeks or months in which there might
have been infectious exposure. Here, we are dealing with a
situation where one may have acquired infection from a sexual
relationship that dates back six, seven, eight, nine years, and
that provides a major practical impediment to doing widespread
contact tracing and notification. I might say further that it
is an extremely expensive public health measure. We would say
that for each attempt at contact tracing and notification, at a

189

 

 
 

 

minimum for each person in terms of personnel time and hours,
it is perhaps in the order of $200 so when you are looking at
resource expenditures for prevention, this would not be high on
the list.

DR. CRENSHAW: This is one of the things the Commission
is trying to struggle with because balancing the $200 budget
figure against not reaching someone in time and then the cost of
treating them is really quite a dilemna.

DR. WERDEGAR: In setting the priorities, therefore,
just so I could reiterate, I would use it where there is
possibility of preventing perinatal transmission. That is what I
think is the most effective use of contact notification on a
voluntary basis.

DR. CRENSHAW: Gosh, I would hope you would use it to
protect the women along the way. I am advocating a lot of
attention to women that sometimes I think get overlooked and we
skip right to the babies, but be that as it may, one thing I
would really appreciate your help on, Mayor Agnos, is that we
just heard from Mayor O’Connor, who is having a very difficult
time releasing any funding from San Diego for AIDS education and
prevention. You succeeded in letting or getting funding, the
million dollars you talked about to begin with when you had no
federal support and no outside help, and managed to do that
before you were Mayor. Can you give any practical
recommendations to a Mayor in San Diego who is trying very hard
to get local funding as federal funding is not yet available
there to get more action, more effort, more energy, devoted to
this problem? She indicated that since the Public Health
Department had not declared it an emergency locally that $6
million that they are holding cannot be attributed to the disease
because of the Proposition 13 restrictions but I would think with
your being very street wise, and having had to fight these
battles up here, there might be some methods that would not have
yet occurred to us yet in San Diego.

MAYOR AGNOS: I just met Mayor O’Connor a couple of days
ago. I will call her and see what we can do about giving her
some advice. I need more advice from her than I can give to her
about how to deal with some issues so maybe we can work together.

DR. CRENSHAW: I would really appreciate that.

MAYOR AGNOS: Thank you.

CHAIRMAN WATKINS: One quick follow up and then we must
close.

MRS. GEBBIE: Just a follow up question to Dr. Werdegar.
We have heard a couple of different cost calculations on contact

190

 
 

 

notification programs, either on a cost per unexpected case found
or cost per contact, and it would be helpful to have your figures
from your program here in San Francisco, if you could supply them
to us, just for comparison with the other information we have
gotten.

DR. WERDEGAR: I will ask Dr. George Rutherford, the
head of our AIDS office, to furnish these to the Commission.

MRS. GEBBIE: Thank you.

CHAIRMAN WATKINS: Mr. Mayor, we thank you for the warm
reception the Commission has received here in San Francisco. It
has been a very useful and fruitful event for us. We have
learned a great deal from a great city, and we thank you very
much for your courtesies.

MAYOR AGNOS: Thank you, sir.

CHAIRMAN WATKINS: That will complete our hearings here
in San Francisco, and we now stand adjourned, as we depart for
site visits at the San Francisco AIDS Foundation, San Franciso
General Hospital, and Bayview-Hunter’s Point Foundation.

(WHEREUPON THE HEARINGS WERE ADJOURNED. )

191

 

 
 

APPENDIX

 

 

 
 

 

 

  

Asia none st ion before the Presidential Commission on AIDS

Davis Y. Ja, Ph.D.
A DS Executive Director
Asian AIDS Project

PROSE CT

 

The Asian AIDS Project since its recent inception early
last year is the only Asian specific program in the United
States providing health education, prevention, training and
research. It currently has an operation budget of $229,000
annually and a staff of six.

The bulk of our activities this year is in AIDS
education; we will target all the major Asian ethnic groups
such as Pilipino, Chinese, Japanese, Korean and Vietnamese.
While some of our education outreach will be conducted
through our health education staff, we will also be
utilizing educators of the various sub-contracted community
agencies.

Our education activities include presentation, media
outreach, and brochure development and distribution. In
addition to educating the lay public, we will also train
Asian health, human service professionals and community
leaders. Another major component of our education program is
an Asian model of the “Stop AIDS Project,” where we will
educate Asian gays through facilitators recruited from the
Asian gay communities.

To date, little is known regarding knowledge, attitudes
and risk behavior around AIDS in our community. However, we
need this information in order to effectively educate the
community. To meet this need for information, we have and
will conduct several needs assessment and research projects.

We were awarded a contract in 1986-87 to conduct focus
groups with the Chinese, Japanese, Korean and Pilipino
Communities to determine the best method of measuring the
attitudes and behaviors that may place their communities at
risk from AIDS. We are now applying for a proposal to
Conduct a baseline survey of knowledge, attitudes and risk
behavior around AIDS in our community. Currently, we are

e also conducting a survey of Asian gays and bisexual funded
2024 Hayes Street

San Francisco, CA 944117
445) 386-4815

A project of Asian American
Recovery Services, Inc.

 

 

 
 

by the Center for AIDS Prevention Studies (CAPS) through the
National Institute of Health. The pilot study titled “AIDS-
associated high risk behaviors among Pilipino and Chinese
gays and bisexuals in San Francisco,” will provide
information vital to our program planning and development.

Besides providing education in and assessing the needs
of our community, we are also organizing an extensive task
force with a total membership of over 300 individuals
comprising of professionals, activists and individuals
concerned about AIDS.

The most difficult aspect of our efforts to educate the
Asian community is the heterogeneity within our community.
There are 32 distinct ethnic groups With different
languages, attitudes, traditions and behaviors. The vehicles
and processes to reach this distinct communities would have
to be different. This diversity is often overlooked in the
past in program development, resulting in inappropriate and
inaccessible services,

The need for culturally specific services for our
community is crucial, given the presence of cultural
attitudes regarding AIDS in most of our communities. Issues
such as difficulties with discussion of sex, contraceptives
and terminal illnesses are prevalent in most Asian
communities. There is also widespread misconceptions
regarding the disease throughout the community; AIDS is
often perceived as a "gay white” disease. This perception is
certainly exacerbated by much homophobia in the community.

It is clear then that education and prevention programs
need to be responsive to issues of diversity in language and
culture, differences in channels of accessing the community
and cultural attitudes that are barriers to education in
order to be effective.

 

 
 

 

Questions for the Presidential AIDS Commission

i. What are the most significant problems that AIDS hds
brought about in the Asian community?

2. What are the barriers ot AIDS education in your
community?

2, What are the most effective strategies of educating the
Asian community about AIDS?

 

 
 

 

Presentation before the Presidential Commission on AIDS

Davis Y. Ja, Ph.D.
Executive Director
Asian AIDS Project

Recommendations:

1. AIDS education programs should be responsive to the
heterogeneity within our community. The diversity of
ethnicity, culture, sexual orientation, national origin and
social economic status should be considered.

2. AIDS education and prevention resources for Asians needs
to be expanded. Existing community-based organizations in
the Asian communities should be provided with these
resources since they have access to the population.

3. In order to provide better services, AIDS surveillance
programs such as the Center for Disease Control needs to

break out the data into specific Asian ethnic groups and

other sub-groups.

4. There should be a coordination of efforts in developing
educational material (whether it is audio, visual or print)
for the Asians nation-wide.

5S. As the number of Asian AIDS cases increase, agencies
providing direct services should be made more responsive to
the Asian community. Furthermore, support groups and
counselling programs for Asian PWA’s should be established.

6. More AIDS sero-prevalence, attitudinal and behaviorial
research should be conducted in the Asian community.

7. There should be increased funding for training of
providers working in the Asian community. Asian providers
need to be trained on basic AIDS knowledge, homophobia and
sexuality issues, while non-Asian providers need to be
educated on cultural sensitivity.

 

 
 

The Black Coalition on AIDS has existed since early 1986 when Noami
Gray, a San Francisco Commissioner of Health, brought together Black
leaders around the Bay Area Black to discuss the impact of AIDS on our
communities . From her perspective on the Commission she had seen
spiraling funding for AIDS education and few activities directed toward the
Black population. Her invitation was a challenge to the Black community to
define and advocate for our own needs. Out of that challenge we have
created a broadly based organization including over 200 individuals and
agencies committed to the education and service needs of our community.

The aim of the Coalition is to insure aggressive, culturally grounded,
education and service to the Black community. However, we do not wish to
become an educational or service program. Rather we foster and support
the expansion of the work already being done in community-based
agencies to include a focus on HIV infection. Many of these organizations
have the expertise to identify and intervene with specific persons at risk, but
have not had the awareness or technical skills to tackle AIDS up to now.

We have worked for the inclusion of the needs of all people at risk in
ongoing city AIDS efforts, the elimination of institutional barriers to care
(such as racism, sexism and homophobia), for increased research on the
course of HIV infection done by Black researchers, and for the appropriate
level funding of indigenous programs for education and service delivery.
Moreover, the Coalition has become a resource for the development of new
strategies to combat AIDS among Black Americans. Much of our activity,
therefore, has been advocacy.

However, specific activities of the Coalition have included a press campaign
to publicize the problem in minority communities and the lack of response
by the City Department of Health; the development of a consensus paper on
antibody testing; AIDS Awareness Month November 1986 in the Black
Community; creation of personalized educational media e.g "Black people
get AIDS too" buttons; assistance in the development and implementation
of the nations first population-based survey of knowledge, attititudes, and
behaviors in the Black community; On-going efforts to affect responsive and
responsible public policy in the San Francisco AIDS Activity Office; technical
assistance in the creation of informational brochures for the expanded
anonymous antibody testing program; creation of a speakers bureau to
reach Black people.

We began as administrators, researchers, ministers, health care
professionals, health officials, and have with time reached more broadly into
the community. The independent, volunteer-run organization now consists
of both gay and heterosexual members including people with AIDS/ARC
and families and loved ones of PWAs. With that expansion come

new concerns and direction for the Coalition efforts: The facilitation of
support groups for Black PWAs and families; the creation of resource lists of
Black therapists, lawyers, hairdressers, etc. available to work with PWAs;

 

 
 

 

2BCA

outreach and networking with those key groups within the community which
reach significant members at risk; the development of a patient bill of rights
for people tested for HIV. We are increasing being asked to take ona
resource and referral function, and the role of the BCA will continue to
change as the needs and awareness in the community change.

You will hear it said that massive homophobia and denial among Black
people is responsible for the poor success of city efforts in our community.
In fact we are asking Black heterosexuals to take on AIDS with all its
phobias, and the Black people of San Francisco, gay and straight, have
come together to struggle with this epidemic in a way unparalleled in the
White community.

We bring several concerns to this Commission today. The first is the
challenge of the now popular notion that AIDS is an new issue in the Black
community. In fact the earliest reports to the CDC included a substantial
proportion of Black and Latino gay men and health anomalies were seen in
IV drug users not long after. Our community has simply been the last
addressed not the last infected. Similarly, we must do away with the
distinctions between the Black populations at risk and the so-called "general
public". The subtle "them-us" racism in such typology only serves to feed
avoidance in the Black community. Nor should AIDS in minorities be
considered an secondary issue as if there exists two diseases, AIDS and
Minority AIDS. The media as well as public and professional educational
forums isolate all discussion of people of color to a single program or
workshop. Certainly important cultural, economic and psychological issues
distinguish AIDS in different communities, and these differences must be
understood and utilized; however, the many peoples and cultures which are
homogenized under the term minority can only be wholly served when their
disease is viewed as an integral part of the American AIDS epidemic, not a
sidebar issue. Nor should White America be assuaged by the sense that
AIDS only effects others.

Having said that, there are specific education and service needs for our
community. We believe that the most effective resources for outreach have
been untapped. It is not true that Black churches are an obstacle to our
work; we regularly recieve calls from clergy and church members asking to
become involved. The process is slow, and every one will not join the effort,
but if taken on their own terms they have much to give. Rather than belittle
them we must actively engage them at a national level as a source of
credibility, man-(or should | say woman-) power, and spiritual support in the
Black community. Black PWAs tell us of their desire to be embraced by the
Church as a statement that they are not abandoned by the community. If
we are to keep the cost of AIDS down we must enlist the wonderful, loving
men and women who serve the church on a volunteer basis. A national
initiative to affect this involvement is necessary.

 

 
 

3 BCA

Other frontline workers must also be top priority for federal and local
support. A centralized AIDS program will never be as effective in the Black .
community as the funding of many small organizations dealing with drugs,
alcohol, teens, women and children, and sexually transmitted disease. All
the clever brochures in the world does not change behavior as does the
personal contact with people we trust. These community programs already
know the people, the needs, the language; they do not need sensitivity
training. Funding and technical assistance will ultimately be the fastest,
most effective and cheapest strategy. After all, these organizations are the
ones who will bear the brunt of the growing epidemic anyway and who are
probably already serving PWAs.

Teen education is crucial to us. The data on STDs and drug use among
Black adolescents makes it clear this population, our future, is at risk and
unreached.

We feel AIDS is not just an IV problem, it is a drug problem. The sexual risk
to non-IV women, for example, is extremely high. They have more partners,
riskier partners and do more unsafe sexual activity. They may trade sex for
drugs with men who are IV users. Yet this largely cocaine- and crack-using
population considers itself outside danger because they have heard
needles are the transmission risk. The national initiative on drugs must be
strengthened by the awareness of the connection of these two epidemics.

However, the majority of Black PWAs in SF are gay or bisexual, as are the
substantial number of those Black persons infected across the country. We
believe these men have fallen between the cracks. They have remained
underserved by gay or Black programs. The incredible figures on
knowledge and behavior change among gay men do not reflect the isolated,
Black-identified gay man. They do not recieve the same education and
service and they are continuing to become infected at an alarming rate. In
the haste to declare the epidemic over in the gay community, we must not
forget these men who have been left behind.

Finally we know from our involvement with service programs around the
state that the Black PWA presents new care management issues. They are
dying alone, frequently only coming for medical services when they are too
sick to walk, incontinant, demented. They then require crisis care or
intensive support and complex case management. We must have specific
studies of the cost of care to minority PWAs because allocations now set will
probably not be sufficient to these needs. We must support active outreach
to infected persons regardless of diagnosis to encourage early intervention
and inclusion of family support. We must expand in-home services with
Medicaid and other third party funding to keep the costs of treatment down
and provide the ill or dying persons of our community with on-going care
and dignity.

 

 
 

[

 

INSTITUTO FAMILIAR DE LA RAZA, INC. ———

ADDENDUM TO ORAL TESTIMONY

TOWARD A RESPONSIVE APPROACH TO THE LATINO COMMUNITY:
NEEDS & RECOMMENDATIONS TO ADDRESS THE AIDS CHALLENGE

Concha Saucedo, PhD
Excutive Director Instituto Familiar de la Raza
San Francisco, CA
March 24, 1988

It is common knowledge that the incidence of AIDS is disproportionately
greater in the Hispanic and Black community than in the dominant culture
(together we number 19% of the population, yet our incidence rate is nearly
40%). What are not so common knowledge are the unique problems and needs
our community faces in halting the spread of the epidemic and in insuring
quality services for Latinos with AIDS. This presentation briefly outlines
some of the problems and needs the Instituto Familiar Latino AIDS Project
has documented through the casework, educational and investigative services
eur program has provided during the last year.

AIDS EDUCATION

Two of the main reasons for the continued increase of AIDS cases in the
Latino community continue to be the lack of sufficient educational resources
and a culturally appropriate educational strategy.

Existing AIDS educational policy and resource allocation focuses atten-
tion on minority high risk behavior groups and ignores our community’s most
valuable resource, our community-at-large. The Latino community requires
educational resources for both high risk target groups as well as those
other segments of our community which could become motivated to become
layperson AIDS educators, such as church people, mothers, youth, etc. Due
to the strong cultural denial of Latino homosexuality and drug use, there is
an even greater need for holistic AIDS education for our communities -— AIDS
education that also includes such areas as communications, sexuality, commu-
nity/family responsibility, etc.

Our need is for policy and financial resources to engage in a proactive
AIDS education strategy, an educational approach that not only seeks to halt
the epidemic, but to motivate Latinos to serve and care for those in our
community who become infected with AIDS. This need for inspiring community
responsibility is critical given the lack of sufficient bilingual/bicultural
health professionals with our present medical/health systems. Interviews
with 14 of the main AIDS service programs in San Francisco underscored both
the lack of sufficient bilingual health professionals and the dire need for
Latino volunteers who could serve to provide emotional support.

2515-24th Street -No.2
San Francisco, CA. 94110
(415) 647-4141

 

 

 

 
 

 

AIDS SERVICES

The AIDS epidemic is casting a light on the existing deficiences of our
various health care systems-- one of the greatest is the lack of bilingual/
bicultural health workers. Consequently, Latinos with AIDS have experienced
the following hardships in San Francisco:

o Patient dying over a course of 6 weeks with no Spanish-speaking

professionals or volunteers on staff.

o Patient“s reluctance to use services because there were no Latinos
present who he felt could understand his situation.

Patient leaving hospital against medical advisement due to the harsh
manner in which diagnosis was given and the general lack of ex-
planation of what was being done to him.

Patient unable to secure a Latino therapist.

Patient being discharged without clearly understanding diagnosis
or how to care for self.

Patient unable to find a Spanish speaking support group.

Patient unable to find a volunteer AIDS program in which he could
serve Latinos and also feel the support of Latinos.

o

o

o

o 6

The healing process requires that patients understand their illness and
treatment options and are able to participate with medical staff in improv-
ing their health. Such healing becomes compromised if communications are
not possible. This is often the case for Latinos who are monolingual Span-
ish speaking or limited English speaking, and whose number is typically
greater than most realize. For example, in San Francisco up to 66% of
Latinos with AIDS are either monolingual Spanish speaking or prefer Spanish
for communicating on such critical or emotional issues as illness and
health. While a number of AIDS services in San Francisco have sought to
remedy this need, a considerable number still have NO bilingual staff what-
soever.

The staffing problem is multi-faceted. Some programs need to be en-
couraged to hire Latino staff. Others have sought to employ bilingual/bi-
cultural nurses and social workers, but the demand is greater than the pool
of professionals available. There is a tremendous need for a strategy to
recruit and retain Latinos into the health professions, particularly in
medicine, nursing and social work.

Until appropriate numbers of Latinos can be trained and employed within
the health systems, there is need to provide for cultural sensitivity train-~
ing for existing health professionals. In our survey of San Francisco’s
AIDS programs, all concurred with their staffs* need for general cultural
sensitivity training, and especially, training and consultation for working
with Latinos. In particular, they expressed their need for cultural under-
standing and skills for the following:

o How to do risk assessment among Latinos?

o How to communicate tne diagnosis with sensitivity?

o How to work with the denial often related to the diagnosis?
o What words to use to educate regarding AIDS and safe sex?

 

 

 
 

 

o What to do when the patient is dying and doesn“t want his family to
know about the AIDS, yet the family wants to understand what is
happening to their son?

o How to facilitate reconciliation among the patient and family, or
patient, lover and family?

o How to communicate to the family regarding issues of death and timing
of death?

o How to support the Latino patient work through issues of guilt,
coming out and death?

SOCIAL SERVICE AND MENTAL HEALTH NEEDS

Responsive health care requires responsive social and mental health
services.

In a study conducted by the Instituto, we found the following needs as
paramount to Latinos at the time of intake -~ soon after their initial
hospitalization and AIDS/ARC diagnosis:

o Financial assistance 63%

o Access to support services (e.g., homecare, hospice, etc.) 34%
o Housing 304

o Aid to resolve insurance issues 20%

o Legal or immigration assistance 16%

Subsequently, during the course of the illness almost 60% encountered tre-
mendous difficulties insofar as maintenance of housing. Their problems
included:

o Need for immediate money to pay rent coming due: 21%
o Need to move because of inadequate housing (overcrowded,

lack of cooking facilities, inadequate heat, etc.): 21%
o Housing became unaffordable because of diminished income: 152%
o Illness left person without housing: 152
o Person living alone, now needs roommate for care,

companionship or to help pay rent: 15%
o Already homeless: 6%

Insofar as mental health services are concerned, the Instituto has
documented up to 70% of their AIDS casework population as in need of “mental
health sensitive" casework and counseling, and periodic psychiatric consul-
tation. Critical to appreciate is the need for a more holistic mental
health or casework approach to serving Latinos with AIDS, which is evidenced
by the multiplicity of services which have been required by Instituto’s
caseworkers. These services have included:

o Advocacy to obtain needed resources (i.e., benefits).

o Advocacy to insure patient rights.

o Advocacy to obtain needed services (i.e., residential care).

o Being a friend: providing support, hospital visitation, sharing
humor and respect.

 

 
 

 

o Brief counseling and psychotherapy.

o Coordinating services.

o Consultation to other providers on cultural issues or community
resources.

Education and information concerning benefits of AIDS,

Enlisting or providing spiritual support (i.e., conventional,
traditional and non-traditional).

Facilitating family reconciliation.

Home outreach.

Mobilizing or developing a support system.

Planning assistance regarding finances, life and funeral
arrangements.

Oo Oo

oo co 0

o Providing support to remaining partner or family.
o Securing volunteer work.

o Translation.

o Transportation.

AIDS TRAINING FOR LATINO PROFESSIONALS

There is need for greater mobilization of Latino professionals to

respond to the AIDS challenge. This requires necessary education, outreach
and training programs. Several recent outreach efforts illustrates this
need,

Oo

Instituto Latino AIDS Project surveyed 95 Spanish-speaking counselor/the-
rapists in San Francisco for their willingness to work with AIDS clients.
Only 18 responded positively. Yet, the key reason for reluctance to
respond appears to be the need for education/training, given that 90% of
the respondents expressed an interest in AIDS related training, and in
particular on how to work with Latinos with AIDS.

The Instituto also conducted interview surveys with 24 Latino Community
agencies, of which 79% expressed an interest in AIDS in-service training.
In particular, many of the program representatives expressed the need for
their program staff to work through issues of AIDS myths, fears of conta-
mination, homophobia and difficulty in accepting IV drug addicts.

The Spanish Speaking Hotline of the San Franisco Foundation mailed out 200
letters to potential Latino referral sources; e.g., attorneys, counselors,
doctors, dentists, etc. The outcome was a list of only 20 who were
willing to be considered as a referral source. Their analysis was that
more educational outreach is necessary in the community.

FOCUSED LATINO PROGRAMS

o

The following programs are seen as necessary for the Latino community.

The need for culturally appropriate and language relevant educational
material; e.g., brochures, home training packages, posters, radios pro-
grams, videos, etc,

 

 
 

The establishment of several regional and national clearinghouses for the

collection, cataloguing, general availability and disbursement of relevant
Latino eduational material.

Priority use of Spanish radio and television programs for education. The
Fairbank, Bregaman & Maullin Study (1987) indicated that "Spanish language
television/radio programs" were the greatest source of health information
for Latinos in San Francisco.

Priority use of the schools for AIDS education. The same Fairbank study
indicated that 82% of Latinos in San Francisco felt that AIDS education
should be done in the schools. The Latino AIDS Project Survey of Commu-
nity Agencies has also highlighted the schools as one of the most effec-
tive ways of mobilizing community education.

Prioritize the need for local and regional trainer-of-trainer programs.
The Latino AIDS program has received numerous calls from concerned Latinos
throughout California requesting services to train AIDS educators. The
pool of Latino Educators could be dramatically increased with a Statewide
trainer-of-trainer progran.

Prioritize the need to develop and document therapeutic and mental health
strategies particular to the Latino population. The Instituto Latino AIDS
Project has already begun to identify the unique cultural, familial,
economic, social and spiritual needs experienced by Latinos with AIDS that
indicates the need for a particular therapeutic approach. The same issue
relates to the need for theory to explain the most appropriate ways for
engaging Latinos in community eduation.

Prepared by: Roberto Vargas, DrPH, MSW

 

Principal Investigator
Instituto Latino AIDS Project

 

 
 

AIDS AND THE LATINO COMMUNITY

Testimony to the Presidential Commission on HIV Epidemic

Concha J. Saucedo, Ph. D.
Executive Director
Instituto Familiar de la Raza, Inc.
2515 - 24th Street, No. 2
San Francisco, CA 94110
(415) 647-4141

 

 
 

AIDS AND THE LATINO COMMUNITY

Testimony to the Presidential Commission on HIV Epidemic
Page 2

Inetituto Familiar de la Raza, Inc.

Demographic Profile

The United States has the six largest “Hispanic” population in
the world, exceeded only by Mexico, Spain, Colombia, Argentina, and
Peru. According to the official U.S. census, between 1970 and 1980
there was a 61% increase in the Latino population in the United
States from 9.1 to 14.6 million persons. Including estimates of
uncounted, undocumented persons and adjusting for growth since
1980, there are probably more than 20 million Latinos, or 8% of
the total population in the United States. Demographic projections
buttress the contention that Latinos may become the largest
minority group in the United States by the year 2000.

Latinos of Mexican origin are the largest subgroup with 59.8%
of the total, followed by Puerto Ricans (13.8%) and Cubans (5.5%).
The category of “other Hispanics" comprised 20.9 % of U.S. Latinos
in 1980, and this many now actually be greater as a result of the
recent influx of immigrants from Central America. Most Latinos
live in urban areas (87%), and 82.9% are concentrated in eight
estates with California and Texas containing 51.6% of the total. In
1980, nearly a third of Latinos were foreign-born and approximately
25% spoke little or no English.

In California, 20% of the population is Latino and most are of
Mexican origin. Los Angeles and San Jose have the largest propor-
tion of Latinos, who make up nearly 30% of their populations. In
San Francisco, Latinos of the other Hispanic category outnumber
those of Mexican origin.

Epidemiology of AIDS and HIV Among Ethnic Minorities

Nationally, 41% of all reported AIDS cases are Black, Latino,
Asian, Pacific Islanders or Native American. The disproportionate
representation of Blacks and Latinos is most pronounced in three
transmission categories: 1) Heterosexual intravenous drug users;
2) Heterosexual partners of persons at risk for AIDS; 3) children
of parents at risk for AIDS. Specifically, 80% of all heterosexual
intravenous drug users with AIDS are Black or Latino, 84% of AIDS
patients who acquired HIV infection heterosexually are Black or
Latino, and 87% of children with AIDS who acquired HIV infection
perinatally are Black or Latino. Additionally, Blacks and Latinos
comprise 74 % of women with AIDS and 56% of adolescents with AIDS.

Thus, nationally while AIDS cases among homosexual and bisexual
men are relatively evenly distributed by race, AIDS cases among
heterosexual intravenous drug users, their sexual partners, and
children are predominately diseases of Blacks and Latinos.

 

 
 

 

AIDS AND THE LATINO COMMUNITY

Testimony to the Presidential Commission on HIV Epidemic
Page 3

Instituto Familiar de la Raza, Inc.

The Latino Community AIDS Education and Prevention Project

In late 1985, a half-dozen Latino activists began to meet
informally to discuss their concerns about the impact of AIDS on
Latinos. They shared a frustration about the lack of AIDS programs
that were linguistically and culturally relevant to the Latino Com-
munity of San Francisco. In May 1986, these activists convened a
day-long conocimiento (knowledge) that assembled a cross-section of
the Latino Community. The conocimiento was a conclave to share our
awareness and understanding of AIDS and to assess our community’s
needs. A tangible outgrowth was the formation of the Latino Coali-
tion on AIDS/SIDA. The Coalition consists of community-based
Latino agencies, gay and straight individuals interested in promo-
ting AIDS awareness within the Latino Community.

In June 1986, the Instituto Familiar de la Raza, Inc. on behalf
of the Latino Coalition, responded to a state request for AIDS
education projects targeted to minorities. El Instituto is the
only bilingual/bicultural program providing mental health services
to San Francisco’s Latinos. Its objectives include direct out-
patient services targeted to prevent family disintegration and
institutionalization, as well as the promotion of cultural values,
and customs to strengthen the community.

In July 1986, the state approved a grant of $ 131,000, and the
Latino Community AIDS Education and Prevention Project started in
August. The Project is the city’s only AIDS organization specifi-
cally for Latinos,its first goal is AIDS education and prevention
for Latinos, but it does far more. The Project has become a
clearinghouse for ali AIDS related matters in the Latino Community.

At first the Project tried to educate the entire Latino Commu-
nity about AIDS, but now they are concentrating on specific high
risk groups: men engaging in high-risk behavior; intravenous drug
users; and youth - especially those out of schools.

The Project has created a model educational vehicle, that is
culturally sensitive to Latinos. The product is a 51-minute video
"telenovela" called "OJOS QUE NO VEN", (EYES THAT FAIL TO SEE) a
Spanish language soap-opera that includes characters from several
high risk groups.

The Project’s health educators travel all over the city and
throughout the Latino Community to make their presentations. Meet-
ings are held in churches, English as a Second Language classes,
schools, confidential house meetings, worksites, health fairs,
businesses and organizations. The Project also provides individual
peer counseling. Each talk is tailored to the audience, be it

 

 
 

 

AIDS AND THE LATINO COMMUNITY

Testimony to the Presidential Commission on HIV Epidemic
Page 4

Instituto Familiar de la Raza, Inc.

recent immigrants, school kids and teenagers, straight couples, gay
men, women or IV drug users.

$162,000 is slated for education, prevention and outreach among
Latinos this year. Unlike last year, this year the money comes
from the San Francisco Department of Public Health (DPPH). This is
the first time the DPH has ever given funds to a Latino AIDS
Service Organization. In addition to engaging in preventative edu-
cation, the Project is conducting a need assessment etudy and is
involved in case-management/counseling. The need assessment study
is a survey to determine the availability of bilingual/bicultural
therapists to San Francisco’s Latino population with AIDS, their
experience in working with Latinos with AIDS and their training
needs.

Minorities need special educational approaches which take lan-
guage and cultural norms into account. For educational materials
to have the maximum desired effectiveness, it is essential to have
not only bilingual staff but also bicultural etaff participating
throughout all stages of development. The message must originate
in Spanish, and with appropriate Latino Cultural values. Transla-
ting into Spanish a message that is in English and targets the
general public will have little effectiveness with Latinos.

I foresee the AIDS epidemic settling into the incidence patter
of many communicable diseases - that it will be more prevalent
among minority and low-income groups. As educational efforts take
hold the more educated, more easily reached populations will change
their behaviors and more effectively prevent the illness. Chronic
drug users who are hardest to reach and least likely to change
their behaviors will continue to get the disease. Poor and mi-
nority groups who are also less likely to be reached by a general
public education campaign will also be slow to learn prevention
methods and will continue to get the disease at a highly rate.

Recommendations:

1) Board of Directors of CBO’s determine mission policy, direc-
tion, priorities, allocation of resources and staffing patterns
of their agencies. Significant minority participation at the
highest policy level of federally-funded AIDS service programs
could provide the perspective and leadership needed for pro-
grams to be more responsive to the needs of minorities.

Z) Prison populations in this country have disproportionate high
numbers of minority inmates. AIDS has been diagnosed among
prison inmates. Many inmates of penal institutions come in

 

 
 

 

AIDS AND THE LATINO COMMUNITY

Testimony to the Presidential Commission on HIV Epidemic
Page 5

Instituto Familiar de la Raza, Inc.

contact with the justice and corrections systems as a conse-
quence of their direct or indirect involvement with IV drug
abuse. These facts state the need for increased education
about high-risk behaviors and for training prison officials and
personnel about AIDS, the care and needs of incarcerated PWA’s/
PWARC’s, and to calm unfounded fears about HIV transmission.

3) The greatest need is for Spanish language information, but much
English language, culturally-sensitive information is also
lacking, especially for adolescents. Adolescents are at risk
because they often experiment with drugs and sex. Schools need
to be encouraged to develop AIDS education programs for inclu-
sion into their curriculum as one of many sexually transmitted
diseases that adolescents should know about.

4) In order to successfully market AIDS prevention to the Latino
Community, it will be necessary to identify and target specific
subgroups within the community for particular messages, given
through certain channels. Messages for teens must be linguis-
tically relevant, often given by age peers, in formats that
attract attention, such as RAP conteste, creation of videos, or
comic books. Rather than focusing exclusively on AIDS, such
messages and activities might include issues like pregnancy,
drug use, and other risk behaviors that tend to cluster with
AIDS risk.

6) Women are at risk if they use IV drugs or have high risk sexual
partners. It is important to target this group for educational
efforts because many women do not realize that they are at risk
and do not realize that they can pass the virus to their chil-
dren during pregnancy and childbirth. Counseling and testing
for antibodies to the AIDS virus should be routinely offered at
federally-funded prenatal and family planning clinics.

7) Given the stigmatization of AIDS and the potential for discri-
mination, antibody testing needs to be anonymous and voluntary.

8) Where necessary, expand or supplement existing AIDS information
hot-line telephone services to meet the needs for bilingual
services.

9) There is a demonstrated value and need for workshops and train-
ing on racism, homophobia, and cultural sensitivity.

10) Institute a program of information and education to funding
sources, public and private, about the need to support AIDS
funding in general and targeted programs for minorities in
particular.

 

 
 

 

AIDS AND THE LATINO COMMUNITY

Testimony to the Presidential Commission on HIV Epidemic
Page 6

Instituto Familiar de la Raza, Inc.

11) Work with federally-funded AIDS service programs and appro-
priate government agencies to establish evaluation criteria and
strategies to monitor the efficacy of AIDS related programs
with respect to minority communities.

12) Minorities need special educational approaches which take lan-
guage and culturally norms into account. It is essential to
have staff that is bilingual and bicultural design and develop
educational materials intended for Latinos. The message must
originate in Spanish and be culturally sensitive. Translating
into Spanish a meseage that is English in origin and that tar-
gets the general public will have limited effectiveness with
Latinos.

13) Commission stafff member, Frank Hagen, facilitated a screening
of the Project’s telenovela "OJOS QUE NO VEN", by Gilbert Car-
dona, Chief of Resources & Clinical Branch, New York Regional
Office, U.S. Public Health Service. Mr. Cardona has hailed

the video as "...a valuable tool for educating Latinos because
it is sensitive to the cultural values of the audience which it
is intended..." . Mr. Cardona recommends that the Public

Health Service make use of the video at federally-funded pre-
natal, family-planning clinics, and other health care clinics.

Testimony
3/88

 

 
 

Report
to the

 

President's Commission on AIDS

March 24, 1988
San Francisco, California

by
Phil Tingley, MSW
on behalf of:
The Native American Community
It must be noted that most of the top ten (10) causes of early
sexual debut are related to alcohol and drug abuse and that
Native American populations have the highest levels nationally
for alcohol and other substance abuse. Not surprising then was
the report from the National Center for Health Statistics that

showed a Native American teen pregnancy rate of 20.8% nationally.

Additionally, it was not surprising that the Center for Disease
Control's 1985 study of seven (7) States with large Native
American populations reported sexually transmitted disease rates
that were ten (10) to one hundred (100) times higher than the

national average.

One must understand that the nation's American Indian and Alaska
Native population is relatively small, and for this reason,

prevention is critical.

Projecting from our high levels of substance abuse, STD's and
teen pregnancies, if our populations do not receive a 100% level
of AIDS prevention education, we will be looking at the final

chapter in Native American history after the year 2000.

 

 
 

 

Report to the
President's Commission on AIDS

March 24, 1988

The Indian Health Service, who has the primary responsibility for
health care for the nation's Native American population, has
repeatedly refused to deal with this issue. Indeed, as late as
August of 1987 the Indian Health Service stated that "AIDS is not
as Indian problem" at the Center for Disease Control's Conference

on Minorities and AIDS.

Yet we know that there are American Indians who have AIDS.
Unfortunately, the Center for Disease Control only reports 53
current cases. It is surprising that they have any data at all.
There is presently no uniform method of reporting AIDS cases from
Counties to States or from States to the CDC, anywhere in the

Union.

Even under such adverse conditions, however, the local American
Indian and Alaska Native community has proved to be very
resourceful. All of the local Indian community-based
organizations and AIDS activists have come together to combat the
epidemic and to prevent the spread of AIDS within the community.
We have trained local Native American community members as
emotional support counselors and community prevention educators.
We have begun to develop AIDS prevention and education materials
that are culturally relevant and appropriate. And we are
developing community-based support networks for persons with ARC
and AIDS and their families and love ones. In keeping with our

concerns, we therefore have the following recommendations.

 

 
 

 

A.

1.

Recommendations:

Prevention, Education and Information

Prevention education must be culturally relevant and

culturally appropriate.

Dollars must be made available to Indian community-based

organizations and tribal governments.

Non-indigenous care systems must recognize the reliance of
Indians on traditional Indian medicine practices in

additional to western medical practices.

Indian Health Service substance abuse prevention and
treatment programs must include funding for drug abuse

prevention and treatment.

B. Direct Services to Persons with AIDS

1.

Funds must be available for case management services since
the majority of the Indian population relys on tribal
government, Bureau of Indian Affairs, or community~based
organization social services agencies as their primary

services agencies.

Fund for emergency, transitional, and permanent housing must

be made available for persons with ARC and AIDS.

Funds for home care services that are culturally sensitive

must be made available.

Funds for peer counseling and culturally appropriate

psychotherapy must be made available.

 

 
 

 

Recommendations:

C. Research

Funds need to be appropriated for:

1. Studying the level of intravenous drug use among American

Indians.

2. Studying the Seroprevalence among American Indians.

3. A discrete category for "American Indian-Alaska Native” must
be established in all reports from states and especially from
counties to states on AIDS and ARC cases specifically and all

sexually transmitted diseases generally.

 
 

 

1818 E. Madison
Seattle, WA 98122

PO. Box 3449
Seattle, WA 98114

(206)329-6923

Board of Directors

Robert Rohan
President

Barry Bianchi
Vice-President

Hub Gilbert
Vice-President
Andrew Shields, ODS.
Secretary

Bea Kelleigh
Executive Director

Honorary Board
of Directors

Brock Adams

Glover Barnes, Ph.D.
Judith Bendich
George Benson
Scott Blair

Bobbe Bndge

The Rev WilliamB Cate

Patrick § Fitzsimons

Virginia Gafle

Stade Gorton

Audrey Gruger

H H = -rHandsfield, MD
it

Par _.abel

Gary Locke

Mike Lowry

Janice Niemi

Ancil H. Payne

Randy Revelle

Norman B. Rice

Charles& Rosanne Royer

Delores Sibonga

Sam Smith

Jim Street

Jeanette Williams

 

AS

NORTHWEST AIDS FOUNDATION

PRESIDENTIAL COMMISSION TESTIMONY
COMMUNITY-BASED AIDS EDUCATION---THE NATIONAL PERSPECTIVE

Bea Kelleigh, Executive Director
Northwest AIDS Foundation

My name is Bea Kelleigh and I am the Executive Director
of the Northwest AIDS Foundation. I appreciate the
opportunity to speak with the commission this morning on
behalf of our community response to the AIDS epidemic.

The Northwest AIDS Foundation was established in June of
1983 by leaders of the gay and medical communities to
respond to the AIDS epidemic in Seattle-King County and
Washington State. At that time, only seven people had
been diagnosed with AIDS in Seattle and King County.

Our mission is two-fold: to provide the education that
can stop the spread of this disease and to build a
network of home and community-based services to allow the
thousands of people who are seropositive and will require
care to stay in their homes and communities as much as
possible and out of expensive hospital beds.

Our social services for People with AIDS are based on a
continuum of care approach with the recognition that
those living with this disease need assistance with a
broad spectrum of services ranging from case management,
low-cost housing, and chore services to home health care
and emotional support. The Northwest AIDS Foundation
directly provides case management services, Information
and Referral, housing assistance and emergency financial
assistance. The Case Management program, which has as
its goal preventing crises such as unnecessary
hospitalization and eviction, is now serving 105 people
with AIDS in the area. Over the past two years, we have
served 40% of the people with AIDS in our area. 70% of
our clients live on less than $400.00 per month, 90% are
unemployed when they come to us, and 15% are people of
color.

In the interests of building the network of needed
services, the Foundation acts as a lead coordinating

e:\word\2\229.mar #2|ga|3-21-88

 

 
 

 

agency for the range of community-based social services.
The Northwest AIDS Foundation acts as a grant maker and
funding source for Chicken Soup Brigade which provides
voluntary chore services, meals, and transportation
assistance, and Shanti Seattle and the Seattle AIDS
Support Group which offer emotional support.

AIDS prevention is the number one goal of our education
programs. We work directly with gay and bisexual men,
offering public education like the "Please Be Safe" and
"Be Well Equipped Campaigns," workshops focusing on
healthy lifestyles, peer support groups, and trained
community volunteers who help other community members
make and maintain a commitment to a safe lifestyle. The
Northwest AIDS Foundation also collaborates with
multicultural groups like the People of Color Against
AIDS, the Women & AIDS Task Forces, and the Seattle King
County Department of Public Health to provide and support
AIDS education for other communities.

Each of the collaborating organizations working on
preventing the further spread of this disease seeks to
help people at risk maintain safe behaviors over time.

In doing this we ask individuals to set the highest
possible personal goals that are achievable and can be
sustained. For many of those at highest risk, gay and
bisexual men, and people who use IV drugs, a monogamous
married relationship is not possible or realistic. We
encourage those for whom marriage and abstinence are not
realistic, to use condoms consistently. In our education
materials we have used language and illustrations that
are straight-forward and easily understood to help people
substitute low risk activities for high risk activities.
This approach has been effective. Over the past 4 years
we have seen a reduction of 80% in sexually transmitted
disease among gay men.

In 1987, 800 volunteers contributed over 70,000 hours to
the education and service programs of the Northwest AIDS
Foundation, the Chicken Soup Brigade, Shanti Seattle and
the Seattle AIDS Support group. Like other communities
across the country, we are concerned that the volunteer
resources will not be able to keep up with the rapldly
growing need. Even in Seattle and King County with 573
people diagnosed as of March 2, 1988, people with AIDS
are staying in the hospital unnecessarily long for lack
of nursing home beds and personal care services.

c:\word\x\229.mar #2|ga|3-21-88

 

 
 

 

In conclusion, the Northwest AIDS Foundation has helped
build the beginning of the public-private corporate
partnership in Seattle-King County and Washington State,
necessary to respond effectively to the AIDS epidemic,
and as a community-based organization, the NWAF has
worked with health officials and others throughout the
state to (1) assure that AIDS education is straight-
forward and effective, and that services programs are
sensitive and responsive to the needs of those most
affected by the AIDS epidemic, (2) encourage the high
level of volunteerism that is helping people with AIDS
remain in their homes, and (3) develop corporate support
for AIDS education and care through mutual education and
fundraising projects.

e:\word\x\229.mar #2|ga| 3-21-88

 

 
 

My name is Sandra Long. I am the executive-director of Aid for
AIDS of Nevada, commonly referred to as AFAN. I would like to
start by giving you a brief overview of our State, our community

and our organization.

Nevada has a population of 1,007,000. It's principal industry is
gaming which brings in yearly qross revenues in excess of 8
billion dollars. Approximately 27 million visitors come to Nevada
annually qiving it the distinction of the top tourist state in the
nation. Approximately 32 percent of the jobs in the state are

gaming related. |

Las Vegas is in Clark County, which happens to be the most densely
populated county in Nevada. Clark County has a population of
631,920. This figure represents 63 percent of the state's
population. Prostitution is leqal in various counties outside of
Clark County. The proximity from Las Vegas to the closest county

which has legalized prostitution is 69 miles.

AFAN is a non-profit volunteer organization that beqan operating
in late 1985 in Las Veaas. AFAN's primary mission is education
and client support. Education is particularly important to our
community because of our daily interaction with the millions of
visitors to the state. AFAN provides a speakers bureau and
conducts seminars on “AIDS in the Workplace" for private business
concerns. It also has a telephone hotline, a newsletter and

media network.

 

 
 

 

The client support mission is also vitally important because the
gaming industry attracts large numbers of transients and indigent
people; some who are infected and have no support system. Our
client support programs include transportation, residential
housinq, hospital visitation, food bank, client counselina,
financial assistance, companion placement (Buddy Proqram) and

several others emerging proqrams.

AFAN has two full-time paid staff positions and one part-time
clerical positions. I should note that the second full-time staff
position was funded just last month. The rest of our 103 members

are volunteers.

In 1987, volunteers donated 39,518 hours of service. That
translates to $132,365 worth of service based upon minimum waae
computations. Moreover, through grants, fundraisers and private
donations qross revenues was approximately $58,000. Our client
expenditure increased by over 100 percent from the previous year
to $237.00. AFAN served 77 clients during the period. This
amount is exclusive of other benefits clients received directly
from volunteers. Accordingly, it is evident that our volunteers
are the mainstay of our orqanization. We are confident that if
grant money was to become available to fund Volunteer Coordinator
and Client Service Director positions, they would qenerate even
aqreater community volunteer participation. The benefits would

aqreatly exceed the cash outlay. Accordingly, we make the

 

 
 

following recommendation: Government grants for home-based AIDS
organizations specifically targeted for volunteer coordinator and

client service director positions.

With respect to the issue of prostitution, let me state that AFAN
does not promote or endorse the practice. There are between 37
and 40 brothels in Nevada which employ approximately 350 legal
prostitutes. Fach prostitute services an average of ten patrons
per day. In a recent article by Patrick Buchanan appearing in the
Washington Times on 12/2/87, he asserted that "it is unusual for a
woman to get AIDS from an infected male through normal sexual
intercourse." He corroborated the assertion by citing that not
one single case of AIDS had been reported in 37 Nevada brothels.
The citation, although accurate, is a poor basis for supporting
the assertion. The Nevada Brothels Association, an association
made up of brothel owners, voluntarily undertook extensive health
precautions to prevent the spread of all STD's. Each woman is
tested for the presence of HIV antibodies monthly and for other
STD's weekly. During a recent 18 month period, nine women were
rejected hased upon positive test results. In addition, condoms
are mandatory and the practice is strictly enforced. There are no
exceptions. Accordingly, insofar as it appears to us that the
brothels are adequately monitoring their activities, we make no
recommendations ian this area. AFAN is concerned, however, with
misleading commentaries which relegate the likelihood of
contracting AIDS through heterosexual contacts. Our concern

primarily focuses on high school and college age people who are

-3-

 

 
 

 

influenced by such commentaries, particularly since the view is
aligned with what they desire to hear. Therefore, AFAN makes the
following recommendation: Target specific AIDS information
programs which can be taught in homes, churches and schools that

deal _ with methods of protection other than abstinence.

Finally, as part of AFAN's services, we assist clients through the
ponderous and burdensome bureaucratic maze for social services.
However, hearings, decisions, appeals, adjudications are all
procedures that persons with AIDS have little time to battle. It
is not uncommon for clients to die prior to receiving their first
Social service award; thereby leaving their families and
Significant others in debt with hospital and burial expenses.

AFAN makes the final recommendation: Establish programs which

 

grant immediate benefits to people with AIDS.

 

It has been my privilege to address you today and I thank you for

considering our recommendations.

 

 
 

 

Teatimony to the President's AIDS Commission
By Gretchen Miller
For the Willamette AIDS Council

Eugene, Oregon

I am here on behalf of the Willamette AIDS Council, a community
organization in Eugene Oregon. Eugene and its suburbs have a
population of about 200,000. Willamette AIDS Council serves that
area, plus much of southwestern Oregon, seventy miles west to the
acean, seventy miles east to the crest of the Cascade Mountains,
and south to the California border. -We provide information and
referrals to medical care. We work closely with Shanti in Oregon,
which provides direct personal support services.

For moral reasons and also utilitarian reasons, we cannot
afford to write off any group as doomed. As we see the infection
continuing to spread in gay men and as we see noys experimenting
with their sexuality and joining that group, we seé a need for
our efforts. As we see drugs in our streets and jails, we see
people deserving of the respect we can offer to each human being,
and a need for our efforts. We do not have the resources we need
to organize and extend the volunteer energy which is available.
We do not have the money to provide written information and
answers to questions, outreach workers to go to the bars and the
drug corners on Saturday night, recovery programs for drug users
who want them, a way to share a sense of self-worth and
possibility for those who may be inclined to write themselves
off. Our message is, "There 18S no town where AIDS is not
happening, no family which is untouched oy this virus. This is
not a gay problem, a minority probiem, a arug apuse problem, 4a
big city problem, a problem causea by immoraiity, a sroblem which
anyone deserves, or anyone else's pron.iem." This virus iS in
Main Street USA and that 15 wnere we neeq to carry tne fight
aqainst 1t.

The wheel 1S being relinAvente@c 1A t
aurogss tne nation. We Go net Aave 3B FOlL2 Na
experlence. What San Franc.Scu Gmu Seattle uRait w.th a Coupisz
of years ago iS now becoming our problem, and we work more than
we should on the basis of rumor, anecdotal resrcrc ang magarine
articies. Th:s drovidaes uf Witn r2at Ipparlasn rc

t

Lnnovatien and imagination, Tat .7 -Sn' 2 ar

= eo.

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xn “7M esana TIAmMMUNLTL. es
- *

TANI er

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Some problems which plague us in our community:

AVALLABILITY OF MEDICAL CARE: Our snysicians sometimes feel
as 1f they are at the end of a long and leaky pipeline--there 1s
no access to experimental treatment outside big cities and it us
hard to keep up with the latest information in order to care for
your Single AIS patient. Retrerrai patterns can ce airticult.
Some services and care options are Simply not avaliaple. The
amount of time which this care requires :S not compensated. Our
sons and brothers are coming home to tine smal.cest towns all over
the country, especially people with intact and loving families,
coming home to live with AIDS and coming home to Gie. One AIDS

 

 

 
 

 

BaANient <4 68 42 teeawendous burden on the famrt.y doctor, tne
local hospitai, the family, and on whoever else is :nvolved.
There are simply inadequate programs and facilities to care for
these patients. The necessary services are too often not
avallable.

AMOUNT OF INFECTION, AMOUNT OF KNOWLEDGE. In less populated
areaS, we are earlier on the curve. Fewer people are infected
and fewer are symptomatic. If, in our area, 25% of gay men who
are tested test positive, 75% are uninfected. We still have many
Opportunities for education. We cannot wait for events to roll
over us. Once the numbers are there, it 18 too late. We know
that the infection curve will flatten when an entire populaticn
1s infected. The challenge is to stop the epidemic before that.

We are earlier on the learning curve, too. Despite our pest
efforts, a lot of people who are at risk have not changed their
behaviors. Behavior change is hard. Ina small community, even
education can be difficult, because gay people and drug users
tend to be better integrated into the community, or they are
hiding better (depending on how you look at it). In some towns
smaller than Eugene, there 1s no community and no opvious source
of support. There may be nowhere a gay man, whether he is
worried well or infected, can go in his hometown and be sure of
support, or get accurate information. If a person is HIV
positive in Myrtle Creek or Deadwood, Oregon, or a man goes back
to his parents there after he learns he 1s infected, he 1s
entirely dependent on the support of the non-infected and so-
caliéd not-at-risk community. This 18 two-sided--if the person
and his family have lived there a long time, his family may be
supported by friends and neighbors. Or, if he is shunned, he has
very few options. He may be driven out of town.

There are a lot of people who think that AIDS won't happen

n their neighborhood or group and that they sacn't nave to worry.
They can stiil look at people at risk as “other” ance not
deserving at respecnr. We Nave miles of Education aneauw of us.

 

RDGCATTON OF GaY MEN 1s writicatly important in aur
SNM. Lae Se TheeGe Stee Ofie WtUbie WhO are, FClLuti.. mow, serve
TRAVEL LORIN Lave ot Mirouerd and tnis le eis oe lan amave
ee Ot. TE fae ek St To ka IE le TPS a .

GAY 7

SenwAcens. We HAVE ucarce.y oOeQGUN tu aucressS tHe
problems of gay teenagers. we have trouble as a scc:ety
Admitting that tney exist. Our aoctors are seeing ooys wno are
sexually active with men or other teenagers who have sexually
transmitted diseases. They are highly at risk. Who 18S going to
Provide education ina way that will reach a teenager? Gay men
are afraid to--and with good reason. A gay man can talk to
ANOLASr gay Man enpalcitiy avout Sater Sex, mare tunes about it,
offer to help him on with his condom. They can make it fun.

That gay man would be smart to stay miles away from a gay
seventeen year old, much less to have that same conversation.

But do you think that teenager 1s going to have that conversation
with me? We know this 1S a population seriousiy at risk.

 

 

 
 

 

However successful our educational eftor 2 1s, there 18 aiways a
new crop of children becoming sexualiy attive who haven't heara
it yet. Why did Pepsi Cola get anead of Coca Cola in sales?
Pepsi sold to a new group which hadn't noticed last year's ads.
If I may mix my metaphors, every year tnere arises a new
generation, which Knows not Josepn.

DRUG USERS. The IV drug of choice in Oregon is
methamphetamine. We Know there 1s a reiatively iow rate of
seropositivity now and a short doubling time. There 1s a list of
needle sharing going on. Metn users are not necessarily poor or
black. They are found all through society, and they usually
become aggressive and dangerous. nis population is extremely
difficult to reach. Resources are inadequate to provide
treatment programs for those who want them, much less to reach
other users.

ISSUES OF INCLUSIVENESS. Obviously, thougn they are a very
high priority, we don't limit our efforts to gay men. For
support groups, for example, nongay people might be uncomfortable
in a Same-sex group. In a big city you could organize another
support group. In a small town you can't fragment that much.
There aren't enough people; everyone can't be his own group and
we can't find volunteers to staff a group for each splinter. We
have to work together.

We have seen the gay community deal with this epidemic ina
tremendous, democratic way, peop.e argan.cring themselves to ceal
with their own health education and risk reduction, without much
help from the government. Willamette AIDS Council has exceilent
representation from gay men and lesbians, from health care
workers of all sorts--doctors, nurses, pnarmar.sts, social
service workers, youth counse.iiors, substance abuse workers, and

all kinds of people. We have an accountant wno vo.unteers
eofeesional assietancze, a jeurna list wi. 3as nelpec aut with
public reiations effertas--peltie from s.. ".5a8 of Wot ame

4
hackgrounds. We aren't big enouan ta exc.ute anyone,

-

 

RESOURCES AND ACTIVITIES. 2 “ave LIne a 8% w.TN A -.7T. es
Saath Lk. ei eat AM ist ea ee et E.  D 2 2 ee tt .
tee omaller wonman ties &@ ree T.v es BS Year, Liv dsrT itr wW.8” “tN
POSitive peod.e wno i1lve in wcrain, NOtl, vodqu...e, Zoos say,
Remote, and who csust l:ve on & r3ac up ir the wocds, oring:ng

them some news from the rest cf tne woria ans srtering support.
Donations bought his gas and 01:, and when he Grove his VW van
into the ground the newspaper ran the story and a family gave
Shanti the car they had been planning to sell. This 1s a
ridiculous, hand-to-mouth way to run a maror oublic health
effort. In our community we “ave a Sma..er vesourc2 case, so we
have to make do with smaller contributions, which are of course
harder to raise.

Some examples of our low budget efforts:
We go to every place we can think of where people will be. We

 
 

 

have wormed with the Chamber of Commerce to send speaxers to
businesses, to sponsor a conference, to print ana distribute
posters. We have worked with the school districts. We have sent
Speakers to unions, to day care workers, to personnel Managers,
to the nospital, to anyone who will listen. We gave away neiium
balloons and condoms in safer sex informationa.i wrappers at the
county fair. We go to all kinds of gatherings with our heiium
tanks, our lapel pins, our condoms, our AIDS quiz, and so on. We
have T shirts; we have coasters for bars to put under drin«xs as
they serve them. And we have done this with volunteers and a
half-time poorly paid staff person. We will not be aple to keep
up this level of effort indefinitely without more paid staf:.

Prevention 18 vastly cheaper than providing services to
persons with AIDS, and we can't afford it.

 

 
 

 

STATEMENT OF JOHN E. WAHL
T0_THE
PRESIDENTIAL COMMISSION
ON THE
HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC

March 24, 1988

Admiral Watkins and Commissioners:

For the better part of a year I was Co-Chair of the
National Steering Committee of Mobilization Against AIDS,
@ grass-roots organization formed to advocate action <= when
state and federal governments were doing little or nothing
in research, education, and treatment concerned with the AIDS
epidemic. I have been a community activist for many years,
currently serving on the boards of the Council on Religion
and the Homosexual, the San Francisco Council of Churches,
and the San Francisco Night Ministry. Hewever, my testimony
ia my own, and does not necessarily represent the view of

any organization.

I speak to you today from a point of view which is
probably different from any you have heard in your formal
proceedings. I am a gay man, openly gay, and happy to be
who I am. I do not see my sexual orientation as a drawback,
defect, disability, or demerit. I am unique as I have been
created, just as each of you is unique in your difference
from me and from each other. The only difficulties that
my homosexuality, my gayness, causes, are artificial diffi-
culties created by those people in society who are hostile
to gay, lesbian, or bisexual people.

Discriminatory laws and economic policies have histori-
cally been imposed on gay, lesbian, and bisexual people. Laws
have long been used to make same-sex sexual activity criminal,
even though approximately ten percent of the population are

only sexually attracted to members of our own sex. Economic

 

-1-

 

 
 

policies have long been used to punish our people: Homosexual

and bisexual people lose their jobs, in many parts of America,

if our sexual orientation is discovered, and we cannot get

other jobs. We face eviction from rented houses or apartments,

or refusal to rent to us, except for enlightened areas, like

San Francisco, where such discrimination has been made illegal.
When the AIDS epidemic began, and when it became clear

that AIDS was primarily a threat to gay and bisexual men,

it also became clear to many of us that the epidemic would

be used to reinforce discriminatory attitudes against us.

And, of course, there are many people who have tried to do

just that: We have been bullied by individuals and groups

(principally on the far right) who have made the illogical

and malicious charge that homosexuality is the cause of AIDS,

and/or that AIDS is God's punishment for being the way we

are made: Homosexual or bisexual. These individuals or groups

then call for quarantine, or internment, of us, or at least

those of us who may test positive for the presence of the

HIV antibody.

I am here today to outline a clear and present danger,

which is presented by the use of the AIDS epidemic against
the gay community. That danger is potentially as great as
the danger presented by the virus itself. The danger I speak
of is the danger inherent in the alienation and disaffection
of potentially millions of people.

Gay, lesbian, and bisexual people no longer believe,
nor will we pliantly accept, the discredited old notions that
we are somehow defective, and must hide who we really are.

We insist on our right to live just as full a life as you

live. We insist on living a full, responsible, sexual life.

We will not accept second-class humanity, anymore, nor will

we hide a basic aspect of who we are. Many of us are committed
to fighting for equality, and as more and more of us realize
that we don't have to accept the old homophobic attitudes,

it becomes impossible to attempt to suppress us, without grave

social dislocation.

—

 

 
 

Homophobia, and biphobia, are clearly just as much
of an obnoxious obstacle to human progress, as is racism.

We all know the horrendous struggles, including our own Civil
War, that have been directly or indirectly related to racisn.
Should sexual orientation become another violently divisive
factor in our society? Of course not. But there are a number
of people who apparently are prepared to let sexual orientation
become such a violently divisive factor.

This Commission is in a good position to work against
the misuse of fear of AIDS, as a tool for those who want to
suppress gay and bisexual people. The AIDS epidemic will
not destroy our liberation movement, but attempts to misuse
the fear of AIDS to suppress us will be very destructive to
social peace. For that reason, it is clearly in the national

interest to work against such misuse of fear of AIDS.

Finaliy, I want to talk about responsibility. Our

people, as most of you know, have been in the forefront of
efforts to prevent the spread of the virus. Our organizations
began the work of educating our people concerning safe sex,
and even now we run into governmental resistance to this kind
of education. This Commission should not, for one minute,

shrink from its responsibility to promote safe-sex education.

To deny Americans safe~sex education, because of somebody's
ideological or religious views about who should have sex,

means that one is willing to expose Americans to lethal risks,
rather than let them know how to have sex safely. Sadly, there
are many people who are willing to do just that. I hope that

this Commission will condemn that kind of dangerous obstruction

to public health education. Those who obstruct safe-sex education
can fairly be said to be responsible for any disease and death
which results from iac« of safe-sex knowledge.

Thank you for the opportunity to address the Commission.

 

 
 

 

Biographical Sketch February 1988

ROBERT N. BECK
Executive Vice President
Corporate Human Resources
Bank of America
San Francisco, California
As Executive Vice President of Bank of America's Human Resource
Division in San Francisco, Robert N. Beck has worldwide responsibility
for all Human Resource matters for the corporation and its subsidiaries,
as well as the BankAmerica Foundation, Corporate Conmunity Development,
and Corporate Security. Bob assumed this position in August 1982, after

serving as IBM director of Benefits and Personnel Services for

International Business Machines (IBM) for the previous four years.

Joining IBM in 1967 as a personnel trainee, Beck was named manager
of Employee Relations Research for Corporate Staff in 1971. A year
later, he was named manager of Personnel and Communications for the
Advanced Systems Development Division. He became Director of Personnel
for the division in 1973. For the next five years, Beck held positions
as Director of Compensation for the Corporation and Director of
Personnel for the General Business Group/International. In 1978, he was

named IBM Director of Benefits and Personnel Services.

Bob earned his bachelor's degree in business administration and
master's degree in behavioral science and industrial relations at San
Diego State University. He served in the U.S. Navy from 1961 to 1963,

and later managed supermarkets for Winn-Dixie and Safeway.

 

 
 

 

Bob is a member of various key committees within the bank
including: Managing Committee; Senior Management Council; Social
Policy Committee; Human Resources Committee; BankAmerica Foundation
Board of Trustees. He is Chairman of the Employee Benefits
Administration Committee and Employee Benefits Finance Committee and
is Secretary to the Executive Personnel and Compensation Committees of

BankAmerica's Board of Directors.

He also serves as a board member and advisor on a large number
of professional, educational, and business organizations and
foundations. He frequently lectures at leading universities across
the U.S., and has been actively involved for several years in the
fields of health care and aging. He has published numerous articles
and co-authored two books. He was the recipient of the ASPA Personnel

Executive of the Year award in 1985.

Current Positions:
Board of Directors

Blue Shield of California

American Federation of Aging Research

National Fund for Medical Education

National Council on Aging

University of California - San Francisco - Trustees
INROADS of San Francisco

American Assembly of Collegiate Schools of Business
San Francisco Chamber Orchestra

 
 

Associations

Labor Policy Association -~ Executive Committee

Employee Relations Council -- Business Round Table
Alpha Group -- Banking

Personnel Forum

Business Institute on Aging-USC -- Chairman

Institute of Medicine - Charles A.. Dana Awards Committee
Senior Executives Personnel Forum

University of California - Berkeley -- Graduate School of
Business Advisory Council

University of California - Berkeley - School of Public
Health - Center for Health Promotion and Disease
Prevention - Advisory Board

American Society For Personnel Administration -- Human
Resource Strategies and Issues Council

Brigham Young University National Advisory Council --
Member .
Northwestern University Advisory Council -~ Member
Charles Dana Awards Committee ~ Institute of Medicine

Positions

White House Conference on Aging -~- Delegate

U.N. World Assembly on Aging -- NGO Delegate

North American Conference on Aging -- Sub-committee Chair
Washington Business Group on Health -- Board

National Dialogue for the Business Sector -- Sub-committee
Chairman

Center for Consumer Health Education Board

Center for Industry and Health Care-Boston University

San Francisco General Hospital Advisory Committee
Business for Higher Education Forum Advisory Committee

 

 
 

Gh

Bank of America

San Francisco Headquarters

Assisting Employees with Life-Threatening I]lnesses

BankAmerica recognizes that employees with life-threatening
illnesses including but not limited to cancer, heart disease, and
AIDS may wish to continue to engage in as many of their normal
pursuits as their condition allows, including work. As long as
these employees are able to meet acceptable performance standards,
and medical evidence indicates that their conditions are not a
threat to themselves or others, managers should be sensitive to
their conditions and ensure that they are treated consistently with
other employees. At the same time, BankAmerica has an obligation to
provide a safe work environment for al} employees and customers.
Every precaution should be taken to ensure that an employee's
condition does not present a health and/or safety threat to other
employees or customers.

Consistent with this concern for employees with life-threatening
illnesses, BankAmerica offers the following range of resources
available through Personnel Relations:

o Management and employee education and information on
terminal illness and specific life-threatening illnesses,

o Referral to agencies and organizations which offer
supportive services for life-threatening illnesses.

o Benefit consultation to assist employees in effectively
managing health, Jeave, and other benefits.

Guidelines - When dealing with situations involving employees with
Tife-threatening illnesses, managers should:

1) Remember that an employee's health condition is personal and
confidential, and reasonable precautions should be taken to
protect information regarding an employee's health condition.

2) Contact Personnel Relations if you believe that you or other
employees need information about terminal illness, or a specific
life-threatening illness, or if you need further guidance in
managing a situation that involves an employee with a
life-threatening illness.

Bank of America National Trust and Savings Association Box 37000 San Francisco, Caitfornia 94137

 

 

 
 

Page 2

3)

4)

5)

6)

7)

8)

10)

Contact Personnel Relations if you have any concern about the
possible contageous nature of an employee's illness.

Contact Personnel Relations to determine if a statement should
be obtained from the employee's attending physician that
continued presence at work will pose no threat to the employee,
co-workers or customers, BankAmerica reserves the right to
require an examination by a medical doctor appointed by the
Company.

If warranted, make reasonable accommodation for employees with
life-threatening illnesses consistent with the business needs of
the division/unit.

Make a reasonable attempt to transfer employees with
life-threatening illnesses who request a transfer and are
experiencing undue emotional stress.

Be sensitive and responsive to co-workers’ concerns, and
emphasize employee education available through Personnel
Relations.

No special consideration should be given beyond normal transfer
requests for employees who feel threatened by a co-worker's
life-threatening illness.

Be sensitive to the fact that continued employment for an
employee with a Jlife-threatening illness may sometimes be
therapeutically important in the remission or recovery process,
or may help to prolong that employee's life.

Employees should be encouraged to seek assistance’ from
established community support groups for medical treatment and
counseling services. Information on these can be requested
through Personnel Relations or Corporate Health Programs.

0374L

 

 
 

 

 

 

 

 

 

OnYour Behalf

PERSONNEL NEWS UR A SL Sa aa galas

JULY ey)

 

 

 

Living with AIDS

 

AIDS is changing America and the
world in ways that are both dramatic
and subtle. The number of AIDS
cases is increasing, but medicine is
making advances in understanding
and dealing with the disease.
Although there is no vaccine or cure
yet, some drugs may be proving effec-
tive in treatment. And it is clear that
education can change attitude and
behavior. Because of new treatment
strategies, more people are living
longer after being diagnosed with the
disease. Over all, however, more of us
are going to know someone who has
the disease—a friend, a co-worker, a
family member, a business associate,
a neighbor.

More than ever, we all need to
understand this disease, and what it
means to us in today’s world.

What is AIDS?

AIDS stands for Acquired Immune
Deficiency Syndrome.

Aquired: This means that it is not

an inherited or genetic condition.

Immune: The immune system 1s the

body’s natural ability to protect

against infection and disease.

Deficiency: Incomplete or lacking.

Syndrome: A characteristic combi-

nation of signs and symptoms.

In other words, AIDS is a weaken-
ing of the body’s ability to fight dis-
ease, It leaves an individual vulnera-
ble to illnesses that a healthy immune
system could protect against.

The AIDS virus, known as HIV
(Human Immundeficiency Virus),
was identified in 1981. It enters the
body and cripples certain
lymphocytes—white blood cells nec-
essary for immunity. People with
AIDS are susceptible to diseases
known as “opportunistic infections,”
and to certain tumors. The infections
are caused by organisms that do not
usually cause disease in people with
strong immune systems. The most

common is pneumocystis pneumonia
(PCP). Kaposi’s Sarcoma (KS) is the
most common tumor associated with
immune deficiency. The direct effects
of the virus on the nervous system,
independent of immune deficiency,
also are increasingly seen.

Some people with AIDS may expe-

rience for years alternating periods
of illness and wellness; others may
die within a year of diagnosis.
Although currently there is no cure
for AIDS, treatments are available
for most of the afflictions suffered
by the AIDS patient during the
Continued on page 2

 

Vw

Your , Employee Handbook

 

Health care plans, Retirement bene-
fits. Life Insurance. Disability Bene-
fits. BankAmerishare. Tuition assist-
ance. What do all of these programs
have in common?

They are some of the programs
that round out your compensation
at BankAmerica. And they are
among the benefit programs that
you can learn more about by read-

 

 

 

 

 

 

ing the new edition of Your
Employee Handbook, published
this month.

The new easy-to-use one-volume
edition of Your Employee Handbook
replaces the previous handbook kit of
six booklets. Among its features are
charts to help employees quickly find

 

out how certain events (marriage,
divorce, child birth, etc.) affect their
benefits. Another feature that will
help employees use the new hand-
book for quick reference is the new,
expanded index.

The handbook includes updated and
revised information about such sub-
jects as:

« New features in the BA Medical
Plan, such as the hospital utilization
review program, prescription drug
programs, non-duplication of bene-
fits, and the preferred hospital
program.

® Expanded information about
medical absences.

« Current information on the volun-
tary life insurance program, as well
as a description of the dependent
term life insurance program.

* Updated CareerAccounts (Bank-
Amerishare and BankAmer-
account) chapters that include the
most recent changes in the tax laws.

" Highlight section at beginning each
chapter, providing a capsule sum-
mary of the programs described in
the chapter.

* More information about programs
such as assisting employees with life-
threatening illnesses, the Alcohol
and Drug Program, ridesharing,
Continued on page 2

 

 

 

 
 

 

AIDS continued

course of the illness. Also, new
drugs such as AZT in some cases are
able to boister an individual’s
immune system, fending off more
severe attacks of the opportunistic
infections.

Several medical problems are
related to AIDS, but are not a basis
for an AIDS diagnosis. These are
known as AIDS Related Conditions.
Although these conditions are not
considered AIDS, people with them
have many of the same medical and
psychological and social needs as
individuals with AIDS.

Many people exposed to the AIDS
virus stay well for a long time. Some
AIDS carriers may never get sick. The
only sign of exposure to the AIDS
virus may be a positive blood test for
antibodies to the virus. It is not
known how many people who are
antibody positive will actually
become ill. Currently, the best knowl-
edge indicates about 30 to 60 percent.
Full-blown AIDS may appear years
after the initial infection, whether or
not AIDS Related Conditions occur.

Who gets AIDS?

Consistently, since the disease was
identified in 1981, only people who
engage in specific at-risk activities
have contracted AIDS. The at-risk
activities are:

« Sexual activity through which
semen or blood or vaginal fluids are
exchanged.

« Sharing IV (intravenous) drug
needles with an infected person.

« Injection of contaminated blood
products, such as in blood transfu-
sions. (This method of transmis-
sion has been checked by blood-
screening programs put in place in
1985, You CANNOT get AIDS by
donating blood.)

* A woman infected with the
AIDS virus who becomes pregnant
or breastfeeds can pass the virus
to the baby.

What about casual contact?

AIDS is difficult to get. The virus is
not easily spread from person to per-
son, and has never been shown to be
spread by casual contact. The AIDS
virus is not passed through the air.
The virus is fragile and must be trans-
mitted from the infected person
directly into the blood stream of
another person.

Sneezing, breathing, or coughing
do not spread AIDS. Touching, hug-

 

ging, holding, « * shaking hands do
not spread AIDS. Daily activities—
working in a group setting, shaking
hands, eating at public restaurants,
swimming in public pools—pose no
AIDS threat. No one has ever con-
tacted AIDS in a work environment
such as Bank of America’s.

What is Bank America’s policy
regarding AIDS?

BankAmerica’s policy states that as
long as employees with any life-
threatening illness, including AIDS,
feel well enough to work and can meet
acceptable performance standards—
and their condition is not a health
threat to themselves or others—they

should be treated like other employees.

The company may make reasonable
accommodations for the employee—
flexible work hours, for example—as
long as these do not hamper a unit’s
business needs.

“We offer a wide range of resources
to employees with life-threatening
illnesses, as well as to managers and
employee groups,” says Katherine
Armstrong, Health Programs Man-
ager, Corporate Health Programs.

“These include management and
employee education and information
on terminal illness and specific life-
threatening illnesses; referral to agen-
cies and organizations that offer sup-
portive services for life-threatening
illnesses; and benefit consultation to
assist employees in effectively manag-
ing health, leave, and other benefits.
Sometimes, we assist employees in
getting help such as grief counseling or
advice on how to talk to and treat aco-
worker with AIDS.”

BankAmerica has received nation-
wide recognition as a leader in the
issue of dealing with AIDS in the
workplace. BankAmerica Founda-
tion supported the “AIDS in the

 

Handbook continued
service awards, the Child Care
Referral Program, and personal
crisis intervention.

The new 1987-88 Your Employee
Handbook is designed to be a ready
reference for employees to use when
they have questions about their bene-
fits. Remember, it is in your interest to
understand the provisions of the vari-
ous programs, because, unless the
proper procedures are followed, you
can risk losing benefits or coverage.
All units received copies this month
for their employees. Managers who
need additional copies may contact
Stationery and Supplies. |

 

Workplace” project, developing
informational materials used by com-
panies worldwide. Bank of America
also provided free office space for the
San Francisco AIDS Foundation.
Nancy Merritt, Manager of Equal
Opportunity Programs, as spokesper-
son for BankAmerica on the subject,
has testified before the California
State Senate and the San Francisco
Human Rights Commission, and has
discussed in national newspapers and
magazines the role that corporations
can play in managing the impact of
the disease.

“It 1s not a contagion issue,” says
Merritt. ‘An employee can come
back and work as long as he or she is
able. Providing a supportive work
environment for people with life-
threatening illnesses not only helps
them financially, it can even prolong
their lives.”

She adds: “Medically, we have
learned nothing to indicate that we
should change our policy. Last
month’s International Conference on
AIDS in Washington, D.C. con-
firmed what we know about the
transmission of AIDS. The fact
remains that some employees may be
uncomfortable with a co-worker’s
life-threatening illness. However, this
apprehension is usually based ona
lack of information.”

On the job, there is no need for
special protection against the AIDS
virus. No cases of AIDS have ever
been linked to sharing typewriters,
telephones, tools, papers, waterfoun-
tains, bathrooms, vehicles, uniforms,
desks, coffee pots, or eating facili-
ties. AIDS is not transmitted
through preparation or serving of
food or beverages.

“The most important point is for
everyone in the work site to show a
caring attitude and not to pass judg-
ment on the person,” says Dr. Linda
Hawes Clever, Chairman of the
Department of Occupational Health
at Pacific Presbyterian Medical Cen-
ter in San Francisco, and an expert in
the field of AIDS. “Be supportive in
whatever way you can. The disease
itself takes a tremendous emotional
toll, and it 1s imperative for persons
with AIDS to have a circle of support
around them.”

BankAmericans have been support-
ive of their co-workers who have
contracted AIDS. Employees with
AIDS have said that the support they
received from their managers and co-
workers, from Personnel Relations
Specialists and Human Resources

Continued on page §

 

 

 

 
 

 

 

Your Benefits

.

BANKAMERISHARE

Here are some questions that employ-
ees have asked about
BankAmerishare.

After Employment Ends

t I’ve been contributing to Bank-
Amerishare. If I leave the company,
what am I entitled to from my Bank-
Amerishare account? Is there a vest-
ing period?

EY au BankAmerishare
contributions—including employee
and employer matching contributions
and all investment results—are imme-
diately 100 percent vested. This
means that you are eligible to receive
your entire account balance after you
leave the company, no matter how
long you’ve been an employee. You
do not have to be retiring in order to
receive your account balance—only
ending your employment.

Receiving your account balance
doesn’t happen automatically
though—see below for the steps that
must be completed first.

[FT if 1 leave, how and when will I
receive my BankAmerishare account
balance?

fH First, your personnel record must
be updated by your manager to reflect
your termination from employment.
Because Bank Amerishare #3994 can-
not pay you until this step has been
completed, make sure that your EDP-
480 record has been changed by your
unit. Nothing else can be done until
your manager has completed this
step, so it will be to your advantage to
make sure that your record 1s updated
as soon as possible.

Then you must submit an Jmmediate
Lump Sum Distribution Form (EXEC
916) to Bank Amerishare #3994 within
six months of your termination date in
order to receive payment of your Bank-
Amerishare account balance, This
payment is called your “distribution.”
Otherwise, you will not be able to claim
your benefits until your 65th birthday,
or until your 55th if you have 15 years of
covered service.

If you are going to roll over your
lump sum distribution (whether cash
or stock certificates) into an IRA, or

 

into another qualified plan, you
should check the box on the form
indicating “do not withhold taxes
from my distribution.”

The value of your BankAmerishare
account is determined on the last
working day of the month in which
BankAmerishare #3994 receives your
distribution form. They will send you
a confirmation notice verifying that
your form was received and the date
that it will be valued. You will receive
your distribution no later than 60
days after that valuation date, and
most distributions arrive within 30
days. For example, if your form was
received anytime in June, the value
would be determined at the end of
June, and you’d receive your distribu-
tion by the end of July—or before the
end of August at the latest.

| If I qualify as a retiree, can I defer
my BankAmerishare distribution
until a later time?

rH Yes. If you are at least 55 and have
15 years of covered service, or if you
are least 65 (regardless of your years
of covered service), you will have
additional choices.

You may defer your distribution
past the age of 65, if you choose. You
must submit the Retiree Deferral
Form (EXEC 655) to BankAmeri-
share #3994. On this form you will

 

need to indicate the date to which you
wish to defer your distribution. On
that date you will be requested to
either settle your account, or further
defer your distribution. You may
defer your distribution up to April
first following the year in which you
reach 70 '4. For example, if a retiree
reached 70 years plus six months in
June of 1990, they would be able to
defer up to April 1, 1991.

As a retiree who has chosen to defer
your distribution, you also will have
the choice of withdrawing part of
your distribution ahead of time, but
you should be aware that doing so
may jeopardize your eligibility to use
special forward averaging tax treat-
ment. It would be to your advantage
to check with a tax advisor first. And
you may also make transfers among
the investment funds.

If you are planning to receive your
retirement funds in monthly annuity
payments, you may transfer a portion
of your BankAmerishare balance to
BankAmeraccount, so that your
monthly pension payments are larger.
Either your Retirement Counselor or
CareerAccounts Customer Service
Representatives can tell you the maxi-
mum amount that may be transferred
(it cannot include your tax basis).
This step should be completed before
your first monthly payments start,
whether this will happen shortly after

Continued on page 4

 

Shareholder Investment Plan

 

Recently, BankAmerica Corporation
announced the launching of the
BankAmerica Corporation Share-
holder Investment Plan (SIP), an
improved stock purchase and divi-
dend reinvestment plan.

Those eligible to participate
include employees who own BAC
common or preferred stock in their
own name, or who have shares of
BAC common stock in their account
in BankAmerishare or the Bank-
American Stock Purchase Plan.
Prospectuses describing the plan and
enrollment forms were mailed to
eligible Bank Americans.

To clarify some questions that have
been asked by employees: SIP is not

 

part of the BankAmerishare Plan. It
is an independent plan. Participation
in SIP will not in any way affect par-
ticipation in BankAmerishare. SIP
account information will not be
reflected in the quarterly Career-
Accounts statement, but will be
accounted for by Corporate Agency
#9510 through a separate statement
sent to SIP participants.

Corporate Agency is the coordi-
nating department for the manage-
ment of the SIP program. All
inquiries, including eligibility
requirements, should be directed to
them at BankAmerinet S.F. 624-4013
or by using the 415 areacode. @

 

 

 

 
 

 

Need documentation of your employment?

 

Under the new federal immigration
law, people who have been considered
unauthorized aliens may apply to the
Immigration and Naturalization Serv-
ice (INS) for legalization in order to
change their status. One requirement
is that they can prove that they have
been living in the United States contin-
uously since December 31, 1981.

One way to prove continuous
residence during that time is by
providing an employment record. If
you need a record of your employ-
ment with BankAmerica, all you
have to do is write a letter saying
that you are requesting employment
verification for legalization. Include
this information:

® Your full name

 

« Your Social Security number
® Your unit’s name and number
* Your work telephone number.

If possible, also include the date
that you were hired. If you had any
breaks in service, it would be help-
ful to include the dates that you left
and came back to work for
BankAmerica again.

Enclose a self-addressed inter-
branch envelope with your letter. Then
send your letter and envelope by inter-
branch mail to Earlieen Rayford,
Personnel Records #5766. Once your
letter is received, it will be acted
upon quickly, so you should expect to
have your reply within ten days (to
allow for mailing time).

 

By law, the deadline for accepting
applications for legalization will be
May 4, 1988. The Immigration and
Naturalization Service (INS) has
recorded a series of messages about
the new immigration law. If you call
800-777-7700, their 24-hour, toll-free
number, you will be able to choose
which messages you want to hear, in
English or in Spanish. You will hear a
list of subjects, and you can choose
what you want to know more about
simply by dialing or punching that
message’s number. Included are mes-
sages that tell you where you can go
for further help in your area, includ-
ing non-government private organiza-
tions or individuals and INS special
legalization offices. —A.W.

 

Your Benefits continued

retirement or whether you are defer-
ring your pension payments until
later. You will receive more informa-
tion at the time of your retirement.

py What about taxes? What choices
do I have?

Hy Upon receiving your distribution,

you have several options.

1. You can roll over your taxable
amount into an Individual Retire-
ment Account (IRA). Essentially,
that means that you can defer pay-
ing taxes until later by redepositing
the taxable amount with a financial
institution that acts as custodian of
your IRA, as long as you do it
within 60 days after you receive
your distribution.

2. If you are working, another possi-
bility is to roll it over into the quali-
fied plan of another employer.
Again, this must be done within 60
days after you receive your
distribution.

3. Youcan keep the money and pay
current taxes.

You will need to find out if you are
eligible to use special tax treatments
(forward averaging or partial long
term capital gains). Your Employee
Handbook’s chapter on Bank Ameri-
share has the specific details.

As tax matters are complex and each
person’s situation is different, we sug-

 

gest that you consult a qualified tax
advisor for advice.

fi Am I entitled to interest and/or
earnings during the time between my
termination and distribution of my
account?

Ei No, the amount of your distribu-
tion is determined at the end of the
month in which your distribution form
is received. After that cutoff date,
administrative tasks are carried out so
that your distribution payment can be
sent to you. The BankAmerishare
Plan does not pay interest during this
processing time.

fl L already know I’m able to roll over
the taxable portion of my BankAmeri-
share final distribution into anIRA.
But, what if I choose to receive stock
certificates rather than cash? WillI be
able to roll over the stock?

Ly Stock certificates may be rolled
over into an IRA handled by a broker-
age house, within 60 days. However,
you should contact the administrator
of the IRA toseeif that IRA will
accept the certificates. You would then
sign them over to the IRA custodian.
Sometimes this can be done through
an electronic transfer, instead.

You also can sell your stock certifi-
cates through a stock broker, and then

 

you have 60 days to roll over the taxable
amount into an IRA, sothat youcan
defer paying taxes until later. If you
don’t choose to deposit the sale pro-
ceeds into an IRA, you will be liable for
ordinary income taxes, and possibly a
10% penaltytax.

 

 

 

If you have any further ques-
tions, please refer to the chap-
ter on BankAmerishare in the
new and revised 1987 Your
Employee Handbook (EXEC
40). It will be distributed to all
employees by the end of July.
For additional help, you
may call the CareerAccounts
Customer Service Representa-
tives at 624-2314, using Bank-
Amerinet or the 415 area code.

 

 

 

 

 

 
 

Good Ideas

 

During May, the following good ideas
were suggested by employees through
teas In Action, a write-in suggestion
program, and through Quality Circles,
groups of employees who identify and
solve work related problems. In total, they
earned $4,399. Some of their suggestions
are listed below. The total savings to the
corporation for the year comes to
$371,913. Employees’ cash awards are
based on the percentage of the resulting
savings—direct or indirect—and the cost

of implementation.

Ideas In Action

 

Nancy L. Burns

CREIG-Sacramento

« Eliminating the procedure of send-
ing promotional! material to bank
groups with limited customer contact:
$630

Patricia Ward
Pleasanton Branch
« Eliminating an Officer Change of

AIDS continued
managers, and from the Benefits
epartment “played a key role” in
-neir return to comparative good
health after their initial convales-
cence. They all feel that the opportu-
nity to return to work and be produc-
tive was important to them both
physically and psychologically.

One employee with AIDS wrote
that, as a volunteer counselor, he has
encountered “the great sense of hope-
lessness experienced by those whose
support systems have let them down.
This factor, in my opinion, is as
deadly an enemy as the virus itself.
Bank of America most assuredly has
not let me down.”

What benefits are available to
employees with AIDS?

The corporate benefit plans treat life-
threatening illnesses, including
AIDS, the same as other medical
conditions. Employees who are dis-
abled from working may be eligible to
receive income protection through
accrued benefits and the Long Term
Disability Plan. When employees are
ut on an approved medical leave of
dsence, benefits continue as follows:

= Coverage for health plans (medi-
cal, dental, vision) continues at the

 

 

 

Status Form for promotions of offi-
cers grade 75 or above: $532

Diane Ellison

BA Canada—Foreign Currency
Services

« Inserting a clause in contracts with
multinational equipment manufac-
turers to enable offshore BA man-
agers to take advantage of U.S. equip-
ment contracts: $500

Jacquelyn Ferguson

Capitol Proof Center

» Revising carrier envelopes to
include clear windows on both sides:
$390

Patricia Bell

Rancho Encinitas Branch

e Eliminating call-backs from Item
Processing Operations to branches
for rejected items except when
branch-endorsed for unpaid returned
items over $2,500: $370

Amy Kiss

Southern California Audit

« Eliminating the Quality Informa-
tion Report and Swingshift Mail Bag
Tags: $350

Jennifer Carlson
Teleservicing Center

pre-disability rate as long as the
employee continues to make
monthly contributions.

= Basic (employer-paid) life insur-
ance continues and so do employee-
paid life insurance benefits as long
as the employee makes monthly
contributions.

Employee banking privileges
continue as long as the person is
considered an employee of the
company.

* BankAmeraccount benefits con-
tinue. Employees continue to earn
pay-based credits as long as they
receive sickness benefits. If sickness
benefits have expired, credits are
earned as long as they are receiving
Social Security disability payments.

* BankAmerishare benefits may
continue as long as an employee
receives sickness benefits. Long-
term disability benefits are not
considered eligible earnings for
BankAmerishare.

Learning about AIDS

“Education is critical,” says
Katherine Armstrong. “Companies
such as Bank of America have an
important role to play in educating
employees and in helping inform the
communities in which we operate

 

 

« Placing adhesive stickers on VER-
SATEL® machines that state: “Under
no circumstance would any BofA
representative ask you for your PIN
number”: $340

Sandi Eastwood

Loma Linda Branch

» Revising the Vault Sheet to improve
recording procedures: $200

Baoing Seto

BA Cheque Corporation

« Consolidating write-off entries for

escheatment by adding a flag in Paid

Cheque Processing systems: $150

Quality Circles ©

Matthew Amorosano, Audrey
Buziecki, Wayna L. Gray, Linda
Lowman, Marilyn Miller, Marcie
Packard, Rebecca Palmer, Rose
Williford, Kirsti Yeazell, Vickie D.
Zelmer, Jeanette Byl (facilitator)
“BARE PATROL”—BARE Residen-
tial Mortgage Banking Group

« Creating a communication form to
provide customers with weekly prog-
ress reports of telephone requests:
shared $250

about the facts concerning AIDS.

All of us can be sure that we are
informed on the subject, that we
avoid behavior that puts us at risk,
and that we provide support to indi-
viduals who need it.

“We can start today to help stop the
spread of AIDS, as well as the unnec-
essary panic and fear. We can help
educate others—including children
and teenagers—about AIDS. We can
support research and education. And,
if at some point one of our friends or
colleagues has the disease, we can
treat him or her not with fear, but
with compassion.” &

 

Toll-free AIDS Information Hotlines:

Northern California: 800-FOR-AIDS
Southern Califormia: 800-922-AIDS
National Public Health Service:
1-800-342-7514

The Personnel Relations Specialists
for your unit can provide information
on referral services and benefits
information.

More information about AIDS 1s
available from Bank of America
Corporate Health Programs. If you
would like to receive some pamphlets
and/or to borrow the % ” video
“AIDS in the Workplace,” call them
on BankAmerinet 622-1113, or use the
415 area code.

 

 

 

 

 
 

Employee Benefits WORD JUMBLE

How well do you know your
employee benefits? You can win
prizes just by reading the new Your
Employee Handbook and complet-
ing the Word Jumble below. Fill in
the letters correctly and you’ll have
a chance to win one of these prizes
in our random drawing.
# One grand prize: An outing kit
from The Company Store. The
navy insulated case with carrying
handles contains a 100 percent wool
plaid blanket and Aladdin thermos.
Terrific for picnics or football
games.
« Three first prizes: A quartz
travel alarm clock with a night
light, snooze button, and carrying
case. From The Company Store.
« Five second prizes: A business
card carrying case with solar calcu-
lator (no battery needed). The case
is black, full-grained leather with
silk lining. From The Company
Store.
« 25 third prizes: Easy Bankercise
rubber band exercise how-to
charts, complete with giant rubber
bands. These 7-minute stretching
and relaxing exercises can be done
at work or at home. From
Corporate Health Programs.

How to enter

Complete the Word Jumble with the
help of the new Your Employee
Handbook, which you’! receive in
July. Return the completed Jumble
with the coupon below to Benefits
Planning #3609.

Rules:

" All active employees are eligible
to enter the Word Jumble contest,
(excluding Benefits Planning and

Personnel Communications). :

= Entries must include name and
department number.

» Entries must be received by
August 14, 1987.

« Prize winners will be determined
by a random drawing from correct
entries. If there are not enough
correct entries, the balance of prize
winners will be drawn from the
remaining entries.

Answers to the Word Jumble will
appear in September’s On Your
Behalf along with a list of the top
prize winners.

 

 

 

 

wy

  

 

 

 

mmr ttt rm we ee eer rer rr met ee er ee ee eH et ee ee ee eK ee eee ee ee ee Le

  

It'sgreen, ~ ie

doesn't talk, but ‘NE ¥

has all the answers. ~ > |
“What Isit2 | —-
wan nnn eee eee eee eee Mi ----5

Employee Benefits Word Jumble

1. Unscramble these 8 Jumbles, one letter to each square. To help, we have
inserted a few letters in their proper places. (Hint: Each word or pair of
words is related to the various employee benefits offered at BankAmerica.)

TTNIOECPOR OROODeEODON
ALONTE OUOOdaO
CTAVNOAI O@®oooo0d0gn
UNRACISEN ONOOOUDOCDQOE
MOH Ooo

ERFE OoOoo

HCCKNGIE Gooud0ond @
EERYLOPM OO 8BOCd0OA0O
TCAMH OOUmada

NEBFTSIE OOOO000 g

2. Now arrange the circled letters above to form the surprise answer. You'll
find a clue in the drawing.

Anwer; Mi OOO OOOOOOOO Ooooooo0o

My Name

 

Unit/Branch Dept#

 

Location

 

Phone

 

Send with completed Word Jumble by interbranch mail to:
Benefits Planning #3609, Attn: VG

 

 

 

 
 

“F Open Line 1s a program

for confidential upward
communication between

& employees and
management Answers of
general interest may be

published in On Your
Behalf, sometimes in
condensed form but only
with the permission of the writers and all marks of
identification removed If you use Open Line and
identify yourself, you will receive a reply whether or
not your question and answer are published here
Open Line forms (EXEC-772) may be ordered from
Stationery and Supplies #3048
Number of Open Line questions since the
program began in April 1972 11,830 Percentage of
questions signed 96%
If you need help on a Personnel Relations matter,
contact your division Human Resources group

SAFE DEPOSIT

4S I would appreciate your giving me
the bank’s thoughts behind our charging
a key deposit on safe deposit rental for
employees. It is now $10, over our prior
$2.50. When an employee transfers from
one branch to another, it seems the key
deposit would be waived or “transferred”
with the box. Currently, they credit the
$2.50 at the old branch and charge the
$10 at the new.

This would also apply to old-time cus-
tomers. Imagine customers’ feelings when
they leave one area after a lengthy time,
transfer accounts to another branch of
Bank of America, only to find their key
deposit has gone to $10! This could prove
to be a customer relations problem...espe-
cially if the branch from which they are
transferring fails to mention this fact ...

s has happened.

With the benefits Bank of America
employees receive, this may seem like a
small item, but many feel it has merit. Why
can’t we add yet another benefit for us?

Thanks for your help.

vb Answer from Ilze C. Grace, SVP,
Individual Financial Markets

We appreciate your concern regarding
the 1985 safe deposit key increase. This
increase (from $2.50 to $£0 00) was initi-
ated as an incentive for customers to
return their keys and properly close their
safe deposit boxes We have discovered
that a number of customers will not go to
their branch to close out their safe deposit
boxes and receive their $2.50 key deposit.
These boxes would go delinquent and
eventually be drilled and require a new
lock at bank expense With the key
deposit of $10.00, there 1s a stronger
incentive for customers to come into the
branch and close out their boxes.

If you have customer relations problems
resulting from this price revision, refer
customers to your Branch Administration
Officer or Manager

We have reviewed your request to main-
tain the $2 50 key deposit for transferred

nployee safe deposit boxes and see the

dditional benefit as negligible, in com-
parison to the cost to implement the
change We view the 50% discount on the
established safe deposit box rate as an

 

appropriate employee benefit for safe
deposit boxes.

CUSTOMER ID

4s I felt very disappointed after hearing
calls to a local radio station. Most of the
calls complained about BofA’s services
related to credit cards.

One caller said he couldn't open a “sav-
ings” account with BofA because he
didn’t have a credit card. He ended up
depositing his money with Wells Fargo.
Another caller was told by a BofA teller
that be couldn’t cash his checks with just
his driver’s license.

1 think public relations is quite crucial
to our success as a retail bank domesti-
cally, Besides, there’s no reason to make it
a necessity to carry a “credit card.”

wb Answer from Larry McNabb, Senior
Vice President, Retail Payments

I share both your concern and disap-
pointment that a potential customer may
perceive that our bank requires a credit
card for identification purposes. When
providing banking services, we generally

 

require two forms of identification to
identify a customer who is not known to
us. Customers who are not regular bank
customers, or who are transacting services
at a branch, other than their own, may be
asked to present two pieces of 1.D. Our
identification procedures serve to protect
both the customer and the bank by ensur-
ing the requestor of any transaction is, in
fact, entitled to its value.

A credit card is only one of the eleven
forms of acceptable identification sted
in the “Opening New Accounts” manual
(PM-117). The most common forms of
identification are the California driver’s
license and major credit cards. However,
if an individual does not possess these,
alternative forms such as a U, S. passport
or an Armed Services identification card
are acceptable.

We agree that positive public relations is
critical to our success. Thank you for
taking the time to bring this issue to our
attention. Your interest in the quality of
service we provide is important to main-
taining the integrity of our first priority—
customer service.

 

 

 

 
  
 

 

 

 
 
 
 
 
   

Career Accounts

PERSONAL anv CONFIDENTIAL

Personne! Data and Benefits Administration 3607

 

 

L

Why look inacrystal ball to see what’s
in your financial future, when all you
need to dois open an envelope?

Just as your pay stub represents
your present financial benefits from
working at BankAmerica, your
CareerAccount statement shows you
what’s being set aside for your
retirement

This statement gives you the clear
picture you need to make ongoing
decisions about your investment
choices. And it also helps you by
giving you information to decide
whether or not to change your level
of participation in CareerAccounts.

But maybe you’re still not con-
vinced that your CareerAccounts
statement 1s Important for you.

Have you ever taken a vacation and
realized you had neglected to set aside
enough money to do all you’d

 

 

- Wer
rcre”® i :
maa ! id

 

  

ft Bie le — *
1989 c, puge’

 
 

 

planned? Without careful planning,
retirement can resemble a bad vaca-
tion, or worse. And the resemblance
wouldn’t end in a week or two,
because retirement encompasses a
significant portion of our lives.

It’s your future, and Bank-
America helps you make it a better
one by providing an employer-paid
retirement plan, BankAmer-
account, and a matched savings
plan, BankAmerishare.

Soon you will receive your quarterly
CareerAccount statement. Along with
it will be an explanation of each line of a
typical statement, including cross-
references to the new employee
handbook.

So take a few moments to read your
statement. Keep it with your other
important papers. As you plan your
future, it will beausefultool.

 

 

 

 
 

 

August Challenge: Be in charge!

 

Accurate, up-to-date personal and
family health records can save lives.
Getting accurate data quickly is an
important part of our daily work in
the bank. It makes us more efficient,
helps reduce errors, and gives us a
sense of being in control. You get the
same benefits when you keep an accu-
rate, up-to-date personal health
record, for yourself and each member
of your family. The August Challenge
could even be a lifesaver!

It’s easy to forget the date you ora
family member last saw a doctor, had
a physical exam, tetanus booster, or
an X-ray taken. And remembering the
names Of illnesses, laboratory tests,
and medicines is a challenge for most
of us. If you have more than one
physician providing care for you, this
information should be gathered by
you in a personal home health record.
In an emergency, this information is
vital to obtaining accurate and appro-
priate treatment.

= If you need guidelines for review-
ing the types and frequency of your
immunizations and would like a
copy of Corporate Health Pro-
gram’s Personal Health Record,
send a self-addressed interbranch
envelope to “Health Record” #3666.

 

August Challenge: Be In Charge

Yes, during August I helped improve my health care by:

 

1, Organizing a personal health record for each member of the family.
2. Reviewing my immunization status and arranging to get any that I need.

3. And checking with my family for any history of diseases and entering the
information in my record.

 

 

 

Signature
Name No. of family members
Unit (name & number) Phone

 

 

To qualify, you must complete this Challenge and send:
1. This coupon
2. And a large (10x13 "), self-addressed interbranch envelope to
Corporate Health Programs #3666.
(Sorry, available only in the United States)

Complete the August Challenge by
doing the following:

1. Organize a personal health record.
If you have a family, be sure to
include everyone.

2. Review your immunization status
(that’s right, they’re not just for
youngsters) and make arrangements
for any needed immunizations.

3. Check any family history of disease
and include it in the record.

If you complete this month’s Chal-
lenge and mail in the coupon below,
you will be rewarded with the helpful
booklet “Protecting Adults Again:
Disease: Immunization.” And in
addition, it will be put in our ran-
dom drawing for 50 free copies of
the popular book Jake Care of
Yourself—A Consumer's Guide to
Medical Care. @

 

 

By request

Cee e e reer errr renee rece eee ee eee ere reer e eee eee re ee nee eee

Taking responsibility for your health
includes learning how to be a wise
consumer of health care systems—
doctors, clinics, hospitals, or other
health care professionals. A 3/4"
video on this subject is available to
borrow from Corporate Health Pro-
grams #3666. “Only the Best” is an
entertaining and informative presen-
tation on how a family finds out ways
to keep their costs under control and
still get the best care for themselves.
A pamphlet for each viewer accompa-
nies the video; let us know how many
you will need. Perhaps your unit
would like to see it during lunch
break? Sorry, it is not available in
home viewing size.

 

Request for “Only the Best” video and
viewers)

—________ pamphlets (number of

Name Phone __.

Unit name & number

 

1) Send this coupon, and

2) A large 10x13”, self-addressed inter-branch envelope to
“Only the Best” #3666

Note: Due to the limited number of videos, requests will be filled on a “first
come, first served” basis. Sorry, available only in U.S.

 

Published by Personnel Communications #365}

 

 
 

 

OTM SR TARO Vela tot Rattle tok ee

Uulerstanding

iis

by Molly Laughlin

Irresponsible headlines call out in
huge type from news stands across
the nation: “Now No One is Safe
from AIDS” and “AIDS: The Epi-
demicis Spreading Like Wildfire.”
We read newspaper and magazine
stories about parents who refuse to
send their children to school because
another child is afflicted with AIDS.
Recently, prompted by the death of
Rock Hudson from AIDS, the
Screen Actors Guild in Hollywood
issued new guidelines about actors
involved in on-screen kissing scenes.
No disease in modern times has

created such fear, largely fueled by
misinformation. Dr. Mervyn

rerman, former director of the

i Francisco Department of Public
Health, says,.“The primary way to
prevent further spread of the dis- ”
ease is by education and informa-
tion. The more we know about it,
the more we can protect ourselves
and can show compassion and
understanding toward those with
this deadly illness. For one thing is
clear: AIDS is everyone's concern.”

AIDS: A background

AIDS stands for Acquired
Immune Deficiency Syndrome.
The AIDS virus, known variously
as HTLV-II and LAV, was identi-
fied in 1981.-Since then, some
15,000 people have been diag-
nosed as having the disease. The
AIDS virus enters the body and
cripples lymphocytes, white blood
cells necessary for immunity. The
weakened immune system then
becomes susceptible to a wide
range of infections and tumors,

 

 

Toll-free AIDS hotiines
Northem 800-FOR-AIDS
Cafifomia  TDD—{415) 864-6606
them
lfomla =—s«1-800-922-AIDS
National Public

Health Service 800-342-AIDS

U.S. Centers for Dis-
easeContrat §=1-800-447-AIDS

 

many of which are serious and
potentially fatal. Among the most
common of these is a parasitic
lung infection, Pneumocystis cari-
nii, and an unusual form of can-
cer, Kaposi's sarcoma.

The illness can runa short,
aggressive course lasting weeks or a
few months, or may last for years.

Although there is no current
cure for the disease AIDS, there
are several available treatments for
most of the afflictions suffered by
the AIDS patient during the
course of the ulness. However,
because AIDS so destroys the
immune system, medications can-
not be boosted by the body's natu-
ral defense system, and will even-
tually lose their effectiveness.

Fiction: I could get AIDS from some-
one on the bus or by using the tele-
phone of aco-worker with AIDS.
PO

Fact: AIDS is very difficult to catch
and no evidence points to transmis-
sion through casual contact, such
as that found in the workplace. The
virus is fragile and requires a warm,
moist environment to survive.
Exposure to the air kills it. Dr.
James Curran, a world-renowned
AIDS expert from the Center for
Disease Control in Atlanta, says,
“No scientific evidence supports
AIDS transmussion by casual con-
tact, by the airborne route (such as
colds and flu), by objects handled
by persons with AIDS, or by con-
taminated environmental surfaces.”
Medical experts agree that AIDS is
far less contagious than hepatitis,
colds, and flu. Despite this, a New
York Tumes/CBS News poll showed
that nearly half the population
thinks they can catch AIDS by
sharing a glass with a person with
the disease.

So how is the virus transmitted?
By direct transmission of blood or
blood-contaminated tissue fluids
from a person with the virus to one
without it. Typically this occurs
through the use of shared intraven-
ous needles where blood is
exchanged and through sexual con-
tact with an infected person. But,
says Dr. Linda Hawes Clever,
Chairman of the Department of
Occupational Health at Pacific
Presbyterian Medical Center in San
Francisco and an expert in the field
of AIDS, “The virus has to enter the
body through one of two places—
the skin or through a damaged

mucous membrane. In addition,

   

Er DR eas a Aaa eal ae Se maar Tremere a. el en

researchers believe the virus usually
strikes someone whose immune
system already is exhausted or
weak due to previous infectious
illnesses or substance abuse.”

The AIDS virus may be present
not only in blood and semen, but
also in other body fluids, including
saliva, tears, and sweat. However,
medical experts believe that daily
activities—working in a group
setting, shaking hands, swimming
at public pools, and eating at pub-
lic restaurants—pose no AIDS
threat. This is because the AIDS
virus is so fragile and it must get
outside of the bloodstream of an
infected person, into the blood-
stream of another person

Fiction: Only homosexual men and
drug abusers get AIDS.
nS

Fact: This is not true, Others not
considered in the “high risk” groups
also have contracted AIDS. How-
ever, up to now, researchers have
found most people with AIDS are
either homosexuals or drug users.
Of the reported cases of AIDS in
the United States, about 73 percent
are homosexual or bisexual men; 17
percent are intravenous drug users;
2 percent are recipients of blood
transfusions where the blood con-
tained the AIDS virus; 1 percent are
heterosexuals who have had sexual
contact with an infected carrier;
another 1 percent are hemophiliacs
who may have had blood transfu-
sions; and 6 percent are classified as
“other/unknown.” This last group
reflects mainly the patients who
have not had a history taken, or
who choose not to disclose their
private lives or habits.

Current statistics show that 90
percent of the stricken adults are
between the ages of 20 and 49; 94
percent are men. Children also may
get AIDS. Usually, these are infants
whose mothers were infected with
the AIDS virus and passed it on dur-
ing pregnancy or hemophiliac chil-
dren who become infected througha
blood transfusion. However, Dr.
Clever points out that the chance of
contracting AIDS through a blood
transfusion was minuscule. Today,
as blood banks carefully screen all
blood donations, the chances are
reduced further.

Fiction: If lam infected with the
virus, I will get AIDS.
RAC

Fact: You might, but youalso might

not. Many healthy people will
develop antibodies to the virus,

 

remain healthy, and display none of
thesymptoms of AIDS, though they
might transmit the disease to others.
About 10 to 15 percent may develop
what is called ARC (AIDS Related
Condition), characterized by mild to
severe illnesses. Finally, another 10
or 15 percent may develop AIDS. It
can take anywhere from a few
months to several years after infec-
tion for diseases to develop.

Prevention is key

Because the primary transmission
of AIDS is through sexual contact
and intravenous drug use, it is
imperative that indjviduals practice
safe sex habits and refrain from
sharing needles, Those in the high
risk groups should protect them-
selves and their sexual partners in
the same way they would for other
sexually transmitted diseases. The
referral agencies listed in the
accompanying sidebar may provide
assistance in methods of protection

How one lives his or her life also
plays a preventive role. Substance
abuse, including alcohol abuse,
poor nutrition, and inadequate rest
and activity may contribute to the
development of AIDS. “The point
is that AIDS is predominantly a
sexually transmitted disease, and
that means it's a disease of life-
style,” says Dr. Silverman. “People
who don’t do certain things very
likely will not get it. People who do
certain things risk getting it.” He
adds that the same points are true
for intravenous drug users.

f
Fiction: People with AIDS should
not be allowed to work.
Oe
Fact: Employees with AIDS, like
persons with other hfe-threatening
illnesses, should be allowed to work
if they choose, aslong as their cond:-
tion does not interfere with their job

BankAmerica’s policy states that
as long as employees with any life-
threatening illness, including AIDS,
are able to meet acceptable per-
formance standards and medical
evidence indicates they are not a
health threat to themselves or oth-
ers, they may work.

Often, says Dr. Clever, an
employee with AIDS may have to
adopt a work schedule to accom-
modate a greater susceptibility to
fatigue. “The most important
point is for everyone in the work
site to show a caring attitude and

Continued on page 2

 
 

 

 

Roll up
, our

sleeves

The decision to give blood is an
individual one. For some, donating
blood is a charitable contribution
that doesn’t involve much time or
money; it's also a way to repay
blood that was given to a friend or
family member in a crisis.

Some people would like to
donate, but can’t because of medi-
cal restrictions, such as being under
the 110-pound minimum weight
limit, recent pregnancy, or prior
exposure to a communicable dis-
ease. Others are afraid of needles
or faint at the sight of blood—
genuine considerations.

The only out-and-out bad rea-
sons not to donate are the ones
based on misconceptions. The latest
and most harmful myth involves
AIDS (Acquired Immune Defi-
ciency Syndrome). Fear of contract-
ing AIDS is causing a serious
decline in donations while the need
for blood continues to rise. In many
areas, more than 50 percent of the

xd used for transfusions comes
: blood drive donations—and
Yimsconceptions are keeping people
away, particularly in urban centers.

AIDS

Continued from front page

not to pass judgment on the per-
son. Be supportive in whatever
way you can. The disease itself
takes a tremendous emotional toll,
and it is imperative for persons
with AIDS to have a circle of sup-
port around them.”

Fiction: A person with AIDS might
pass along infectious illnesses to co-
workers or because that person's
immune system is weak, he or she
might be more susceptible to the
normal “bugs* that strike an office.
DS

Fact: The person with AIDS does
have a lowered immune response to
fight off infections, but is unlikely to
pass along the AIDS-related ill-
nesses, such as pneumocystis,

ruse most adults already have

exposed to this infection some-

enste earlier, and havea built-in
immunity. As far as contracting
diseases, the person with AIDS may
have a slightly higher-than-normal
susceptibility to such contagious

Donating blood does not cause
AIDS. If you are at risk to contract
or carry AIDS, don't give blood. If
you're not, the blood banks can use
your help.

“All blood collection agencies
use new needles for each donor,”
says U.S. Surgeon General C.
Everett Koop, M.D. “That needle
is sterile and is thrown away after
a single use. You cannot get AIDS
by giving blood.”

Many blood banks follow the
procedure used by San Francisco's
Irwin Memoria! Blood Bank, where
each needle used in donation comes
sealed in its own protective casing.
The covering is not removed until
the appropriate spot on your arm
has been cleaned with an antiseptic
solution. After the donation, a
nurse detaches the needle from the
blood bag and discards 1t 1n a spe-
cial waste bag so it can be destroyed
at the end of the day.

How did this fear of contracting
AIDS by donating blood come
about? Probably because a small
percentage of people who received
blood have developed AIDS. To
make donating safer for you, blood
banks review your medical history
with you to ensure you're in good
health; they also examine you for
physical or laboratory signs essen-
tral to qualify you as adonor. Check
with your local blood bank for
information on their procedures.o

 

Reprinted with permission from Pacific
Beli UPDATE.

diseases as colds and flu, but usually
does quite well. Although most of
the immune response is destroyed in
AIDS, there usually remains a frac-
tion of immune ability to fight off
these less serous illnesses

Where can a BankAmerican with
AIDS turn for assistance?
ees

BankAmerica offers a range of
resources through Personnel Rela-
tions for employees with hfe-
threatening illnesses, including
AIDS. Among the services are:
management and employee educa-
tion and information on terminal
illness and specific life-threatening
illnesses, referral to agencies and
organizations that offer support-
ive services for life-threatening
illnesses; and benefit consultation
to assist employees in effectively
managing health, leave. and
other benefits.

Is an employee with AIDS eligible
to receive Bank America benefits?
res

Yes Thecorporate benefit plans
treat life-threatening illnesses

This 1s what a group of employees
from the Los Angeles Dealer Center
is saying about the aerobics class
they head off to after work VP and
Area Admunistration Officer Robert
Mandela says it’s a great way to
reduce the stress after a busy day in
this production-oriented unit.
Employees agree. Four days a week,
28 of them gather for an hour after
work to stretch, bend, jump, and
even shout in the pursuit of physi-
cal hitness.

The pilot class was made possible
through a new program developed
by Corporate Health Programs.
The class accommodates both the
beginner and the more experienced
fitness buff. The convenience of

(including AIDS) the same as other
medical conditions. Employees who
are disabled from working may be
eligible to receive income protection
through accrued benefits and the
Long Term Disability Plan When
employees are out on an approved
medical leave of absence, benefits
continue as follows:

© Coverage for health plans
(medical, dental, vision) con-
tinues at the pre-disability rate as
long as the employee continues to
make monthly contributions (see
page 11 of the “Health Care”
benefits booklet).

© Basic (employer-paid) life insur-
ance continues and so do
employee-paid hfe insurance bene-
fits as long as the employee
makes monthly contnbutions (see
page 32 of the “Protection” bene-
fits booklet).

¢ Employee banking privileges con-
tinue as long as the persons consid-
ered anemployee of the company

« BankAmeraccount benefits con-
tinue Employees continue to earn
pay-based credits as long as they
receive sickness benefits. If sickness

 

exercising right after work allows
employees to work off steam ina
positive way, and then head for
home feeling relaxed. The price of
$2 per class seems well worth the
personal benefits.

Other classes are underway for
employees at Willow Glen Branch in
San Jose, Salinas Main Office,
Slauson-Pacific Branch in Hun-
tington Beach, Bay Area Loan Cen-
ter, and for several administrative
units in San Francisco. Interested
managers can obtain information on
starting an aerobics class by contact-
ing Corporate Health Programs
#3666, San Francisco 622-1113.0

benefits have expired, credits are
earned as long as they are receiving
Social Secunty disability payments.
¢ BankAmerishare benefits may
continue as long as an employee
receives sickness benefits. Long-
term disability benefits are not
considered eligible earnings

for BankAmerishare.

Important resource groups
within the corporation are Person-
nel Relations in each division.
These groups can provide informa-
tion on referral services and bene-
fits information oO

—Kathenne Armstrong, Corporate
Health Programs, and Nancy Merritt,
Personnel Relations, contnbuted to this
article, which es intended to present
Bank of Amenca employees with cur-
rent information regarding AIDS This
article is a composite of data from vari-
ous sources including articles, current
statistics, and the opinions of leading
AIDS experts throughout the United
States Bank of Amenca will continue
to make an effort to momtor new opin-
tons and information concerning AIDS
and will endeavor ta remain alert to
any significant new developments that
affect our employees

 
 

 

PACIFIC GAS AND ELECTRIC COMPANY

TP Gs+ Te —+— 77 BEALE STREET * SAN FRANCISCO, CALIFORNIA 94106 © (415) 781-4211 © TWX 910-372-6587

March 18, 1988

Enclosed is my resume and a description of my current position in
the San Francisco corporate headquarters of Pacific Gas and
Electric Company, a major Northern California Utility.

I am a licensed Marriage, Family and Child Therapist working with
PG&E's Employee Assistance Program. This department is
responsible for providing AIDS education and prevention services
for employees and for consulting with management and supervisors
on AIDS related issues within the workforce. The program is
committed to updating this material with the most current
information available. Additionally, we offer psychological
interventions and referral services to employees with AIDS as
well as support services for their family members. The
department also assists management in program planning and policy
development and implementation.

In my former position as the director of a large outpatient
chemical dependency clinic in Santa Cruz County, California, I
worked predominantly with chronic I.V. drug users. This work
also involved developing AIDS education and awareness programs
and assisting in the establishing of The Santa Cruz AIDS Project.

I am delighted to have the opportunity to speak at the
Presidential Commission about PG&E's experience in addressing the
issue of AIDS in the Workplace.
Sincerely,
ln Bi

— CAVAA—

Cynthia D'Anna M.A.,M.F.C.C.

 

 
 

 

CYNTHIA D'ANNA

 

375 Eleventh Avenue, #1 . San Francisco, California 94118
415/751-5436 Home . 415/972-1628 Office

EXPERIENCE:

1985 to
Present

1982-1985

1982-1984

1981-1985

1976-1982

EMPLOYEE ASSISTANCE SPECIALIST, Pacific Gas & Electric, Corp-
orate Headquarters, San Francisco. Provide consultation, crisis inter-
vention and psychological referral services to management, employees
and their families.

* Design and present educational Wellness and Prevention Programs with
a mental health or behavioral focus.

* Consult on fitness for duty issues as impacted by social, emotional! and
family problems.

* Evaluate treatment resources and utilize diagnostic skills to assist in
treatment, referral and case management.

DIRECTOR / Program Development Specialist, California Health Assoc-
iates, Santa Cruz. Directed out-patient substance abuse program.
Supervised Counseling, Medica! and Clerical Staffs, and Interns; designed
and facilitated in-service training; chaired staff meetings; assigned work-
load. Interviewed and evaluated applicants. Participated in team
management, and planning for regulatory compliance.

CONSULTANT - on Call, Santa Cruz County, working in out- and
In-patient psychiatric facilities. Made clinical assessments, diagnoses
[using DSM II] and appropriate referrals for chronically mentally i! and
acute crisis clients.

LICENSED PSYCHOTHERAPIST, Santa Cruz. Built private practice with
emphasis on Consulting and Training. Dealt with such issues as communi-
cation, conflict resolution, stress management, team building, creative
problem solving, decision making, and substance abuse, working
one-to-one and with groups.

Santa Cruz Community Counseling Center.

COORDINATOR, Out-Patient, 1979-1982. Coordinated central intake.
Developed policy. Designed and :mplemented recruitment and outreach
programs. Screened/interviewed service applicants; made referrals.
Provided individual/group/family drug treatment and educational
programs.

SUPERVISOR /{ COUNSELOR, Residential [Oranda], 1976-1979. Super-
vised and evaluated Interns and employees. Developed training programs
and seminars utilizing team building and peer feedback. Member of Board
of Directors; chaired Personnel Committee. Marketed progiams to the
community.

EDUCATION:

1980
1977

M. A., Psychology, Antioch University West, Pacific Grove, California.
B. A., University of California, Santa Cruz.

PROFESSIONAL CREDENTIALS and AFFILIATION:

State of Callifornia Marriage, Family & Child Therapist License #MW
15829.

California Community College Credential: Psychology and Counseling.
Member, California Personnel and Guidance Association.

REFERENCES available upon request.

 

 
 

AIDS IN THE WORKPLACE - OUTLINE

By Cynthia D'Anna M.A., M.F.C.C.

I. Introduction:

This presentation provides an overview of how PG&E successfully
manages AIDS in the Workplace.

II. Managing AIDS in the Workplace.

How do you do it? - The nuts and bolts of the process.
What are the issues? - A review.

Why should companies take responsibility?
(why they cannot afford complacency?)

III. PG&E'S position.

CDC's guidelines- No health risk to other employees.

IV. Key elements in the development of the AIDS program.
1. Know your company's concerns.

2. Communicate the company position to employees.
example, AIDS policy.

3. Provide ongoing educational services to employees.

4. Keep current with updated information on a regular basis.

Ve Historical Perspective.

PGandE first became aware of the crisis in 1983 when
several service employees were concerned about going into
the homes of customers.

The program grew out of a need to dispel myths and minimize
fear that surrounds the fatal disease.

Contracted with experts who addressed employees concerns.

 

 
 

 

VI. The Role of EAP within the company.

Confidential and voluntary benefit to employees and their
families.

Provides assistance for a broad range of personal problems. ie:
Family/marital, psychological ‘and drugs and alcohol.

Consult with management and supervisors when a mental health
perspective is needed.

Provides prevention and educational programs to employee groups
management and supervisors.

VII. At PG&E, EAP is the designated department to carry out the AIDS
services to the employees.

Psychological services.
Educational services.
Additional services.

" VIII. New focus/trends.
Prevention.

The impact on the family.

Ix. Questions and answers

 

 
 

PACIFIC GAS AND ELECTRIC COMPANY

pee ete WED —- 77 BEALE STREET « SAN FRANCISCO, CALIFORNIA 94106 * (415) 781-4211 + TWX 910-372 6587

PG&E has long been recognized as taking a proactive approach in addressing the
issue of AIDS and AIDS related complex (ARC). The Company's position reflects
the position of the U.S. Department of Health and Human Services Centers for
Disease Control that employees with AIDS do not present a health risk to other
employees in the workplace.

The AIDS Education Program was first developed in 1983 when several service
employees were concerned about going into the homes of some customers. Many
employees were afraid that AIDS could be transmitted through casual contact.
To address these concerns, PG&E developed a three step approach; cormunicate,
educate and provide current and updated information on a regular basis. This
strategy has been extremely successful in reducing fear and changing
misconceptions of how the disease is transmitted. It has also served to
replace fear and panic with sensitivity and concern for employees with

AIDS /ARC.

Our current AIDS Prevention Education is provided by our Employee Assistance
Program (EAP). The program includes a nine minute videotape entitled, "AIDS
in the Workplace," which was prepared by PGsE's EAP, with the technical
assistance of Dr. Paul Volberding, National medical expert on AIDS. We also
use "An Epidemic of Fear: AIDS in the Workplace" videotape developed by S.F.
AIDS Foundation and local businesses headquartered in San Francisco. During
the educational program, we distribute various informational pamphlets from
local resources. A major portion of the program is devoted to addressing
individual employees' concerns or questions.

 
 

 

62-6216 (REV, 10/83)

PGwvE

FOR INTRA—COMPANY USES |

From Division or

Department VICE PRESIDENT - HUMAN RESOURCES

To Division or Department

FILE NO. 705
RE: LETTER OF
SUBJECT AIDS
July 16, 1987
OFFICERS:

For some time now, PGandE has been a corporate leader in providing information
to-its employees to help them understand the nature of AIDS and related
issues. Due to the magnitude of the problem, its costs, and its impact on
family, friends, co-workers, and others, we must do more. In spite of all the
media coverage and other available information, there are stil] many
misconceptions about AIDS.

To help combat the AIDS problem, we are changing our focus and educational
efforts to concentrate more on prevention and high risk behavior. This
reflects a shift of emphasis from training of what AIDS is and is not to one
of prevention. We must help our employees reduce their exposure to the AIDS
virus.

These three steps are:
1. Communication

Implementation of a comprehensive AIDS facts and general education
communication program for our employees developed in cooperation with the
Corporate Communications Department.

2. Education

This is the most critical step and can be the most productive. Effective
immediately, we are recommending that Company-sponsored AIDS training for
all PGandE employees be conducted as follows:

- Provide a one-hour formal presentation by an Employee Assistance Program
(EAP) counselor. If your employees have not had AIDS training within
the last 12 months, please contact your Human Resource Managers to
coordinate a program. Your Safety Engineering Representatives also are
available to assist with AIDS training or to answer supervisors’
questions.

~ Supervisors are encouraged to give their employees a brief AIDS update
quarterly. The AIDS Bulletin, soon to be published by EAP, may be used
as the basis for this update. Bulletins will be published as additional
information is available, but at least quarterly. The first update
should start with a review of our AIDS policy (Attachment 1) and an
update of the questions and answers (Attachment 2) issued last year.

 

 
 

 

Officers 2 July 16, 1987

- We recommend that AIDS training be offered to employees' families,
after hours and on weekends. Our EAP staff is available to assist in
conducting these sessions. In addition, EAP's video on AIDS is
available to employees to take home and share.

- Include the AIDS policy and latest Bulletin as part of the new employee
orientation program.

3. Keep Current

EAP counselors and Safety Engineering Representatives will be trained and
kept current in the latest AIDS information. The Employee Assistance
Program maintains a contract for consultation service with Dr. Paul
Volberding, Assistant Professor at the University of California, San
Francisco and Chief of the AIDS Activities Division at the San Francisca
General Hospital. EAP counselors will share this information with you as
it becomes available.

Three auditorium sessions have been scheduled. Each session will be
videotaped with copies forwarded to your Human Resource Managers.

Date Subject Speaker
July 30 AIDS Update Dr. Volberding
August 10 AIDS Prevention Dr. Wofsie

The third session will be on AIDS in Children and Teens. However, the
date and speaker have not been confirmed.

AIDS is an increasing problem and one that we cannot ignore. Currently, we
have approximately ten confirmed AIDS cases and 100 AIDS-related complex (ARC)
cases at PGandE. We project that in five years these figures will be 175 and
1750, respectively, unless a prevention program works to significantly impact
the exposure of our employees to AIDS. (See Attachment 3 for more
information.) We project 56 new AIDS cases per year will add $4.3 million to
our health care costs. Aside from the humanistic concerns, these statistics
reinforce the fact that it makes good business sense for us to provide
preventive educational information on AIDS to our employees.

If you desire additional information, please contact your Human Resource
Manager or Joe Mattox (Extension 222-2634), Administrator of our-Etmployee
Assistance Program.

RUSSELL H. CUNNINGHAM
RHC: tm
cc: Merek E. Lipson
Regional/G.0. Human Resource Managers

G.0. Human Resource Directors/Supervisors

Attachments

 

 
 

PACIFIC GAS AND ELECTRIC COMPANY ATTACHHENT 1

POLICY STATEMENT AND GUIDELINES ON
AIDS IN THE WORKPLACE

In keeping with two of our Corporate objectives to ensure a safe, healthy work
environment for our employees and the public we serve, and to prohibit all forms
of arbitrary discrimination in employment, we have developed the fotlowing
policy statement and guidelines on how to handle personnel matters related to
employees afflicted with AIDS. The policy statement and guidelines are based on
the most current medical information on this subject available. If any
significant medical developments occur, we will revise the statement and these
guidelines accordingly.

Policy Statement

It is PGandE‘s position that employees afflicted with AIDS do not present a
health risk to other employees in the workplace under normal working conditions.
Employees with AIDS are subject to the same working conditions and performance
requirements as any other employee. However, if there is supervisory concern
that an employee with AIDS is not able to perform assigned duties, a medical
clarification examination may be required to determine the employee's fitness
for work. Lastly, employees with AIDS, provided that they are otherwise
eligible, are entitled to coverage under the Company's sick leave, medical leave
of absence, disability benefits, and equal employment opportunity policies.

Guidelines

1. Employees afflicted with AIDS should be treated the same as any other Company
employee. However, if their medical or physical condition affects their
ability to perform their assigned duties, they should be treated as any
other employee who has a disability that prevents them performing the duties
of their job.

2. If a supervisor has a reasonable basis to believe that an employee with AIDS
is unable to perform the duties of their position, the supervisor must
request the employee undergo a medical clarification examination. The
results of the medical clarification examination shall guide future
personnel decisions affecting the employee.

3. Employees afflicted with AIDS, to the extent they are otherwise eligible,
are entitled to coverage under the Company's sick leave, medical leave of
absence, disability benefits, and equal employment opportunity policies.
When requested, supervisors and personnel department representatives should
furnish information regarding those policies to affected employees.

4. If employees who share the same work environment with an employee with AIDS
express concerns over their personal safety and health, supervisors must
explain that, based on guidelines issued by the United States Public Health
Service and expert medical opinions, causal contact with a coworker with
AIDS poses no threat of transmission. If necessary, supervisors should
contact an appropriate EAP counselor to arrange for more comprehensive
education efforts for the work force.

— > _ ~
hewtil —<Liteey HE
APPROVED BY HR. RUSSELL CUNNINGHAM
July 16, 1987

DATE

 

 
 

 

Attachment 2

 

QUESTIONS AND ANSWERS ABOUT AIDS

 

What is “AIDS"?

"AIDS" stands for “Acquired Immune Deficiency Syndrome," a disease first
recognized by the medical profession in 1981. AIDS is caused by a virus,
commonly known as HTLV-III (human T-lymphotropic virus type III), which infects
and destroys T-helper lymphocytes, a type of white blood cell which maintains a
person's immune system. By destroying T-helper lymphocytes, the HTLV-III virus
causes a severe suppression of the affected person's immune system, thereby
leaving that person vulnerable to a variety of opportunistic infections and
malignancies. Some of the opportunistic illnesses which a person afflicted with
AIDS may suffer include Kaposi's Sarcoma (a rare form of skin cancer) and
Pneumocystis carinii pneumonia (also a usually rare illness). There is
currently no known cure for AIDS.

How is AIDS transmitted?

 

Current medical information establishes that the transmission of AIDS has
occurred only through the exchange of blood, blood products, or semen, between
individuals. The exchange of these specified bodily fluids is normally
associated with sexual intercourse, blood transfusion, and sharing of
hypodermic needles by intravenous drug users. No evidence exists to indicate
that the AIDS virus can be transmitted by the types of casual person-to-person
contact that takes place within the household, school, or work environment.

The AIDS virus has also been found in bodily fluids such as saliva, urine, and
tears. However, there has been no case reported where those fluids have been
found to transmit the AIDS virus from one person to another.

How widespread is the AIDS disease?

 

As an initial point of clarification, federal guidelines basically specify that
an individual must suffer from one of the opportunistic infections or
malignancies which normally afflict AIDS patients before an AIDS diagnosis is
made. Based on those guidelines, as of the end of 1986 there were 25,000
reported cases of AIDS nationwide. Almost one-third of those cases were
reported during the first nine months of 1986. Based on current trends, the
number of AIDS cases can be expected to double over the next twelve months.
About 14,000 AIDS patients have died since their diagnosis, and approximately
80 percent of those deaths occurred within two years of the diagnosis.

Medical statistics compiled thus far also reveal that, for every patient
diagnosed with AIDS, approximately ten individuals suffer from milder forms of
the disease called AIDS-Related Complex (ARC). Some of the symptoms of ARC
patients are generalized swelling of lymph nodes, unexplained weight loss,
unexplained fevers, and a general feeling of ill health. It is unclear at
this time whether ARC patients will eventually develop AIDS or whether they
will continue to suffer from their current symptoms as a milder variant of
AIDS.

 

 
 

 

Is it safe to work with AIDS patients?

According to the Surgeon General's Report of the U.S. Public Health Services
(USPHS), and several studies conducted by medical experts in this field, the
answer is yes. Specifically, the USPHS guidelines make the following points
regarding this issue:

- No known risk of transmission to coworkers, clients, or
consumers exists from individuals with AIDS in work
settings such as offices, schools, factories, and
construction sites.

- AIDS infection is spread by sexual contact with infected
persons, injection of contaminated blood or blood products,
and by prenatal transmission.

- Workers with AIDS should not be restricted from work solely
because they suffer from AIDS. Moreover, they should not
be prohibited from using telephones, office equipment,
toilets, showers, eating facilities, and water fountains.

 

 
 

PGandE AIDS PROJECTION

Current Sfatus & Expected Cumulative Current & Expected
Number of AIDS Cases at PGandE Number of ARC Cases at PGandE_

| 500 ras ! 5000
i
|

 

 

  

  
 
 

 

 

 

 

400 - 4000
300 3000
200 2000
100 -- 1000
0 ~~~ ie ee 0 -~ . REG | wee etree ween
Current 1992 Current 1992
Annual Health Care Costs Associated with AIDS ° Annual Expected Health Care and
Cases Compared to Standard Health Care Costs ' Related Costs for AIDS Cases at PGandE '
a 7 aan a ee OEE - a 5 won !
{ t
Health care ; 1
| double | 4
E 9 - Health care costs” ! & 1
3 increased by 25% 3° ot ;
‘Ss ‘S tere _— i
= 2 ;
= $52.4 million 22 en
—- 4 E
ag Seraes, !
~~ Le eee vee 0 ae. ve eet ed —-
56 1170 Current 1992

 

Number of PGandE AIDS Cases

 

 

 
 

TESTIMONY FOR THE PRESIDENT'S AIDS COMMISSION
DELIVERED BY
KPIX VICE-PRESIDENT AND GENERAL MANAGER CAROLYN WEAN

THURSDAY, MARCH 24, 1988
SAN FRANCISCO, CALIFORNIA

GHULP

Ww A Public Gereice rom on foe ere

 

 

 

 
 

SINCE 1985, KPIX HAS BEEN INSTRUMENTAL IN BRINGING AIDS EDUCATION AND

INFORMATION TO THE BAY AREA AND MOST RECENTLY TO THE NATION THROUGH A NATIONAL

PUBLIC CAMPAIGN WE PROVIDE TO LOCAL TELEVISION STATIONS.

I BELIEVE WE ARE HERE TODAY TO DISCUSS OPENLY WHAT WE CAN DO TOGETHER - TO

CHANGE THE COURSE OF AIDS.

I WOULD LIKE TO SHARE A TAPE WITH YOU THAT FOCUSES ON EFFORTS TO PROVIDE

INFORMATION TO THE PUBLIC, THESE EFFORTS WERE SUPPORTED BY CORPORATE

SPONSORSHIP AND THE EXPERTISE, TIME AND ENERGY OF MANY PEOPLE IN COMMUNITY

ORGANIZATIONS

TAPE

THERE IS MORE NEED, THAN BEFORE, TO EDUCATE AND INFORM. THE PUBLIC IS

CURRENTLY BOMBARDED BY DIFFERENT OPINIONS AND VIEWS, SOME CREATING REAL ALARM

AND PANIC, OTHERS COMPLACENCY.

 

 
 

 

AS YOU SAW, KPIX MADE A COMMITMENT TO INFORM THE PUBLIC ON THE AIDS CRISES.

HOWEVER, LAST YEAR WITH MORE THAN A THOUSAND NEWS REPORTS BEHIND US, WE HAD TO

ASK OURSELVES WERE WE INFORMED? DID WE HAVE UNANSWERED QUESTIONS... POINTS OF

CONFUSION... AREAS OF FEAR. WERE WE AS MANAGERS PREPARED TO DEAL WITH AIDS IF

IT WAS ONE OF US OR ONE OF OUR EMPLOYEES?

WITH THE HELP OF EXPERTS, THE SAN FRANCISCO AIDS FOUNDATION, WE SET UP A

SERIES OF SEMINARS. ‘THE FIRST TO GIVE INFORMATION TO ALL OF US AT KPIX. THE

SECOND TO MAKE SURE OUR MANAGERS UNDERSTOOD OUR POLICY AND TO ALLOW THEM TO

DISCUSS HOW TO DEAL WITH AN EMPLOYEE WHO HAD AIDS. SIMPLY PUT, OUR POLICY IS,

AN EMPLOYEE WITH AIDS IS TO TREATED THE SAME AS ANY PERSON WITH A DEBILITATING

DISEASE. INSURANCE COVERAGE WOULD BE THE SAME. DISABILITY WOULD BE THE

SAME. AS LONG AS THE PERSON IS ABLE TO PERFORM HIS JOB, HE CAN WORK.

 

 
 

 

PERSONAL STORY

WE WERE ABLE TO BECOME MUCH BETTER INFORMED WITH SUPPORT OF COMMUNITY GROUPS.

IT 1S JUST THIS TYPE OF PARTNERSHIP THAT HAS ALLOWED US TO MEET THE NEEDS OF
KPIX, TO HELP INFORM OUR COMMUNITY AND TO PROVIDE A NATIONAL INFORMATION

CAMPAIGN TO LOCAL T.V. STATIONS ACROSS THE COUNTRY.

SOME EXAMPLES OF OUR PUBLIC PRIVATE PARTNERSHIPS:

IN 1985, THE SAN FRANCISCO AIDS FOUNDATION AND KPIX CREATED AND DISTRIBUTED
THE AIDS LIFELINE BROCHURE; NOW IN FOUR LANGUAGES AND BRAILLE. ‘THERE ARE MORE

THAN 1/2 MILLION IN CIRCULATION.

IN 1986, AMFAR, THE SAN FRANCISCO AIDS FOUNDATION AND KPIX CO-PRODUCED 62
PUBLIC SERIVCE ANNOUNCEMENTS WHICH WERE DISTRIBUTED THROUGHOUT THE NATION TO

LOCAL TELEVISION STATIONS FREE OF CHARGE.

 

 
 

 

IN 1987, TOGETHER WITH THE NAMES PROJECT, KPIX PRODUCED AN HOUR LONG PROGRAM

IN PRIME TIME TO BRING TO THE BAY AREA “THE NAMES QUILT" IN ITS FIRST SAN

FRANCISCO SHOWING THE SAN FRANCISCO EXAMINER JOINED IN THIS EFFORT. WE CALLED

THAT SPECIAL "THREADS OF LOVE". IT SHOWCASED BAY AREA PEOPLE WHO GIVE THEIR

TIME TO HELP AIDS PATIENTS. THE SPECIAL OFFERED THE PEOPLE A DIRECTORY

TELLING THEM HOW TO VOLUNTEER. ONE HUNDRED TWENTY THOUSAND DIRECTORIES WERE

DISTRIBUTED.

WHEN THE NAMES PROJECT NEEDED MONEY TO TAKE THE QUILT ON TOUR ACROSS THE

COUNTRY, WE CREATED WITH THEM, THE “ADOPT-A-QUILT FUND. NEXT WEEK, THIS

PROJECT FEATURES A NEW NATIONWIDE PUBLIC SERVICE ANNOUNCEMENT WITH COMEDIAN

ROBIN WILLIAMS.

WITH THE HELP AND FUNDING OF METROPOLITAN LIFE, AND WITH THE COOPERATION OF

THE WORLD HEALTH ORGANIZATION OUR CAMPAIGN, AIDS LIFELINE, IS NOW A NATIONAL

EFFORT BRINGING INFORMATION TO MORE THAN 50 TELEVISION MARKETS. IT CAN

POTENTIALLY RAISE OVER A MILLION DOLLARS FOR PATIENT CARE IN LOCAL COMMUNITIES.

 

 
 

 

WE ENCOURAGE ALL STATIONS IN THE AIDS LIFELINE NETWORK TO FORM WORKING

RELATIONSHIPS WITH THEIR OWN COMMUNITY ORGANIZATIONS. FOR EXAMPLE, IN SAN

FRANCISCO, ALL OF OUR MATERIALS ARE MADE AVAILABLE FREE OF CHARGE TO THE

CATHOLIC TELEVISION NETWORK AND TO THE SAN FRANCISCO UNIFIED SCHOOL DISTRICT.

IN 1988, WE WILL PRODUCE APPROXIMATELY 50 PUBLIC SERVICE ANNOUNCEMENTS, AND WE

ALSO WILL SPONSOR SAN FRANCISCO'S LARGEST AIDS FUND RAISER, "AIDS WALK - SAN

FRANCISCO." NONE OF THIS COULD HAVE BEEN ACCOMPLISHED ALONE.

IN WASHINGTON, WE SUGGESTED THREE THINGS:

1) THAT A NATIONAL NEWSLETTER BE PRODUCED. THIS NEWSLETTER WOULD BE A

WEEKLY DIGEST ON THE LATEST DEVELOPMENTS WITH AIDS, PROGRESS WITH

TREATMENT, MODEL PROGRAMS, THE LATEST INFORMATION FROM THE CDC, THE NIH

AND THE PUBLIC HEALTH SERVICE.

 
 

 

2)

WITH A CENTRAL AIDS INFORMATION OFFICE, THE MEDIA COULD SPEED UP

LIFESAVING INFORMATION TO THE GENERAL PUBLIC. IF YOU NEED AN EXAMPLE OF

A MEDIA ALERT, LOOK TO THE SAN FRANCISCO AIDS FOUNDATION. ITS

NEWSLETTER IS SIMPLE, EASY TO PRODUCE, YET IT KEEPS US CURRENT ABOUT

AIDS IN SAN FRANCISCO. A NATIONAL NEWSLETTER COULD SERVE THE SAME

PURPOSE FOR THE NATION

NEXT, WE SUGGESTED THAT YOU USE THE BAY AREA AS A MODEL AND SET UP A

NATIONAL SEMINAR FOR THE MEDIA. WE WOULD BE HAPPY TO HELP COORDINATE

SUCH A SEMINAR. RADIO, T.V. AND NEWSPAPERS COULD SEND THEIR PEOPLE TO

MEET WITH NATIONAL AND LOCAL EXPERTS TO DEVELOP WAYS TO IMPROVE THE FLOW

OF INFORMATION AND TO ADDRESS LOCAL AUDIENCES AND REACH GROUPS SUCH AS I

V DRUG USERS. THE DEVELOPMENT OF PUBLIC PRIVATE PARTNERSHIPS COULD BE

THE THEME OF THE MEETING.

 

 
 

 

 

3) LASTLY, WE ASK THAT PRESIDENT REAGAN STEP FORWARD TO MOTIVATE AND UNIFY.

THAT HE BECOME A VISIBLE SUPPORTER OF AIDS EDUCATION AND OF

VOLUNTEERISM.

THAT HE BECOME A VISIBLE SUPPORTER OF RESEARCH AND DRUG TREATMENT,

ESPECIALLY WITH FEDERAL FUNDING.

THAT HE BECOME A VISIBLE LOBBYIST FOR A CRISES INCREASING DAILY... THE

CHILDREN WITH AIDS.

I BELIEVE THAT WE MUST HAVE SUPPORT AT THE HIGHEST NATIONAL LEVEL. IF WE DO,

WE CAN TAP WHAT IS BEST IN THE AMERICAN SPIRIT - THE DESIRE "TO MAKE IT

BETTER", THAT SUPPORT MEANS MONEY AND THE WILLINGSNESS TO STAND UP.

YOU HAVE BEEN CHARGED TO MAKE RECOMMENDATIONS - THIS IS AN AWESOME

RESPONSIBILITY. YOU HAVE THE POWER TO HELP US CHANGE THE COURSE OF THIS

DISEASE, TO INTERVENE AND REWRITE THE FUTURE.

 

 
 

NSS

KPIX-TV is a leader among Bay Area corporations in AIDS education,
education not only of the public but of KPIX employees as well. As
Journalists, we felt aresponsibility to educate internally before launching a
national effort to educate the country. This in-house education program
will be one of three topics addressed when Carolyn Wean, Vice President and
General Manager of KPIX, testifies before the President's Commission on the
HIV epidemic. Although this is her second appearance before the
Commission, the testimony will be very different.

Ms. Wean has already told you how KPIX has launched a national public
service campaign called AIDS Lifeline. Now in fifty cities, AIDS Lifeline is
an on-going series of primetime specials, news reports, public service
announcements and home videos. The license fees which stations pay for
Lifeline programming are donated to AIDS caregiving organizations.

In her new testimony, Ms. Wean will address KPIX employment policies on
AIDS, the ways in which KPIX has educated its employees, and the unique
relationship KPIX has with the Bay Area's numerous community-based
organizations. That relationship is truly significant. No other bay area
media outlet has done more to assist local community groups in educating
the public Working closely with the San Francisco AIDS Foundation and The
Names Project, KPIX has sponsored numerous events, publicized those
events and kicked in financial assistance to insure their success. It is an
unprecedented partnership which can and should serve as a model to local
television stations throughout the country.

GROUP

QW’ A Public Service Effort of Group W Television, Inc.

 

 
 

News Release

23 March 1988

  

Contact: David Landis
Celeste M. Alleyne
(415) 765-8874

AAKRKKAAAKKKARAKRERAE KPIX 5

MEDIA ADVISORY
ARAKKKAKKEKRAKKEEKKKKEKE

 

ot je os
78

KPIX-TV VICE-PRESIDENT AND GENERAL MANAGER CAROLYN WEAN
TESTIFIES BEFORE “PRESIDENT'S COMMISSION ON THE HUMAN
IMMUNO-DEFICIENCY VIRUS EPIDEMIC

WHAT: KPIX-TV Vice President and General
Manager Carolyn Wean testifies
before the "President's Commission
on the Human Immuno-Deficiency Virus
Epidemic.”

Her testimony will include: an
update on the National AIDS Lifeline
campaign activities and productions;
KPIX employment policies on AIDS;
how KPIX has educated employees on
AIDS; KPIX'S support of community
based organizations regarding AIDS;
suggestions for a national AIDS
newsletter

WHERE : San Francisco Department of Health
101 Grove Street
Third Floor

WHEN: Thursday, March 24, 2:15 p.m.

WHO: Representatives from the following
major San Francisco corporations
will give testimonies: KPIX-TV;
Pacific, Gas & Electric; Bank of
America; Wells Fargo; Transamerica
Insurance and Levi Strauss

KRAREKAKEKERARKKAKKEARAK

KPIX-TV Vice President and General Manager Carolyn Wean
testifies before the "President's Commission on the Human
Immuno-Deficiency Virus Epidemic,” at 2:15 p.m., Thursday,
March 24 at the San Francisco Department of Health. For
further information on Ms. Wean's testimony, please phone KPIX
at (415) 765-8874.

-30-

855 BATTERY STREET, SAN FRANCISCO, CA 94111-1597 (415) 362-5550 Ww

 

 
 

 

To: Don Mitzner Carolyn Wean

December 8, 1987

Employee Awareness on
AIDS

In response to your memo, the following measures have been
taken to insure that all employees are informed about AIDS
and that managers and supervisors are aware of the company
policy regarding AIDS related concerns in the workplace:

1. Seminars were given in September 1987 for all employees
regarding AIDS. An additional series of AIDS classes
(5) are scheduled for December. The presenters are from
S.F. AIDS Foundation. The classes are being held during
all hours of the day to insure maximum attendance from
employees working different shifts. Another series will
be conducted in January/February 1988.

2. Additional classes are being held specifically for
managers and supervisors to discuss the ramifications of
AIDS in the Workplace and to familiarize them with Group
W’s guidelines. Speakers are from the S.F. AIDS
Foundation. Attendance at the general AIDS classes and
those for managers and supervisors are mandatory for
individuals supervising employees.

3. Brenda Lowe has reviewed the case study of "Rowena"
(used during the Group W training modules) with
department heads and their management staff.

After speaking to all the department managers, we feel that
there is a general awareness of AIDS among our employees
due to distributed materials (from S.F. Aids Foundation and
Group W), classes and the programs about AIDS from the news
and programming departments.

 

 
 

 

Yhe best defense against AIDS and against the fear of AIDS

i

nformation.....Jts the responsibility of the stations

ti..c commit themselves to educating the public, also commit
to implementing an internal education program for their
managers, supervisors and employees.

l.

Company policy:

a. Develop policies that fall within the confines of
existing laws.

b. Keep abreast of laws in different jurisdictions
where company branches are located.

c. Consider types of potential litigation arising from
employer or employee action.

d. Develop standard guidelines that apply policies
consistently throughout departments.

e. Secure senior management approval and support of
the policies and programs.

f. Alleviate anxiety of employees with AIDS by clearly
stating company expectations and policy.

f. Plan ahead to avoid a crisis and decrease response
time to an actual case.

Excerpts from "AIDS in the Workplace" Business Leadership
Task Force of the Bay Area

Employee Education Programs

Develop a series of employee meetings with the local
AIDS agency. The most effective meetings were the ones
that communicated the "basics" of AIDS and encouraged
employees to ask questions. Although the meetings were
not mandatory, employees were strongly encouraged to
attend by their supervisors. Vary meeting times and
dates so that all employees find a convenient time to
attend during their work schedules.

Each meeting should last approximately between 45
minutes - 1 1/2 hours. The Human Resource manager
should also attend all the meetings to reinforce
company policies and guidelines and to keep a "pulse"
on employee attitudes of AIDS in the workplace. A copy
of the company guidelines and policy should be
distributed to al] employees. The Human Resource
manager should communicate both negative and positive
feedback to senior management.

 

 
 

 

Management Education Program

‘A

Since managers and supervisors will be challenged by a
number of issues having both legal and human resource
ramifications, separate meetings should be held in
addition to the general AIDS employee meetings. The
attendance of supervisors and managers at the employee
meeting and supervisory meeting should be mandatory
(the supervisors and managers should attend the AIDS
education class first). Again, the meetings are
coordinated with a representative from the local AIDS
community agency.

Three basic general principles are explored:
Rational, Humane Treatment

Legal Rights and Responsibilities

Medical Information

Discussions include but are not limited to the
following areas:

Confidentiality

Testing

Employees with AIDS

Employees that Have Tested Positive
Refusal to Perform Job Duties
Facilities: <A Safe Working Environment
Education

Counseling

anna hh ON

 

 
 

 

 

 

ae

 

GROUP = —
Questions And Answers About Aids — Related Concerns at Group W

o_o
——E

 

 

 

 

As the AIDS epidemic continues, we at Group W are committed to
responsible management of our concerns about AIDS both internally and in
the communities we serve. Managers have been provided with an overview of
the principles, policies and management practices for dealing with
AIDS-related concerns at Group W.

This is the first in a series of communications aimed at providing all employes
with the most current information about AIDS in the workplace.

1. What is AIDS?

The initials, AIDS, stand for Acquired Immune Deficiency Syndrome.
This is a medical term that refers to an infection caused by a virus. It
causes a collapse of the body’s natural ability to fight other diseases.
Because of the collapse, people with AIDS are vulnerable to diseases,
including a rare type of cancer, and certain infections that do not
ordinarily threaten people whose immune system is working normally.

2. How Do You Get AIDS?

The only way to get AIDS is to get the virus in your blood. The four main
ways that this can occur are (1) through sexual contact, (2) by sharing an
infected hypodermic needle, as drug users often do, (3) by receiving
AIDS intected blood or blood products through transfusion or injection,
and (4) by an infected mother transmitting it to her baby during
pregnancy.

3. Can You Get AIDS from Food, Air or Water?

The answer is NO! There have been no known cases resulting from
transmission by toilet seats, clothing, dishes, utensils, sneezing,
coughing, touching, biting, kissing, or simple contact with someone who
has AIDS.

In families where children have played, eaten, slept, kissed and fought
with a brother or sister with AIDS, there have been no cases of
child-to-child or child-to-adult transmission. In fact, there are no known
cases of family members being affected with AIDS by simply living with a
relative who has the disease.

4. Is There a Cure for AIDS?

No, not at the present time. No immediate cure is likely in the near future.

 

 

 
 

 

 

 

Are any AIDS-related blood tests (HIV antibody, T-Cell tests, etc.)
given as part of a pre-employment physical or other medical
examination requested by Group W?

The current state of medical knowledge presents no medically sound
reasons to test employes or applicants to determine whether they have
AIDS antibodies. Group W, therefore, has no plans and anticipates no
future need for such testing.

if an employe has a medical history that includes an AlDS-related
iliness or a positive antibody test before they are employed by
Group W, might they be denied employment or insurance
coverage?

No

lf an employe, program guest or any other person with whom
work-related contact is required has AIDS or a positive antibody
test, do other employes have a “need to know’ this information?

No. The exception would be the unlikely case involving physical contact
that could result in transmission of blood from an infected person, but
such a situation would be very rare in our business. Based on numerous
studies of transmission the U. S. Center for Disease Control has
concluded that there is no likelihood of the spread of AIDS in a
workplace such as ours, as casual contact does not spread the virus, the
virus is not airborne (e.g. through coughs or sneezes), and the virus
cannot penetrate unbroken skin. While the virus has been found in very
low concentrations in saliva, the only known mode of transmission is
through semen and blood, where it may be found in relatively high
concentrations.

Do such employes have the right to refuse to work with such an
employe or to take precautions (rubber gloves, face masks, etc.)
that they feel are necessary?

No. Employes do not have the right to refuse to work with such employes
because there is no danger of infection in the course of routine job duties.
CDC recommends that no special precautions be taken regarding AIDS in
ordinary workplace circumstances, except that in first aid situations
appropriate precautions should be taken regarding contact with blood.

if | know or suspect that someone has AIDS or a positive antibody
test should | notify Human Resources, management or any other
employes?

No. The divulgence of such medical information is the sole province of
the individual with the medical condition.

 

 

 

 

 
 

 

 

Nevin?

 

10.

11.

12.

13.

14.

15.

if | know or suspect that | have AIDS or might be at high risk for
the iliness, how should | handle this at work?

First, immediately seek appropriate medical assistance for confirming or
negating such belief or suspicion, and follow your doctor’s advice about
prevention or treatment. The responsible approach at work would be to
inform those who “need to know” at the appropriate time. The decision
to communicate the exact nature of one’s illness rests with the individual.

What kind of medical insurance does Group W provide for people
with AIDS?

AIDS is a medical condition. As such, medical benefits are payable in
accordance with the Westinghouse Insurance Pian or the employe’s
Health Maintenance Organization (HMO).

What if an employe with AIDS needs to be treated with expensive
experimental drugs — is the cost covered?

insurance carriers vary with regard to experimental treatments for AIDS.
At this time, Equitable may under certain circumstances, pay for such
treatments on a case by case basis. Many HMOs however, will not cover
treatments deemed to be experimental in nature. Specifics on the
treatments covered must be obtained through Equitable or your own
HMO.

What if | become partially disabled or completely unable to work as
a result of ARC (AIDS-related complex) or full-blown AIDS?

Disability benefits are payable under the terms and conditions outlined in
the Westinghouse Insurance Plan. Other benefits may be payable under
the Long Term Disability Program or the Management Disability Benefits
Plan provided the employe is eligible and enrolled in the Program.

If my disability benefits through Group W insurance and/or social
security would represent only a portion of my salary, should |
consider getting additional coverage if | know I’m at risk for AIDS
infection?

While we believe that Westinghouse benefits are adequately designed for
those employes who meet the eligibility and enrollment requirements, it is
up to the individual to assess if additional disability coverage is required.

What about life insurance? How do | know if my Group W coverage
is enough?

lt is important for each individual to decide how much life insurance is
enough. Your Human Resource Representative can inform you of
howmuch insurance coverage you have through the Westinghouse benefit
plans.

 

 

 

 
 

 

 

 

A Word of Advice...

It is most important that each of us be intimately familiar with our insurance
coverage, not only for ourselves, but for our dependents. There are some
variations in benefits between HMOs and the Westinghouse Insurance Plan.

Likewise, there are several different disability plans, depending on employment
category and whether or not we have elected to participate in a specific plan.
So make it your business to fully acquaint yourself with your benefits. If
you’re not certain, see your Human Resources representative.

If you have questions about AIDS, that do not relate to benefits, I’ll be happy

to help.
Wade Williams
1 — 800 — 225 ~~ 4299

 

 

 

 
 

 

 

 

 

To Learn More About AIDS....

Free Publications (send a self-addressed, stamped, long envelope)

“When A Friend Has Aids”
“| Can't Cope With My Fear Of Aids”
“Women Need To Know About Aids”

Write: The AIDS Service and Education Foundation, Box 274,
132 West 24th Street, New York, N. Y. 10011

“Acquired Immune Deficiency Syndrome: 100 Questions and
Answers”

Write: AIDS, N. Y. State Health Dept., Empire State Plaza,
Corning Tower, Room 1931, Albany, N.Y. 12237

“How To Talk To Your Children About AIDS”

Write: Dept of Health Education, N. Y. University, 715
Broadway, New York, N. Y. 10003

“The Surgeon General’s Report On AIDS”
Write: AIDS, P.O. Box 1452, Washington, D.C. 20044

Telephone Hotlines

AIDS Hotline — Public Health Service
800/342 — AIDS

National Gay Task Force
AIDS Information Hotline
800/221 — 7044
212/807 — 0616 (New York State)

Information sources

U.S. Public Health Service
Hubert H. Humphrey Bidg.
Room 721-H
200 Independence Ave., S.W.
Washington, D.C. 20201

 

For Other AIDS information and assistance call your RAP Hotline:
800/225 —- 4299

 

 

 

 
 

 

MANAGEMENT GUIDELINES
AlDS-Related Concerns at Group W

As a leader in the communications industry, Group W has a long tradition of
positive, forward-looking approaches to contemporary issues as they impact on
our workplace. Publicity about acquired immune deficiency syndrome (AIDS)
continues to grow, and we recognize the desirability of updating our guidelines for
managers in dealing with work-related questions posed by AIDS.

These guidelines are intended to educate managers about the principles of
conduct that we expect will be applied in AIDS — related situations, including
situations where AIDS Related Complex (ARC) or seropositivity to the virus
believed to cause AIDS may be involved. However, they are not intended to
create legally binding contractual commitments to employes, are not intended for
distribution to employes other than selected managerial personnel, and may be
changed at any time by the company.

GENERAL PRINCIPLES
There are three basic general principles underlying these guidelines:

1. Rational, Humane Treatment: Our goal of treating people (employes
and non-employes) in a fair and compassionate manner.

2. Legal Rights and Responsibilities: Our responsibility to adhere to the
requirements of all applicable federal, state and local laws both with
respect to the legal rights of employes and applicants and to the
duty to provide a safe working environment.

3. Medical Information: Our commitment to base our management
practices to the latest responsible medical information available from
public health officials, especially the Centers for Disease Contro!
(CDC) of the U.S. Public Health Service, and other medical experts.

Rational, Humane Treatment

Segregation, discrimination or humiliation of people are against the principles
upon which Group W hopes to see people treated. In the context of AIDS, we
cannot condone any inhumane or irrational conduct directed at a person who has
AIDS, is thought to have AIDS, is thought to be at risk for AIDS or associates with
any of these groups. Managers should understand that Group W’s high standards
for fair and equal treatment (of members of our workforce, applicants and
members of the public in all contexts) extend to AIDS - related situations as
forcefully as they do to any other.

 

 

 

 

 
 

 

 

Legal Rights and Responsibilities

Although the issue has not been definitely settled on the federal level, it presently
seems that AIDS qualifies as a handicap under the federal law, and many state
fair employment practices agencies and a few state courts have declared AIDS,
ARC and even positivity to the antibody to the AIDS virus to be a protected
condition under state law. Some jurisdictions (e.g. the City of Los Angeles)
specifically prohibit AIDS — related discrimination.

Federal law applicable to federal contractors and subcontractors prohibits
discrimination in employment against otherwise qualified individuals based upon
the individual’s handicap, a perception that the individual has a handicap or the
individual's record of having had a handicap. In addition, federal contractors and
subcontractors must make reasonable accommodations if that will enable
handicapped persons to perform their jobs. The laws of most states and many
cities and countries have similar requirements.

Without necessarily conceding that federal, state and local law requires such
conduct, our practice should be to assume that an individual with AIDS, ARC or
who is seropositive (or who is perceived as such) is protected by the laws
prohibiting employment discrimination against the handicapped.

In addition, managers should be aware that unwarranted behavior against
individuals (typically arising from unawareness or prejudice) may give rise to other
kinds of liability, either for the company, an individual or both. This could include
suits for libel, slander, intentional infliction of emotional distress (sometimes called
“outrage”), invasion of privacy, malice, assault, battery or malicious interference
with contract relations.

Medical Information

The CDC has issued official guidelines concerning AIDS in the workplace,
premised on current medical information indicating that the AIDS virus is spread
by sexual activity involving the exchange of infected body fluids, sharing needles
in intravenous drug use, transfusions of infected blood or from an infected mother
to a fetus during pregnancy.

Based on numerous studies of transmission, the CDC has concluded that there is
no likelihood of the spread of AIDS in a workplace environment such as ours, as
casual contact does not spread the virus, the virus is not airborne (e.g. through
coughs or sneezes) and the virus cannot penetrate unbroken skin. While the
virus has been found in very low concentrations in saliva, the only known mode of
transmission is through semen and blood, where it may be found in relatively high
concentrations. Repeated, rather than one, exposure appears to increase the
likelihood of transmission.

CDC recommends, in effect, that no special precautions be taken regarding AIDS
in ordinary workplace circumstances, except that in first aid situations appropriate
precautions should be taken regarding contact with blood.

 

 

 

 
 

 

 

 

SPECIFIC SITUATIONS

While these guidelines cannot be exhaustive, the following applications of the
above principles in selected situations about which managers may have concerns
may be illustrative.

1.

Confidentiality

Consistent with our general policies regarding medical information,
all medical information regarding an employe who has AIDS, or ARC
or who is seropositive should be kept strictly confidential. Medical
information will not be shared with managers and supervisors except
at the employe’s specific direction. Managers and supervisors who
obtain medical information regarding an employe will treat such
information as confidential, and will disclose such information on a
confidential basis only to the local Human Resources representative
if guidance on medica! matters is needed, and the Director of
Human Relations Services (Wade Williams), in the event guidance
on policy is needed.

insurance claim information Is to be treated as confidential
information.

Respect for the privacy of non-employes (including actors and guests
on programs) should be consistent with this policy. Unless an
individual disseminates information about his or her health,
discussion or speculation about the medical condition of
non-employes who may be involved with our businesses for any
reason is inappropriate.

Testing

Under the current state of medical knowledge there is no medically
sound reasons to test employes or applicants to determine whether
they have AIDS antibodies, and Group W will not do so.

Employes with AIDS

Any employe who is known or believed to have AIDS or ARC should
be permitted (and indeed should be expected) to continue working
as long as he or she is able to perform the job with reasonable
accommodation; this is the same treatment we would give and
expect of any employe having a handicap. Reasonable
accommodation will be determined on the basis of financial cost and
business needs. No negative decision regarding accommodation of

‘an employe whose doctor certifies him or her as being able to work

should be made without consultation with both the local Human
Resources representative and Director of Human Relations Services.

 

 

 

 

 
 

 

 

Our accommodation to AIDS and AIDS - related conditions should
be the same as, and performed with the same commitment as, our
accommodation to any other medical condition, such as pregnancy.
We do not "favor” AIDS — we treat it like any other medical
condition on a case-by-case basis.

It should go without saying that any segregation, discrimination or
negative treatment of any kind by any employe toward another
person related to that individual’s having or being perceived as
having or being at risk for AIDS or ARC or being antibody positive is
totally inconsistent with these guidelines and requires prompt and
effective management intervention.

Any employe who is medically unable to work because of AIDS or
ARC will, of course, receive whatever disability benefits he is entitled
to, as well as his regular medical benefits as appropriate. Our
insurance carrier has been instructed to undertake case
management procedures in all cases, including AIDS, having
catastrophic potential, in order to assure the delivery of appropriate
medical care at the most reasonable cost.

Refusal to Perform Job Duties

As all job responsibilities and acceptable social interaction in the
workplace requires only casual contact (of the kind CDC states does
not give rise to the danger of infection), refusal by an employe to
perform his or her job assignment because it involves dealing with
people who have or are believed to have AIDS or ARC or who are
known or thought to be AIDS-antibody positive is no more justified
than any other refusal to perform assigned work and should be dealt
with accordingly. This is true whether the refusal arises from dealing
with the public (e.g. refusal to cover a story related to AIDS) or from
interacting with a co-worker.

However, managers should be aware that the best way to fight this
kind of behavior is through education and counseling about the
medical realities of AIDS transmission.

Facilities: A Safe Working Environment

According to CDC guidelines, no special precautions are required
with respect to facilities or equipment in offices, shops, cafeterias or
restrooms, including telephones, documents, typewriters, tools and
other equipment. Managers cannot permit special "precautions”
involving tools, equipment or facilities if there is a danger that this
will make handicapped or perceived handicapped people
uncomfortable or subject to differential treatment.

 

 

 

 
 

 

 

 

6/28/87

Group W is committed to providing a safe workplace for all
employes, and we are advised that special safety precautions related
to AIDS are unnecessary.

Education

In conjunction with Wade Williams, Corporate Director of Human
Relations Services, and local Human Resources managers,
information can be distributed to employes and, if needed, extensive
educational programs can be developed. This may include current
publications from public health officials and responsible medical
sources, and video programs such as the “AIDS Lifeline” series
produced by our own Group W TV stations. It may also include
utilization of authoritative federal, state or local health officials or
other health professionals.

Managers are also strongly encouraged to attend Part Il of the
Group W Management Training Program, which includes case
Studies and decisions on Group W policies and procedures for
dealing with AIDS - related incidents.

Counseling

Our RAP (Referral Assistance Program) provides completely
confidential access to appropriate professional services (including
medical, psychological and legal referrals). The assistance is
available through local RAP representatives or by calling Wade
Williams, Corporate Director of Human Relations Services,

212 - 307-3790. Mr. Williams may also be called anonymously on
the RAP hotline, 1-800 — 225-4299.

Reporting to Management on AIDS — Related Incidents and
Legal Developments

We are eager to keep abreast of developments as they occur in the
communities we serve. Accordingly, managers are expected to
report to Wade Williams any new legal developments in their areas
relating to AlDs, as well as any major incidents involving our
employes.

Accordingly, any inquiries regarding AIDS policy and procedure or
medical facts should be addressed to Wade.

 

 

 

 
 

 

AIDS QUESTIONNAIRE

Circle the correct answer:

10.

Can you legally fire an employee who has AIDS? yes or
no

Can a company force an employee with AIDS to take a
medical leave of absence? yes or no

Can a company force employees with AIDS to work in
isolated areas? yes or no

Can you test employees and job applicants for AIDS?
yes or no

Can you allow healthy employees to refuse to work with
an employee who has AIDS? yes or no

Can a company dismiss an employee because he has the
AIDS virus but hasn’t developed the disease? yes or no

Can the company release AIDS test results to other
employees? yes or no

Can a health insurance carrier test employees for
AIDS? yes or no

Can the company’s health insurance provider cancel a
policy if it finds that the company has employees with
AIDS? yes or no

Can you ask employees or job applicants if they have
AIDS? yes or no

 

 
 

 

AIDS PANEL LIST

Cherie Pies

Alameda County Department of Public Health
499 5th St. ;
Oakland, CA 94607

Ed Hilton

San Mateo County Department of Public Health
225 37th Ave.

San Mateo, CA 94403

573-2588

Bart Amarillas
Gay-American Indrans
AIDS Outreach Program
333 Valencia St. #207
San Francisco, CA 94103
621-3485

John Lorenzini

AIDS Project of the East Bay
400 40th St. Ste. 200
Oakland, CA 94609

420-8181

Anne Marie Madison

,2210 Jackson St. #404
San Francisco, CA 94115
929-7577

David Burgess

Santa Clara Department of Public Health
2220 Moor Park Ave.

San Jose, CA 95128

408-299-5858

45 |

Miguel Ramirez

P.O. Box 6182

San Francisco, CA 94101
864-4376

Catherine Maier

P.O. Box 6182

San Francisco, CA 94101
864-4376

 

 
 

 

Reggie Williams

Black and White Men Together
2269 Market St.

P.O. Box 199

San Francisco, CA 94114

Noel Day

Ursa Institute

‘China Basin Bldg. Ste. 6600
185 Berry St.

San Francisco, CA 94107

Peng Ngin

Asian AIDS Project

2024 Hayes St.

San Francisco, CA 94117

Edward Morales
Bay View Hunter's Point Foundation
6025 3rd St. A
San Francisco, CA 94124

Connie Wodsy

San Francisco General Hospital
Co-director of AIDS Project
1001 Potrero Ave.

San Francisco, CA 94110

Greg Day

Shanti Project

525 Howard St.

San Francisco, CA 94105

Hettysmith JOH N Ce ce

San Francisco AIDS Foundation
P.O. Box 6182

San Francisco, CA 94101
864-4376

 

 
 

PRESIDENTIAL COMMISSION

ON THE

HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC

Testimony presented by:

David Werdegar, M.D., M.P.H.

Director of Health

City and County of San Francisco

March 25, 1988

San Francisco, California

 

 
Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

THE PRESIDENTIAL COMMISSION

Those of us battling the AIDS epidemic in our local
communities have been urging a cogent national response -- for
too long, it seemed, to no avail. This dangerous epidemic
requires a national response, guided by an organized plan of
action, funded as we would a national emergency, and benefited
by the continuous oversight of a wise and representative
Presidential Commission.

We have been encouraged by the preliminary report of
the Presidential Commission issued last December, and its
interim report of February 24th. We appreciate the earnest,
open hearing process of the Commission and the sense of urgent
national purpose conveyed. We note particularly the attention
to health care system issues, need of accelerated research and
clinical trials, and call for substantial federal support of

drug abuse intervention programs.

 

 
 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

COMMUNITY RESPONSE

The theme of your two days of hearings here in San
Francisco is “Community Response To The Epidemic".

In San Francisco we have sought to develop an organized
community response involving public, private, and volunteer
sectors; health workers and institutions, community-based
organizations, advocacy groups, schools, the churches, labor,
and industry. We took the view that the epidemic involved all
segments of the population: gay and straight; minority and
majority; friends and neighbors, families and lovers. AIDS
affected us all and we would fight it on a united front.

The AIDS problem extended to our neighboring counties,
and regional planning was, therefore, necessary. Our health
departments are indeed, engaged together in regional planning.

Our community efforts have been remarkably helped by an

informed media and enlightened political leaders.

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

The Health Department has served as the focal point --
the center of gravity -- for convening, planning, coordinating,
and monitoring the City's AIDS program. It has worked closely
with community hospitals, community-based organizations and
practitioners, both in education preventive efforts as well as
provision of health services.

An unrelenting community-based educational program has
been a hallmark of the San Francisco program. Within the
Health Department, itself a major provider of health services,
we have coordinated AIDS efforts in neighborhood health centers
maternal-child health programs, substance abuse, mental health,
forensic, and many other health department services. The
department's acute care facility, San Francisco General
Hospital, has of course been a major center for AIDS care,
teaching and research.

We have never accomplished all that we could have, or
Should have, or wished we had. Nevertheless, we have been
constantly motivated by our tragedy to develop a model
program, an ideal program, that would not only to benefit our
own community but, by way of example, and through shared
experience, other communities as well. This community resolve
has been the foundation for the intensity, generosity, and

Creativity which have characterized San Francisco's response.

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

I say this to the Commission out of the personal
conviction that the best of programs and plans will not reach
fruition, unless we can reach into the collective psyche of the
nation to summon forth, similarly, a national will and
resolve. "A call for collective dedication", was a phrase in

your preliminary report that caught my eye.

AIDS IN SAN FRANCISCO:

CURRENT STATUS AND FIVE-YEAR PROJECTIONS

Only a ten days ago, the Health Department of San
Francisco submitted to its seven-member Health Commission a
detailed report on the current status of the AIDS effort in our
community, with estimates of needs for the next five years --
to 1993. Authoritative epidemiological studies portray the
epidemic and provide carefully considered projections for the
next five years.

I submit to the Presidential Commission, herewith,
copies of this recent report for whatever value it may have to

the Commission and staff in its endeavor.

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

The report is the product of our AIDS Office staff,
working in close association with colleagues throughout the
department and a broad-based community advisory committee. The
report might well be emulated by other counties, state health
departments, and federal agencies.

No city in the United States has suffered the AIDS
epidemic so severely as San Francisco, where 10% of the
nation's epidemic has been centered. The number of cases since
the epidemic began, seven years ago, now approaches 5,000; the
number of deaths close to 3,000. The number of cases in racial
and ethnic minority groups, now 16% of the total, is climbing
more rapidly than in the white population.

We believe the epidemic will peak in the mid-1990s and
then, mercifully, decline. The intervening years will be
enormously difficult. We foresee by 1993, barring major
medical breakthroughs, a three to four-fold increase in the
number of cases. In 1993 we shall likely have more than 6,000
persons with AIDS under care in San Francisco, as compared to
the 1700 at present. While we plan assiduously, so as to be
prepared, it must stated that our health services system is
already under very great strain. Without substantial federal

assistance, it will be overwhelmed in the years soon ahead.

 

 
 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

One interesting analysis in the report depicts the
spending on AIDS programs and patient care from all sources.
It is now at a rate close to $100 million annually, and
projected to rise nearly to $400 million by 1993. These
figures exclude all volunteer services, which can be valued in
the millions, as well as income supports from General
Assistance, Social Security Disability Insurance, sick benefits
and private disability insurance. Nor does it attempt to
estimate the value of work and productivity to our society
through early death and disability. AIDS is now the third
leading cause of death in San Francisco (after heart disease
and cancer); far and away the leading cause of death in terms

of years of life lost.

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

BRIGHT SPOTS IN A BLEAK PICTURE

In reviewing the AIDS report, one of our commissioners
asked, “Are there any bright spots in all of this?" Let me
Suggest a few.

Startling as it may seem, the AIDS epidemic in San
Francisco has largely been arrested. Without wishing to
suggest any sense of complacency, or to ignore population
groups where it is not altogether the case, the rate of new HIV
infections has been remarkably lowered both in the gay
community and in IV substance abusers. We ascribe the success
to vigorous education/prevention programs, ready availability
of anonymous and confidential antibody testing (coupled with
counseling), prohibition of mandatory testing, policies to
prevent discrimination against persons who are HIV positive,
and other factors.

A second bright spot is the lengthening duration of
life of persons with AIDS. While the average extension of life
is still measured only in months (from 10 in 1986 to 15 months
currently) the increase is real, appears to be associated with
quality of life, and is probably ascribed to newer medications
(AZT, pentamidine, and others). There is prospect of further

improvement.

 

 
 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

We have demonstrated that the cost of AIDS care can be
contained through more sparing use of the acute care hospital
and continuous development of an extensive network of
out-of-hospital support services.

Organizational structures are developing in racial and
ethnic minority communities, as they have in the gay community,
for effective education, prevention, and support services.
They greatly need funding support.

The Health Department and the School system have teamed
up successfully to develop curricula in which to teach our
youth how to take responsibility for their health, giving
meaningful attention to AIDS, substance abuse and other
dominant health issues.

We have a conceptual framework, an organized plan, a
network of services, and a community resolve to bring us
through the difficult years ahead.

We have persuasive data on which to base requests for

very substantial state and federal assistance.

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

GAPS IN SERVICES

There are significant gaps in our continuum of
services, largely owing to problems of resources. I will
mention some that seem most important:

(1) Long-term care: We face very serious impending
shortages in personnel, facilities, and funding for various
aspects of the longer term care of persons with AIDS.
Appropriate skilled nursing care facilities, psychiatric
facilities and day-care programs are especially needed as the
numbers with AIDS dementia and AIDS psychoses increase. We
also need substantial increase in supervised residential care
facilities, especially for those with concurrent substance
abuse problems.

We already have many patients who could benefit from
skilled nursing care, but virtually none is available. We have
a growing problem of homeless persons with AIDS, often those
with substance abuse or behavioral problems.

Many supportive services have been generously provided
by volunteers: meals for the home, transportation, and help
with activities of daily living; we are reaching the point
where these supports cannot be maintained through volunteer

efforts alone.

-10-

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

In many instances, third-party reimbursement mechanisms
fail to provide sufficient stimulus and support. Dr. Lee will,
I believe, discuss these financing policies in greater detail.

The San Francisco region has prospect of obtaining a
former U.S. Public Health Service Hospital for use as a skilled
nursing facility with associated ambulatory care, day care,
respite care, hospice care and other programs. We believe this
facility, which would require full federal funding to be
feasible, would be a God-send in terms of regional needs it
would provide a remarkable opportunity to fashion model
demonstration programs in long-term care and to offer training
to all categories of health care workers involved in various
aspects of long-term care.

(2) Medical care and psychosocial support for asymptomatic
individuals who are HIV positive. There are some 30,000
asymptomatic HIV-positive individuals in San Francisco. Many
have no established source of primary care. As evidence mounts
for the benefits of medical supervision and psychosocial
support starting early in the course of HIV infection, we
expect a surge in demand for appropriate primary care services
-- well beyond that currently available through public and

private sectors.

-ll-

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

(3) Substance abuse services: Massive assistance is needed
at all levels. This would include vigorous educational
programs, especially in schools and minority communities; early
family-oriented intervention; outreach services; detoxification
and treatment services; residential care; methadone treatment
slots; innovative demonstration programs; research. In
addition to the IV drug use problem, intimately related to
AIDS, there must be attention to other substance abuse problems.
(4) A vigorous educational program which avails itself of
every opportunity for AIDS prevention education must be
maintained. Resources are still far too limited. Governmental
restrictions pertaining to preparation of educational materials
which are presented in frank, explicit and vernacular terms is
also a serious impediment.

(5) Health care personnel: We are concerned about the
availability of physicians, nurses, dentists, social workers,
public health personnel, and all other workers to stay abreast
of the needs for AIDS services. Here in San Francisco, we are
constantly called upon to provide advice, consultation and
training, based on our experience. Although always willing, we
cannot realistically absorb these demands on top of existing

responsibilities.

~12-

 

 
 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

RECOMMENDATIONS

Let me offer a number of recommendations, some of which
doubtless reiterate those you've heard before -- ‘or have

already incorporated in your reports:

1. A comprehensive plan, implemented with executive
leadership, and benefited by the continuous oversight
of a representative commission, with scientific
advisory panels is the nation's most critical need.
Its implementation must be provided with resources
commensurate with the awesome magnitude of the

epidemic..

2. Federal Block Grants directly to the health departments
of cities seriously affected by the AIDS epidemic, to
be used flexibly for purposes of education, prevention
and treatment programs -- especially in areas where
categorical grants or third-party reimbursements are
unavailable. The health departments should utilize
such funds to support the activities of community-based

agencies.

~13-

 

 
 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

Financial incentives for the development and support of
the continuum of long-term care services, including
homecare, daycare, assisted residential care, and

skilled nursing care.

Greatly accelerated clinical trials of potentially

useful drugs to reduce the morbidity and mortality of
HIV infection. The national cooperative drug trial
approach is unduly long and cumbersome. It should be
supplemented by speedier mechanisms. As our own

projections show only too well, time is of the essence.

Community-based trials in high prevalence areas is one
such approach. The Health Department in San Francisco,
for example, would welcome the opportunity to conduct
large scale clinical trials locally, utilizing the San
Francisco General Hospital, the Public Health Hospital,
community hospitals and practitioners, and the
University of California Health Science Center. These

could get under way promptly.

-14-

 

 
 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

Continued support of anonymous and confidential testing
programs: These have been an important element of the
educational effort. They are also vital in primary and
secondary prevention. These tests, when properly
coupled with education and counseling, are not
inexpensive -- (approximately $85) but on a relative

scale, are an excellent investment.

We are concerned about waning support, just at a time
the programs should be expanding to reach a broader

segment of the population.

Legislation to prevent discrimination in jobs, housing
and health insurance. This legislation is extremely
important from a public health view as successful
experience in San Francisco would attest. Relief from
concern over such discrimination, would encourage many
more individuals at risk of HIV infection to seek

testing, counseling and care.

-15-

 

 
 

 

Presidential Commission on AIDS
Testimony: David Werdegar, M.D., M.P.H.
March 25, 1988

FINAL OBSERVATIONS

The preliminary report of the Commission describes
creation of a national climate, “setting aside prejudice and
fear in favor of compassion and sense of community
responsibility." If the reports of the Presidential Commission
can help create such a national climate, we shall all have
reason to be grateful. The next several years, all projections
indicate, will be exceedingly difficult, and will call for our
collective best effort.

For all its tragedy, the AIDS epidemic can open our
eyes to needs in the education of our children about life and
health; about fundamental weaknesses in our approaches to
health care and our health care system; about the social needs
of our minority populations. The epidemic can teach us about
the bonds of brotherhood and sisterhood that unite our diverse
population. The research on AIDS will have remarkable benefits
in all aspects of viral diseases, addiction, dementia, cancer.
Thus, one day the epidemic may repay society for the many lives

lost to AIDS.

-16-

 

 
 

STATEMENT
OF

Poicip R. Lee, M.D.
PRESIDENT
HEALTH COMMISSION
City AND COUNTY OF SAN FRANCISCO

BEFORE THE

PRESIDENTIAL COMMISSION ON THE HUMAN
IMMUNODEFICIENCY Virus EPIDEMIC

MarcH 25, 1988

SAN FRANCISCO, CALIFORNIA

 

 
 

Mr. CHAIRMAN, AS PRESIDENT OF THE HEALTH COMMISSION FOR THE
City AND County oF SAN Francisco, I AM PLEASED TO JOIN OUR
DIRECTOR OF HEALTH, Dr. Davin WERDEGAR, IN WELCOMING YOU TO SAN
FRANCISCO. I ALSO WANT TO COMMEND THE PRESIDENTIAL COMMISSION ON
THE HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC AND ITS STAFF FOR WHAT
YOU HAVE ACCOMPLISHED TO DATE. PARTICULARLY, I WANT TO COMMEND
YOU FOR THE LAST REPORT OF THE COMMISSION,

THE JOB, HOWEVER, HAS JUST BEGUN. THE HEALTH COMMISSION IS
PROUD OF WHAT SAN FRANCISCO HAS ACCOMPLISHED IN DEALING WITH THE
HIV/AIDS epipemic, Dr. WeERDEGAR HAS DESCRIBED SOME OF OUR
PROGRESS, AS WELL AS THE PROBLEMS WE FACE, AND Mayor Art Acnos
ALSO WILL ADDRESS THESE PROBLEMS. Former Mayor DIANNE FEINSTEIN
WILL GIVE YOU A MORE DETAILED PICTURE OF JUST HOW THE PROGRESS WE
HAVE MADE WAS ACCOMPLISHED, FORMER MAYOR FEINSTEIN, THE BOARD OF
SUPERVISORS, AND Dr. MERVYN SILVERMAN, WHO WAS DIRECTOR oF HEALTH
FROM 1978 to 1985, DESERVE A GREAT DEAL OF CREDIT FOR WHAT HAS
BEEN ACCOMPLISHED, THE MEDIA -~ NEWSPAPERS, RADIO, AND
TELEVISION -- DESERVE A GREAT DEAL OF CREDIT. EVEN MORE CREDIT.
HOWEVER, MUST BE GIVEN TO THE MEMBERS OF THE GAY COMMUNITY IN SAN
FRANCISCO WHO PROVIDED CRITICAL PRIVATE SECTOR LEADERSHIP AT A
TIME OF EXTRAORDINARY STRESS AND CRISIS, THE NATION OWES A DEBT
OF GRATITUDE TO THESE INDIVIDUALS THAT CANNOT BE MEASURED,
THROUGH THEIR EFFORTS. MOVING IN COOPERATION WITH PUBLIC HEALTH
OFFICIALS AND POLITICIANS, THEY HAVE MADE SIGNIFICANT
CONTRIBUTIONS TO OUR UNDERSTANDING OF HOW THE VIRUS’ IS
TRANSMITTED, WHAT BEHAVIORS PUT AN INDIVIDUAL AT RISK, HOW THOSE

 

 
 

 

THE PARTICULAR ISSUE THAT I WILL FOCUS ON TODAY IS THE “WHO
WILL PAY’ QUESTION, FROM THE PERSPECTIVE OF THE HEALTH
COMMISSION, THIS IS THE MOST CRITICAL QUESTION. WE HAVE REACHED
THE LIMIT IN SAN FRANCISCO OF WHAT TAXPAYERS CAN CONTRIBUTE
THROUGH LOCAL AD VALOREM TAXES TO COMBAT THE AIDS EPIDEMIC AND
PAY FOR THE CARE OF PERSONS WITH AIDS,

CURRENTLY, IN SAN FRANCISCO, THE SOURCES OF FUNDING FOR AIDS
ACTIVITIES INCLUDE $24,453,243 THROUGH THE BUDGET OF THE CITY AND
County oF SAN Francisco (TaBLe 1 ano Figure 1), $11.2 MILLION OF
THIS AMOUNT IS LOCAL TAX FUNDS, THE REMAINDER IS PRIMARILY MeDI-
CAL PAYMENTS AND OTHER FEDERAL/STATE PROGRAMS, SUCH AS MENTAL
HEALTH, THAT ARE NOT AIDS-sPECIFIC, IN ADDITION, THERE IS
$3,060,870 IN STATE GRANTS AND $9,174,452 IN FEDERAL GRANTS TO
THE City aND County oF SAN FRANCISCO. KNOWN FUNDS THROUGH
COMMUNITY HOSPITAL AND COMMUNITY AGENCIES TOTAL $52,575,959 FoR A
TOTAL OF $89,264,525,

THE LOW ESTIMATES OF THE COSTS IN SAN FRANCISCO FoR 1992-93
ARE $159,379,798: MIDDLE ESTIMATES ARE $260,217,195: AND HIGH
ESTIMATES ARE $376,401,529 (Ficure 2),

THE BULK OF THESE COSTS ARE FOR HOSPITAL INPATIENT CARE,
PRIMARY AND SPECIALIZED OUTPATIENT CARE, CHRONIC CARE, HOUSING,
AND RELATED SUPPORT SERVICES. THE LARGEST PROPORTIONAL INCREASE
BETWEEN 1988 aNnpD 1993 WILL BE IN THIS LATTER CATEGORY, WHERE
THIRD-PARTY PAYMENTS (PRIVATE HEALTH INSURANCE, SELF-INSURING
EMPLOYERS, AND MEDICAID) ARE LEAST AVAILABLE,

IT WILL NOT BE POSSIBLE FOR LOCAL TAXES TO SUPPORT THE COST
OF THESE SERVICES AS THEY ARE TODAY. CURRENTLY, LOCAL TAXES
ACCOUNT FOR ABOUT 1] PERCENT OF TOTAL EXPENDITURES, [HIS MONEY

 

 
 

 

NUMBER OF PUBLIC VS. PRIVATE HOSPITALS IN THE PARTICULAR AREAS
SAMPLED, AND OTHER FACTORS,

NATIONALLY, DURING 1984-1985, 55 percent of AIDS patients
DISCHARGED FROM HOSPITALS EXPECTED PRIVATE INSURANCE TO PAY FOR
THEIR CARE. AND AN ADDITIONAL 21 PERCENT EXPECTED TO USE
MEDICAID: THUS, 76 PERCENT oF AIDS PATIENTS EXPECTED A THIRD
PARTY TO PAY (TABLE 4), FoR THE REMAINING 24 PERCENT, EITHER THE
INDIVIDUAL HAD TO PAY FOR CARE DIRECTLY OUT OF POCKET OR LOCAL
GOVERNMENT WAS LEFT TO PICK UP THE TAB. THESE FIGURES DIFFER
FROM ALL OTHER PATIENTS UNDER AGE 65 YEARS, WHERE 63 PERCENT OF
TOTAL DISCHARGES INDICATED PRIVATE HEALTH INSURANCE COVERAGE AND
A LOWER PROPORTION (13 PERCENT) LISTED MEDICAID,

SEVERAL OTHER STUDIES HAVE REVEALED A RELATIVELY HIGH
PROPORTION OF PERSONS WITH AIDS WHO ARE ELIGIBLE FOR MEDICAID:

0 In SAN FRANCISCO HOSPITALS. PUBLIC AND NONPUBLIC,

APPROXIMATELY 3/7 PERCENT OF AIDS PATIENTS DISCHARGED
ARE COVERED BY PRIVATE HEALTH INSURANCE, 30 PERCENT BY
MEDICAID, 4 PERCENT BY MEDICARE, AND 29 PERCENT SELF-
PAY OR OTHER SOURCES (£.6,. KAISER-PERMANENTE) (TABLE 5),

O THE SouTHERN CALIFORNIA HosPITAL COUNCIL REPORTED THAT
23. PERCENT OF THE PATIENTS IN SURVEYED SOUTHERN
CALIFORNIA HOSPITALS WERE COVERED BY MEDICAID,

0 In New York City’s HEALTH AND Hosp1Tacs CoRPORATION
HOSPITALS, WHICH ARE THE PUBLIC HOSPITALS. 65 PERCENT
oF THE AIDS PATIENTS WERE MEDICAID RECIPIENTS,
21 PERCENT WERE SELF-PAY (OR BAD DEBT), 13 PERCENT PRIVATE
HEALTH INSURANCE, AND 1 PERCENT MEDICARE,

 

 
 

 

THE RELATIVELY HIGH PERCENTAGE OF PATIENTS CURRENTLY COVERED
BY MEDICAID IS GROWING. IN CALIFORNIA, 12 PERCENT OF ALL PERSONS
with AIDS weRE covERED BY MEDICAID IN THE PERIOD FROM JuLy 1983
THROUGH AucusT 1985, IN AN ANALYSIS THROUGH DECEMBER 1987 IT wAS
FOUND THAT 20 PERCENT OF ALL AIDS PATIENTS WERE COVERED BY
MEDICAID, CURRENT ESTIMATES ARE THAT 30 PERCENT ARE NOW COVERED
BY MepIcAID. IN SAN FRANCISCO, DATA FROM THE West Bay HoSPITAL
CONFERENCE INDICATES A SIMILAR SHIFT FROM THE PRIVATE TO THE
PUBLIC SECTOR. BETWEEN THE PERIOD 1984-85 AND THE FIRST THREE
QUARTERS OF 1986, THE PROPORTION OF HOSPITAL costs oF AIDS
PATIENTS PAID BY PRIVATE INSURANCE DECLINED BY 29 PERCENT, WHILE
THAT ASSUMED BY MEDICAID GREW ABOUT 85 PERCENT.

IN ADDITION TO DIRECT MEDICAL CARE COSTS, THERE ARE DIRECT
NONPERSONAL COSTS INCLUDING RESEARCH, TRAINING, BLOOD SCREENING,
AND EDUCATION, THESE COSTS ARE BORNE LARGELY BY THE FEDERAL
GOVERNMENT AND BY STATE AND LOCAL GOVERNMENTS. My COLLEAGUE,
Anne SCITOVSKY, A HEALTH ECONOMIST, HAS ESTIMATED THAT TOTAL
DIRECT COSTS RELATED TO AIDS wiLt STAND AT $8 BILLION IN 1991,

FEDERAL EXPENDITURES

THe AIDS EPIDEMIC EMERGED JUST AS THE UNITED STATES WAS
MOVING TO ADOPT PUBLIC POLICIES DESIGNED TO REDUCE THE ROLE OF
THE FEDERAL GOVERNMENT IN DOMESTIC SOCIAL PROGRAMS,

In tHE UniTeED STATES THE INITIAL FEDERAL POLICY RESPONSE TO
THE AIDS epipemic IN 1981 was SHAPED BY A NEW SET OF POLICY
GOALS:

 

 
 

GENERAL REVENUE FOR AIDS ABOVE THAT ALLOCATED FOR MEDICAID.
CURRENTLY, CALIFORNIA AND New York ACCOUNT FOR 60 PERCENT OF THE
TOTAL AMOUNT STATES SPEND ON AIDS, Appine New Jersey, FLORIDA.
AND MASSACHUSETTS TO THIS ACCOUNTS FOR 7/5 PERCENT OF THE TOTAL.
HOWEVER, AS MORE STATES EXPERIENCE INCREASES IN AIDS CASES, THE
DISTRIBUTION WILL BECOME MORE EVENLY SPREAD, Dr. MERRITT
PREDICTS THAT IN THE FUTURE MORE MONEY WILL BE SPENT ON
COUNSELING, TESTING AND SUPPORT SERVICES, AND LESS WILL BE SPENT
ON RESEARCH AND SURVEILLANCE ACTIVITIES AT THE STATE LEVEL.

ALL STATES (EXCEPT ALASKA AND WYOMING) COVER PRESCRIPTION
DRUGS AS AN OPTIONAL MEDICAID SERVICE. SOME STATES EITHER LIMIT
THE NUMBERS OF PRESCRIPTIONS WHICH CAN BE REFILLED, THE TOTAL
QUANTITY OF EACH PRESCRIPTION, AND/OR THE TOTAL COST,

VIRTUALLY ALL STATE MEDICAID PROGRAMS REQUIRE FDA APPROVAL
BEFORE COVERING A NEW DRUG. MANY REQUIRE ADDITIONAL STEPS, SUCH
AS APPROVAL BY A STATE COMMITTEE OR EVEN PUBLIC HEARINGS,
CALIFORNIA RECENTLY ENACTED A LAW UNDER WHICH AIDS-RELATED
THERAPEUTICS APPROVED BY THE FDA WILL BE GRANTED IMMEDIATE
TEMPORARY APPROVAL STATUS ON THE MEDICAID DRUG FORMULARY WHILE
THE FORMAL REVIEW PROCESS IS CONDUCTED. MEDICAID EXPENDITURES
FOR A SINGLE DRUG, RETROVIR, TO TREAT AIDS raNces FROM $41,000 IN
MONTANA TO $26 MILLION IN NEw York,

IN ADDITION TO MEDICAID PAYMENTS FOR RETROVIR, THE HEALTH
RESOURCES AND SERVICES ADMINISTRATION/PHS/DHHS 1S IN CHARGE OF
IMPLEMENTING A PROGRAM CREATED BY CONGRESS TO PROVIDE $30 MILLION
To ASSIST AIDS PATIENTS IN PAYING FOR Retrovir. Money Is

 

 
 

 

11

IT IS NOT ENOUGH JUST TO PROVIDE MONEY. THERE NEEDS TO
BE A NATIONAL AIDS pian. state AIDS prans, and AIDS
PLANS AT THE COUNTY-COMMUNITY LEVEL. WE NEED TO HAVE
ADEQUATE RESOURCES FOR PROPER PROGRAM PLANNING AND
ADMINISTRATION AT ALL THE LEVELS, IF THESE PLANS ARE TO
WORK,

FINALLY. THE EFFORT IS NOT JUST A PUBLIC SECTOR
RESPONSIBILITY. THERE NEEDS TO BE COOPERATIVE PUBLIC-
PRIVATE SECTOR PARTICIPATION AT ALL LEVELS, IF WE ARE
TO DEAL EFFECTIVELY WITH THE EPIDEMIC.

 

 
 

 

 

Tarte 1

FUNDING DISTRIBUTION FOR ALL AIDS SERVICES IN SAN FRANCISCO
FISCAL YEAR 1987 - 1988

CITY STATE FEDERAL KNOWN TOTAL.
VI E BUDGET GRANTS GRANTS OTHER CONFIRMED

Surveillance, Epidemiology

and Related Research 125,933 118,544 2,531,712 2,098,643 4,874,832
Public Education 1,036,308 1,402,323 1,861,010 506,762 4,806,403
Provider Education

and Staff Support 181,955 111,333 345,136 306,752 945,176
Primary and Specialized

Outpatient Care 5,364,365 0 2,793,943 13,479,369 21,637,677
Hospital Inpatient Care 11,075,925 0 0 31,380,193 42,456,118
Chronic Care, Housing and

Related Support Services 3,296,873 537,042 572,902 4,271,151 8,677,968
AIDS-Related Mental Health

Services 2,519,946 156,097 38,499 433,089 3,147,631
AIDS-Specific Substance

Abuse Services 27,131 735,531 1,031,249 100,000 1,893,911
Administrative Support

and Coordination 824,809 0 0 0 824,809

TOTALS 24,453,245 3,060,870 9,174,451 52,575,959 89,264,525

Source: AIDS Office, San Francisco Department of Public Health, February 24, 1988.

 

 
 

 

Fiaure 1

Funding Sources for AIDS Services in San Francisco
Fiscal Year 1987-88
Total Amount: $89.3 million

City General Fund ($11.2 mil.
Direct Grants to Providers ($2.9 mil.) y und mil)

   
  

Private Donations ($2.2 mil.) Other City Revenues

including third-party payors
($13.3 mil.)

— State Grants to City
. . fo ($3.1 mil.)
Direct Third-party Payors
($47.5 mil.)
Federal Grants to City
($9.2 mil.)

Source: AIDS Office, San Francisco Department of Public Health, March 15, 1988.

 

 
 

 

tigure z

Cost Estimates for AIDS Services in San Francisco

Fiscal Years 1987-88 through 1992-93

$400,000,000 + High Estimate
a
$350,000,000 + Lo
$300,000,000 + "
ZO Middle Estimate
$250,000,000 + a a
6
$20,000,000 + _— > a
o Low Estimate
a @
$150,000,000 1 —_— eo."
a
oO
$100,000,000 +,
$50,000,000 +
$0 _ 4 A i k 1

 

 

1987-88 1988-89 1989-90 1990-91 1991-92 1992-93

Source: AIDS Office, San Francisco Department of Public Health, March 15, 1988

 

 
 

 

Table 2

PRIVATE SECTOR: PRIVATE HEALTH INSURANCE, AND SELF-INSURED
EMPLOYERS, AND Direct Qut-oF-PockeT EXPENSES

 

1. STATE REGULATED
--  Brue Cross anp Bue SHIELD
-- COMMERCIAL INSURANCE

-- GROUP PRACTICE - PREPAYMENT (NOW CALLED
HEALTH MAINTENANCE ORGANIZATIONS)

2. EXEMPT FROM STATE REGULATION

--  SELF-INSURING EMPLOYERS REGULATED UNDER
ERISA AND EXEMPT FROM STATE INSURANCE LAWS,

3. Direct Out-of-Pocker

 

 
 

Table 3

PUBLIC SECTOR AS INSURER. PURCHASER OF HEALTH INSURANCE, AND

PROVIDER OF CARE

l,

3,

INSURER

-- MEDICARE (FEDERAL)

-- MEDICAID (FEDERAL/STATE)
--  CHAMPUS (FEDERAL)

PURCHASER

-- PUBLIC EMPLOYEE HEALTH INSURANCE
(FEDERAL. STATE. LOCAL)

DIRECT PROVIDER

-~ VETERANS ADMINISTRATION (FEDERAL)
--  DepARTMENT OF DEFENSE (FEDERAL)

-- STATE GOVERNMENT: MENTAL HOSPITALS

-- LOCAL GOVERNMENT: PUBLIC HOSPITALS
AND CLINICS

 

 
 

Table 4

 

 

ee ee ee _,

 

PRIMARY SOURCE OF COVERAGE
FROM A SAMPLE OF U.S. HOSPITALIZATIONS, 1984-85

 

ALL HOSPITALS
FOR PERSONS
AIDS CASES UNDER 65
PRIVATE
INSURANCE 55% 63%
MEDICAID 21% 13%
OTHER 24% 24%

Source: National Hospital Discharge Survey
Data, reported In Hospitalizations
For AIDS, U.S., 1984-85, AJPLI, June, 1987

 

 

 

 

 
 

Table 5

AIDS HOSPITALIZATIONS BY PRINCIPAL PAYOR
SAN FRANCISCO, 1984-86

PRIVATE INSURANCE 37h
Mepi-CaL 30%
OTHER® 29%
MEDICARE KZ

100%

"OTHER 1S SELF-PAY (60%) AND KaIser PERMANENTE (402),

SOURCE: STRYCHAZ FM, “AIDS Inpatient CARE IN THE West Bay, 1984-86,”

 

 
 

 

Table 6

AIDS HOSPITALIZATIONS BY TYPE OF PAYOR
STATE OF NEW YORK, 1985

(samPLE OF 6,142 HOSPITAL DISCHARGES)

PRIVATE INSURANCE (OTHER THAN BLUE Cross) 9,02
MEDICAID 43.0%
Blue Cross 30.0%
OTHER PRIVATE INSURANCE 9,0%
SELF-PAY 10,42
MEDICARE 1.8%
OTHER GOVERNMENT 1.2%
UNCOMPENSATED (NO CHARGE) 1.42
OTHER MISCELLANEOUS 2.3%

100.0%

Source: DATA PROVIDED BY THE New YORK STATEWIDE PLANNING AND
RESEARCH COOPERATIVE PLAN. ANALYSIS CONDUCTED BY THE
HosPITAL STUDIES PROGRAM, NATIONAL CENTER FOR HEALTH
SERVICES RESEARCH.

 

 
 

Table 7

 

 

 

PRIMARY SOURCE OF COVERAGE
OF AIDS CASES IN PUBLIC HOSPITALS
AND PRIVATE TEACHING HOSPITALS

 

PUBLIC PRIVATE
HOSPITALS TEACHING
PRIVATE
INSURANCE t% 45%
MEDICAID 62% 35%
SELF-PAY 18% 13%
OTHER 13% 7%

Source: The Provision and Financing Of Medical
Care For AIDS Patients in US Public and
Private Teaching Hospitals,
JAMA, Sept., 11, 1987

 

 

 

 
 

 

Table 8

Federal spending on AIDS (millions of current dollars).

 

 

 

 

Fiscal ycar

* Type of spending
1986 1987 1988
Research and education 234 494 931}
Treatment* 155 243 433
Medicaid 130 210 375
Vetcrans Administration 24 30 52
Fedcral Bureau of Prisonst ] 3 6
Blood testing 79 76 55
Defense Department 79 74 52
State and Labor departments 0 2 3
Income maintenance 0 26 4S
Total 468 839 1467
*These figures do not include Medicare expenditures. tAlso includes spending on

random testing of new inmates and universal testing of released inmates.

Source: Bloom DE and Carliner G. The Economic Impact of AIDS
in the United States. Science, vol 239, pp. 694-610,
February 5, 1988.

 

 
 

 

Table 9

 

EXPENDITURES FOR Puplic HEALTH AIDS Procrams, SeLectep States*
FY 83-87

FY 83 FY 84 FY 85 FY 86 FY 87
CALIFORNIA $3,400,000 $4,000,000 $16,000,000 $31,000,000 $58,000,000

New York a 2.800.000 4,500,000 9,500,000 16,400,000

New JERSEY 530,000 920,000 2,000,000 5,000,000 8,000,000

MASSACHUSETTS -- 1,500,000 1,600,000 4,100,000 7,600,000

FLORIDA 25000 32,000 276,000 5,600,000 12,500,000

*NOT INCLUDING MEDICAID

 

SOURCE: INTERGOVERNMENTAL HEALTH Pocicy Provect,
GeorGE WASHINGTON UNIVERSITY, 1988

 

 

 
 

 

ADDENDUM TO TESTIMONY OF Dr. Puicip R, LEE

CurRENT Costs AND PRovections oF Future Costs

ECONOMIC COSTS ARE BOTH DIRECT AND INDIRECT, JHE MAJOR
COMPONENT OF DIRECT COSTS IS THE CARE OF PATIENTS IN AND OUT OF
THE HOSPITAL, INCLUDING PHYSICIANS SERVICES, DRUGS, NURSING AND
HOME HEALTH CARE, AND RELATED EXPENDITURES. INDIRECT COSTS
REFLECT THE ECONOMIC LOSS TO SOCIETY, GENERALLY MEASURED BY LOST
WAGES DUE TO SICKNESS AND EARLY DEATH, DIRECT COSTS ARE HIGH IF
HOSPITAL AND NURSING HOME CARE LOOMS LARGE IN PATIENT TREATMENT,
INDIRECT COSTS ARE HIGH IF ILLNESS AND DEATH OCCUR IN YOUNG
PEOPLE AT THE PEAK OF THEIR EARNING POWER. BOTH OF THESE
CIRCUMSTANCES ARE CHARACTERISTIC OF AIDS,

THE DIRECT COSTS OF AIDS INCLUDE TWO MAJOR COMPONENTS:

1) PERSONAL MEDICAL CARE IN AND OUT OF THE HOSPITAL

2)  NON-PERSONAL COSTS (E.G., RESEARCH, EPIDEMIOLOGIC,
SURVEILLANCE, TESTING, ETC,),

THE ESTIMATES OF THE COST OF TREATING PERSONS WITH AIDS FROM
DIAGNOSIS TO DEATH HAVE VARIED ENORMOUSLY. SOME RECENT ESTIMATES
HAVE BEEN MADE BY:

0 MepiIcaAL DIRECTOR OF THE AMERICAN
INSURANCE CONSULTANTS (NATIONAL) $200,000

0 HARDY AND ASSOCIATES AT THE CENTERS
For Disease Controc (CDC), U.S. DEPARTMENT

oF HEALTH AND HUMAN SERVICES (NATIONAL) $147,000
oO CALIFORNIA DEPARTMENT OF HEALTH SERVICES

(CALIFORNIA)

-- Mepicarp (Mep1-CaL) $36,000-$64 ,000

-- Non-MedICAID (BILLED cosTs) $61,000-$102,000
0 INSTITUTE FOR HEALTH POLICY STUDIES, $45,800

UCSF (SAN FrANcISsco)

 
 

 

THE MOST DETAILED STUDY TO DATE WAS DIRECTED BY ANNE
SCITOVSKY OF THE PALO ALTO MEDICAL FouNDATION AND THE INSTITUTE
FOR HEALTH Poticy Stupies. UNIVERSITY OF CALIFORNIA, SAN
FRANCISCO, AND PUBLISHED IN 1986, In THIS sTupy oF 445 AIDS
PATIENTS ADMITTED TO SAN FRANCISCO GENERAL Hospital (SFGH) purRING
1984 we FOUND A MEDIAN SURVIVAL OF 11,2 MONTHS AND A LIFETIME
cost OF $41,500, WHEN THE HIGHER COSTS OF HOSPITAL CARE USED BY
HARDY AND HER COLLEAGUES WERE APPLIED AS WELL, THE AVERAGE
LIFETIME COST FOR SFGH PATIENTS INCREASED To $45,800,

In THAT sTuDY AT SFGH puRING 1984 we FOUND THAT THE BULK OF
COSTS--OVER 80 PERCENT--WERE RELATED TO INPATIENT CARE. IN OUR
CURRENT STUDY BEING CONDUCTED IN SAN FRANCISCO, WE HAVE FOUND
THAT FOR A GROUP OF PRIVATE PATIENTS BEING SEEN BY COMMUNITY
PHYSICIANS ONLY ABOUT 66 PERCENT OF THE COSTS ARE RELATED TO
INPATIENT CARE, THE REMAINING COSTS ARE FOR PHYSICIANS’
SERVICES, HOME CARE, AND PSYCHOSOCIAL SUPPORT SERVICES, IN THIS
STUDY WE HAVE NOT INCLUDED THE COST OF DRUGS PRESCRIBED ON AN
OUTPATIENT BASIS,

A sTuDY OF PROJECTED AIDS cosTS WAS COMPLETED RECENTLY BY
Anne Scitovsky and DorotHy Rice For THE CENTERS for DISEASE
CONTROL. THEY ESTIMATED THAT IN 1991 pirecT costs WILL BE $10.9
BILLION AND INDIRECT COSTS WILL TOTAL $55.6 MILLION,

 

 
 

TESTIMONY OF DIANNE FEINSTEIN

BEFORE THE PRESIDENTIAL COMMISSION

 

ON THE HUMAN IMMUNODEFICIENCY VIRUS EPIDEMIC
PUBLIC HEALTH BUILDING
SAN FRANCISCO

MARCH 25, 1988

I would like to congratulate the Commission on the 60 page
interim report with its 180 recommendations. Its is a giant step
forward in Federal participation, and I hope good recommendations
will be taken seriously and that a new era of dynamic Federal

leadership will result.

The Commission has set forth a number of comprehensive

recommendations and I would like to comment on a few:

Research -- I agree with the Commission recommendation to
eliminate wherever possible the use of placebo-controlled
trials in patients with life-threatening HIV-related
illness. Science protocols must not be used to deprive
individuals with these fatal conditions of possible relief

from suffering.

Testing -- Low or no cost testing must be widely available

on a voluntary and confidential basis. Anonymous testing is

 

 
 

 

an incentive for those who fear others will have access to
test results. Federal support will be necessary to realize
this goal. Testing must also offer rapid results. When
first offered in San Francisco, the waiting list was 4 to 6
weeks. I gave the directive to reduce that time to 48
hours. Tests are now done the same day in San Francisco. A
new mail-in blood test kit is soon expected on the market.
The individual takes his or her own sample and returns it to
the lab in a cold pack. Results are mailed or phoned back.

I hope this type of service receives FDA approval soon.

Education -- Funds invested in education and prevention pay
the greatest dividends, but much later. Prevention should
be part of every basic high school curriculum. It should
become part of the consciousness of every teenager and

adult. AIDS education should be mandatory.

Federal Leqislation to Prevent Discrimination--
Congressional action is needed now to extend civil rights
protection to those infected with the virus. Victims have
been summarily deprived of housing, jobs, medical care and
insurance protection when others learn of their illness.
Discrimination occurs at a time when compassion and support
is desperately needed by the child, man or woman weakened by

their infliction with this disease.

 

 
 

Federal Support -- While I believe the Federal share for
treatment programs should approximate 80% instead of 50%, I
strongly concur with the Commission's recommendation to
increase Federal support for AIDS programs. We must
recognize that the spread of AIDS cannot be stopped without
substantial increases in Federal spending on every front--
prevention, education, care and research. If we think we
can't afford it now, try to imagine the cost and sacrifices
we will face if we wait five years. If a modest Federal
effort is projected to cost $2 billion today, it will cost

perhaps $16 billion just for treatment in 1992.

Finally, the Federal Government must pick up the cost of AZT
and other life-prolonging agents. Burroughs~Wellcome has
said that the research and development costs of AZT was
about $80 million. This investment averages $1,600 per
patient today -- AZT treatment costs can reach $10,000 per
patient. No one should be denied access to these life-

prolonging drugs because of cost.

San Francisco is currently contributing more per capita for
AIDS than any city in the nation and more per capita for
substance abuse prevention and treatment than any other county in
California. Local governments cannot and should not carry the
burden for developing comprehensive and compassionate programs of

AIDS care. Currently, the City and County of San Francisco is

 

 
 

 

spending an estimated $19 million on AIDS programs, about 22% of
the total citywide public and private spending. Citywide public
and private spending could triple by 1992 from $89 million up to

an estimated $159 million to $376 million.

Similar AIDS programs must be made available elsewhere
through federal funding so that quality regional treatment
programs will be available for AIDS patients. The costs of care
can be reduced by hospice and home care as alternatives to
hospital care. Federal cost sharing should be offered on an
incentive formula so that the cost burden is shared and victims
are not forced from their homes for treatment and care. Cost
sharing should be offered at 80% Federal match. This amount
should also be offered to the new AIDS care hospital (the former
Public Health Hospital) in San Francisco's Presidio. The city
does not have the operating funds to open this badly needed

regional care facility.

Between 1981 when the first case of AIDS was diagnosed in
San Francisco, and 1988 there have been over 4,300 cases of AIDS
and over 2,500 deaths. The City has experienced an enormous
amount of grief and suffering and there is more to come. In five
years, the Health Department expects the caseload to triple or

quadruple, to between 12,000 to 17,000 persons.

 

 
 

 

In June of 1983, there were 1,552 recorded cases of AIDS in
the United States, 76 in San Francisco. At that time, there was
little national attention focused on the problem, and health
departments in a few large cities were struggling to develop
effective responses to a new public health threat. Today, less
than four and a half years later, there are over 47,000 reported

cases in the United States and over 26,700 deaths.

Since 1983, San Francisco has mounted an unprecedented
effort in the battle against AIDS and over $51 million in local
funds have been appropriated for specific AIDS services, more per
capita than any other city in the nation. In those early years,
I convened a Task Force of health officials to meet regularly in
my office. Our agenda covered mortality and infection rates, as
well as prevention and education efforts. From these first
efforts sprung a program that is a worldwide model for
coordinated AIDS services -- including the nation's first AIDS
outpatient clinic and inpatient ward at San Francisco General
Hospital. Local health department experts and the medical and
scientific staff at San Francisco General Hospital became
international leaders in the fight against AIDS. I also had the
opportunity to Chair the first AIDS Task Force of the U.S.
Conference of Mayors where Mayors could come together and share

vital information and separate fact from fiction.

 

 
 

 

The broad range of services in San Francisco also includes
community education, counseling, housing and social services.
The city pioneered what has become a model program of
compassionate care -one that utilizes home and hospice care,
thereby reducing acute hospitalization costs. Many of the
initial services were offered through community agencies such as
the AIDS Foundation and the Shanti Project. Volunteers were
trained to provide emotional support to patients in the hospital,
at home, and in hospices. Today, volunteers are still providing
much of the supportive services ‘that sustain AIDS and ARC
patients. Successful programs require that the resources of the
entire community be mobilized and supported at the highest level

of local government.

The response from the gay community in San Francisco to the
AIDS crisis has been unparalleled. Leaders in the gay community
organized to develop an extensive AIDS network to educate the
community on transmission of the disease, reduce its spread, and
avert hysteria. The gay community worked with the Health
Department to develop a sophisticated educational program that

changed the social behavior that was producing AIDS.

The Health Department has been mobilizing for the second
wave of the epidemic and the expected spread of AIDS beyond the
original primary risk groups of homosexual and bisexual men to

the IV drug abusing population. Through substance abuse, AIDS is

 

 
 

expected to impact the heterosexual communities, most especially
the Black and Hispanic communities of our city. It is estimated
there are 18,000 IV drug users in San Francisco and it is feared
that San Francisco might be one and a half years away from a 50%
rate of infection among IV drug users. For San Francisco, the
task is to repeat the successful efforts in the gay community
and halt the spread of AIDS in the IV drug user and minority
communities. Intensive education and information programs are
taking place with the drug using populations in ali drug

treatment programs and on street corners.

Cities like New York and Newark have seen the rate of
infection among IV drug users soar as high as 70% in some
neighborhoods. These cities have apparently lost the battle of

IV drug users and AIDS.

In San Francisco, there have been major achievements in
containing the further spread of AIDS. There have been
demonstrated successes in the area of AIDS education and
prevention as well as more limited successes in the area of

treatment.

- Recent studies indicate San Francisco's extensive
efforts to educate and inform the gay community about
AIDS transmission have worked. Three large studies of

gay and bisexual men show the rate of new infections is

 

 
 

 

now less than 1% of this population. This means that
gay men have made important changes that do not lead to

the spread of AIDS.

There are preliminary indications that San Francisco
will not experience the increase of cases of AIDS among
intravenous drug users that cities in the eastern U.S.

and elsewhere are experiencing.

There were 18 reported new cases of AIDS among IV drug
users in 1987. The rate of increase is the same as
1986 and has not spiraled as projected in earlier
estimates. It now appears that earlier projections
that AIDS education programs would not be as effective

in the drug user community may not be true.

The average life of an AIDS patient has grown longer
with the use of AZT. The median AIDS patient lived 11
months from the date of diagnosis in 1980; today the

average San Francisco AIDS patient lives 14.4 months.

AIDS education efforts have had an impact. San
Franciscans are relatively well-educated about the
disease and know how to take precautions to keep it

from being spread.

 

 
- In San Francisco, we have minimized AIDS. hysteria.
Nondiscrimination laws were enacted in 1985 and few
examples of employment or housing discrimination have
been reported. We can be proud that there are several
children with AIDS attending our public schools in a
safe and humane manner. AIDS education curricula have
been implemented in our schools with little or no

controversy.

- Minority communities in the City have mobilized to
develop cultural and linguistic models that will work

in their communities.

Most of the news about AIDS is still not good news.

- There is still no vaccine or long-term effective
treatment and the effects of the development of this

disease will be spread over a period of 20 years.

~ Most of those currently testing positive to the virus

were infected between 1978 and 1984.

- The incubation period is now believed to be an average
of 5 years and as long as 10 years -- the 100 to 150

new cases of AIDS that are diagnosed each month are the

 

 
 

result of exposure to the virus five or more years ago

when little was known about its transmission.

- The numbers of new cases of AIDS is not expected to

begin descending until after 1993 or 1994.

We have learned that AIDS is a preventable disease if social
behaviors that cause the transmission of this fatal disease are
changed. At this time, education and information are the only
effective weapons to stop the spread of AIDS. The information
gained from San Francisco's experience with the gay community

must be duplicated to halt the spread of the AIDS virus

throughout our nation.

kK

-~ 10 -

 

 
 

IT.

SUMMARY OF SAN FRANCISCO'S AIDS PROGRAN

August 1987
History of City Funding

 

 

 

Year Total # AIDS Cases Total City Funds
Diagnosed as of July ] for Fiscal Year

FY 1982-83 76 $ 180,447

FY 1983-84 242 $ 4,303,056

FY 1984-85 58] $ 7.4 million

FY 1985-86 1200 $ 8.8 million

FY 1986-87 2853 $12.9 million

FY 1987-88 3402 $19.0 million

Summary of Programs Funded by City - FY 1987-88

Contract Services Provided by Community Based Agencies

(1) Shanti Project
Fiscal Year 1987-88 Funding: $1,062,876
Description of Services: Provides free counseling, support and
advocacy for the terminally 411 and those affected by terminal
iliness. Services are provided by small paid staff and a large corps
of volunteers. These services include: ©
General Psychosocial Counseling and Information Services: in group
and individual -sessfons in person and on .the .phone to persons with
AIOS, their families and loved ones;

- Counseling Services at San Francisco General Hospital (the County.
hospitat): at both the outpatient clinic and the intenstve care ward
for AIDS patients;

- AIDS Residential Program: provides long-term low-cost housing to
persons with AIDS who are evicted;

~ Community Volunteer Program: provides support services to AIDS
patients including transportation, shopping, meal preparation,
housework, etc.

For further information: Jim Geary, Director; Shanti Project, 890 Hayes

Street, San Francisco, California 94117, (415) 558-9644

(2) San Francisco AIDS Foundation
Fiscal Year 1987/88: $797,315
Description of Services: Services are provided by a relatively small
paid staff and large group of volunteers. Services include: AIDS
hotline to provide information on all aspects of AIDS and medical and
psychological referrals; development and distribution of literature
on AIDS targeted to a wide range of groups including special
high-risk groups (i.e., gay men, intravenous drug users), health care
providers and the general population; speakers bureau to provide
experts on AIDS to speak to community groups, corporations and other
agencies; public forums on AIDS for specific groups; trainings of
health care professionals; media campaign to make information on AIDS
fully accessible and to encourage high-risk groups to reduce
high-risk activities; direct social services to assist people with
AIDS to access various social service programs including food stamps,
general assistance and emergency housing.

For further information: Dr. Tim Wolfred, Director, San Francisco AIDS

Foundation, 333 Valencia Street, San Francisco, California 94103, (415)

864-4376.

 

 
summary of San francisco AluDd riuyr aii
Page Two
August, 1987

(3) Counseling/Therapy Services and Related Education
Fiscal Year 1987-88 Funding: $639,496
Description of Services: Provides mental health, substance abuse
and counseling services through several agencies and at several
sites. Services are provided to both AIDS patients and worried
well to address fears about AIDS, management of stress, proper
nutrition, and to encourage reduction of high-risk practices
through peer support.
For further information: Jeff Amory, Administrative Director AIDS,
San Francisco Department of Health, 1111 Market Street, San
Francisco, California 94103 (415) 864-5571

(4) Home Health and In-Home Hospice Services
Fiscal Year 1987-88 Funding: $918,468
Description of Services: Provides home health care services to
AIDS patients unable to care for themselves, but who do not need
hospitalization. Some services are reimbursed by Medi-Cal
(Medicaid).
For further information: Jeff Amory, Administrative Director AIDS,
San Francisco Department of Health, 1111 Market Street, San
Francisco, California 94103 (415) 864-5571

 

 

(5) Garden Sullivan Hospital.
Fiscal Year 1987-88 Funding: $417,000
Description of Services: Provides continuing care beds for.
patients who do not need acute care but who must stil] be seen on
an inpatient basis. Some costs recovered through Medi-Cal and
third party providers.
For further information: Jeff Amory, Administrative Director AIDS,
San Francisco Department of Health, 1111 Market Street, San
Francisco, California 94103 (415) 864-5571

 

(6) Other Contract Services
Fiscal Year 1987-88 Funding: $378,533
Description of Services: Surveillance; education to health
providers; clinical screening.
For further information: Jeff Amory, Administrative Director AIDS,
San Francisco Department of Health, 1111 Market ‘Street, San
Francisco, California 94103 (415) 9864-5571

 

B. San Francisco General Hospital
Fiscal Year 1987-88 Funding: $10,500,000
NOTE: SFGH is the County-owned hospital. It is estimated that 50%
of all San Francisco AIDS inpatients and a larger proportion of
outpatients are served at San Francisco General. A significant
portion of the costs are recovered through MediCal (Medicaid),
Medicare and third party payers.

(1) Outpatient Services
Description of Services: Full-range of outpatient services to
approximately 427 patients a week. Services include clinical
care and related drugs and testing and lab work; dental care
provided by dentists who donate their time but use hospital
facilities, and epidemiologic research.

 

 

 
 

Summary of San Francisco's AIDS Program
Page Three
August, 1987

(2) Inpatient Services: Special AIOS Unit - 28 beds
NOTE: Because the AIDS Ward is usually full, AlDS.patients are
also treated in other areas of the Hospital.
Description of Services: acute care services provided in special
AIDS ward staffed by persons who volunteered for assignment.
Because services are centralized, ward is focus point for Shanti
counseling services, donations from community, etc.
For further information: Alison Moed, Head Nurse, Ward 5A, San
Francisco General Hospital, 1001 Potrero Street, San Francisco,
California 94110 (415) 821-5318

C. San Francisco Health Department
(1) AIDS Office
Fiscal Year 1987-88 Funding: $538,583 (costs do not include
administrative overhead or support services provided by various
administrative units of department.)
Description of Services: for epidemiology, surveillance and
related research; administration of Citywide AIDS program. AIDS
Office serves as the central office for information on the City’s
AIDS program, operation of the AIDS Advisory Groups;
dissemination of informational materials, coordination of health
-providers; development of public relations program. monitoring of
legislation, etc. , "
For further information: Dr. George Rutherford, AIDS Medical
Directors 1111 Market Street, San Francisco, California 94103 (415)
864-5571.

All Other Services
Fiscal Year 1987-88 Funding: $4,358,000

(2) Bureau of Disease Control and City Clinics
Description of Services: Screening, tracking and related
epidemiologic and laboratory services for Citywide AIDS program.
For further information: Dr. Dean Echenberg, Director of Bureau of
Communicable Disease Control, San Francisco Department of Health, 101
Grove Street, San Francisco, California 94102 (415) 558-4046

(3) Community Public Health Division
Description of Services: surveillance, clinical screening
services, services in schools, perinatal and family health,
outpatient treatment, and related laboratory work provided at
City-owned clinics.
For further information: Florence Stroud, Deputy Director of
Health, San Francisco Department of Health, 101 Grove Street, San
Francisco, California 94102 (415) 558-2023

 

(4) Community Substance Abuse Service
NOTE: Services are also provided through ongoing substance abuse
programs.
Description of Services: provides information and training on
AIDS and drug use to agencies dealing with substance abuse.
For further information: Or. Wayne Clark, Community Substance Abuse
Services, San Francisco Department of Health, 170 Fell Street, San
Francisco, California 94102 (415) 558-2356

 

 

 

 
 

Summary OF dan rrativssty aus rroyt ail
Page Four
August, 1987

(5) Community Mental Health Services

Description of Services: Inpatient and outpatient psychiatric

services for AIDS patients and for persons with psychiatric
problems associated with AIDS. These include acute and subacute
hospitalizations for AIDS/ARC patients with dementia, other

 

neurological disorders, or other psychiatric problems.
For further information: Dr. Reiko True, Deputy Director of
Health/Mental Health, (415) 558-4387

(6) Forensic Services
Description of Services: AIDS prevention, education and

treatment, including occasional hospitalizations to incarcerated

individuals in City jails or youth facilities.

For further information: Nancy Rubin, Program Chief, (415) 558-5127

ITI. State and Federal Funding ~ as of August, 1987
Fiscal Year 1987-88: *$14,955,262

Surveillance, Epidemiology and

Related Research $ 1,240,979
Public Education 2,088,821
Provider Education 305 474
Mental Health Services 98,595
AIDS Specific Substance Abuse 874,267
Chronic Care and Related Support Serv. 1,047,126
Minority Education 600,000
AIDS Research Laboratory (capital) 5,700,000
AZT Drug Treatment 3,000,000

Total $14,955,262

“Does not include state Medi-Cal expenditures, federal Medicaid and
Medicare expenditures, payments by private insurance companies,

payments by individuals, or private contributions.

SO
Revised August, 1987
1800r

 

 
 

 

 

TESTIMONY SUBMITTED BY ANNE RUDIN, MAYOR, CITY OF SACHAMENTO
PRESIDENTIAL COMMISSION ON THE HUMAN IMMUNODEFICIENCY
VIRUS EPIDEMIC

HEARINGS ON THE WESTERN STATES RESPONSE
MARCH 24-25, 1988

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH
101 GROVE STREET, ROOM 300
SAN FRANCISCO, CALIFORNIA

Good morning Chairman Watkins and commissioners. Thank you for
the opportunity to speak on this most pressing issue. I am Anne
Rudin, the Mayor of Sacramento.

Sacramento is the capitol of the largest state in America and we
are facing the most serious health problem of our nation, Human
Immunodeficiency Virus (HIV) Infection. The population of the
Sacramento area is close to one million. HIV is a threat to over
10%, or 100,000 of these people. According to the Sacramento
County Health Department, to date, 182 individuals have been
diagnosed with HIV infection, 72 have died. Statistics show that
there will be over 600 people with AIDS by 1991.

Ordinarily, municipal governments would be expected to take a
modest role in addressing a public health issue. Except in
regions where city and county governments overlap, there is no
direct health care role for cities. The AIDS crisis, however,
has forced a shift in the usual patterns of responsibility, and
cities are awakening to a new role of leadership in the
coordination of service delivery, funding and lobbying for
program support from the private sector and other levels of
government.

The people of Sacramento have addressed this need for
involvement. Volunteers, health care providers and political
leaders have developed a well integrated community that provides
services for those with HIV and their families and partners.

Our first AIDS cases were diagnosed early in 1983 at which time
the AIDS Foundation was formed and today provides a variety of
services including education to high risk individuals, health
care workers and the general public; operates an AIDS information
hot line, is establishing minority outreach programs, and
provides gay outreach.

The Sacramento County Health Department administers a variety of
programs including condom distribution, which costs $11,000
annually, education at adult detention facilities, HIV testing,
and a variety of social services.

The Stop AIDS Project, Clinic for AIDS Related Disorders, Home

 

 
 

 

2.

Health Care, and Hand to Hand are a few of the other community
services available in Sacramento.

In 1985 I formed a Mayor's Task Force on AIDS to gather
information to enable us to formulate public policies to address
the problems associated with AIDS. Many of these recommendations
have been implemented and an ordinance has been enacted which
prohibits discrimination against those with HIV infection in
regards to employment and housing. Training has been provided
to all our emergency response employees and Police Officers.

Sacramento County has established an ongoing AIDS
Education/Prevention Task Force to help solve the AIDS crisis. It
has been recommended that an AIDS Prevention Unit be formed to
implement these recommendations. This unit was funded and is
active.

Although we believe the programs and services we provide in
Sacramento are having a positive effect on deterring the spread
of AIDS, they are not enough. Prevention programs and services
are under funded and it is time for the federal government to
provide adequate funding now. We only need to look ahead to see
that the money we spend today will save money in the future. For
each HIV infection that occurs in Sacramento during 1988,

government will spend approximately $15, 000 for health care over

the next 10 years. >Gtree—500—ne -—Peeren sa—are—expecttt—it
Sat) ee TTC tee. ied Pe—year—this transtatesto—$7,506,000-—worty
i

Pe a Cay 1 a stn oa er er rs Stile! ot t é

2 5 5 — 7 5 ee

 
 
   

There is overwhelming evidence that education is the key to
prevention. According to Dr. Neil Flynn, Associate Professor of
Clinical Medicine and Director of the Clinic for AIDS and Related
Disorders, at the University of California, Davis, Medical
Center, in New York City, 60-70% of IV drug users are infected
with HIV. In California this is not true. 15-20% of IV drug
users in San Francisco are infected, 10% in Los Angeles and only
5% in Sacramento. If HIV infection is allowed to spread rapidly
among IV drug users on the West Coast, we will be setting
ourselves up for an enormous financial burden as well as a
needless loss of human lives.

It is clear that once IV drug users become infected, the HIV
virus is spread to their sexual contacts, who frequently are not
IV drug users, and to their children. New York City has an
horrendous problem with HIV infected infants born to HIV drug
using mothers who are sexual partners of IV drug users. This
must not be allowed to occur here. Massive education and
prevention programs must be funded for cities like Los Angeles,
San Francisco, Sacramento, Fresno and San Diego as part of a
federal campaign to slow the spread of the AIDS virus.

It is estimated that Sacramento could use at least $1,000,000
for prevention programs for IV drug users. Currently about

 

 
 

 

3.

 

$150,000 is available in Sacramento County for fiscal year 1988.
This is inadequate.

There is also a need for better funding of education projects for
members of other high risk groups and the general public. Target
groups for education and prevention immediately should include
gay men, adolescent gay men, IV drug users, their potential
sexual partners, and heterosexuals who have many partners. The
information in these educational programs must be aimed at the
specific audience, be explicit, and contain practical information
other than "Just Say No", to prevent spread of the virus. While
most educators teach abstinence from the activities which place
an individual at highest risk, we know that such perfection is
rarely achieved. Therefore, they need to know that if they
participate in these activities, they must do them as safely as
possible. We must not trade the loss of lives for idealistic
purity.

In Sacramento, the situation is still manageable in that it is
still feasible to trace heterosexual contacts of high risk
individuals such as bisexual men or IV drug users who have HIV.
It is not possible to trace the sexual contacts of gay men
because of the average number of sexual partners and the high
prevalence of the virus among gay men.

The evaluation of vaccines for the prevention of HIV infection
must be accelerated, according to Dr. Flynn. Some of the simpler
vaccines have not been tested due to the fact that they are not
patentable because they do not use new technology, and thus are
not profitable. A killed whole virus vaccine is not patentable
and therefore, has not been tested. The National Institute of
Health must overcome the obstacles toward finding new vaccines
which may be tested immediately. Sacramento has an ideal
population for such a test because we have hundreds of IV drug
users who share drug paraphernalia without disinfection and are
therefore at high risk for acquiring HIV infection.

The major problems with services at this time in Sacramento
revolve around reimbursement issues. Since approximately half of
the people with AIDS are on Medi-Cal which reimburses at a very
low rate, close to 44% of actual charges, hospitals and health
care providers have been reluctant to provide care fa of ople
with AIDS. At this rate, a considerable amount of money the
care of people with AIDS As a result, pressures are tremendous
to constrict and restrict the AIDS Clinics or cut financial
losses.

This problem can be addressed in two ways. First Medi-Cal
reimbursements must be increased. Second, a regional center for
AIDS care should be established. In a model proposed by Dr.
Flynn, this center would bring together AIDS physicians, social
services, case managers, and home nursing personnel. The center

 

 
 

 

would house a clinic facility, transcription services for
physicians who use the facility, a special billing system which
allows private physicians to bill from the center through their
own private offices, an AIDS library, and social services to
coordinate lower cost home care. Private physicians would come
to the center to see their AIDS patients instead of seeing them
in their own offices. The physicians would pay a use of facility
fee calculated to be slightly lower than their overhead for their
own offices. The supplemental funds to run the center would be
provided by grants from federal, state, local and private grants
and donations. All administrative and support services could be
provided at one center.

Another urgent problem in Sacramento is a lack of beds in skilled
nursing facilities for people with AIDS who are unable to care
for themselves. We are on the verge of acquiring some skilled
nursing facility beds in the Sacramento area, provided more than
the current $44.00 per day Medi-Cal reimbursement is available
for the care of such patients. The skilled nursing facility
owners in the area have said that they cannot care for people
with AIDS with the needs for infection control and other special
needs for less than $150.00 per day. This rate is less than the
costs to keep a patient in the hospital.

AIDS patients are unnecessarily staying in acute care hospital
beds instead of skilled nursing facilities because of the low
reimbursement rate. Last year, The University of California at
Davis, Medical Facility accounted for 1,500 bed days that were
used by people with AIDS who could not be placed in skilled
nursing facilities. These patients had to remain in the hospital
at the cost of $300-400 per day. Precious acute hospital beds
were lost and the cost of care was double or triple what it could
have been in a skilled nursing facility had there been one
available. The reimbursable cost by Medi-Cal needs to be raised
from $44.00 per day.

The federal government can help solve this problem by
accelerating the process for increasing the reimbursement rate.
This is currently being negotiated by the state Health Department
and Medicaid administrators. The procedure takes too long given
the seriousness of the problen. AIDS is epidemic and
consequently the process for handling this special circumstance
needs to be adapted to this critical need.

Sacramento has some special problems in providing services to
people with HIV infection due to its high military population,
the rapid growth of the metropolitan area, and the low cost of
living.

The civilian health and social services in Sacramento have no
formal ties to the military establishment. Now that the military
is screening troops, who live in Sacramento, for HIV antibodies,

 

 
 

 

it is important that these patients receive information and
referrals to local providers who can assist them and their family
members with health care delivery, emotional support, health care
planning information and resettlement information should they be
discharged to this area.

The population of the Sacramento metropolitan area is increasing
at a brisk pace. This increase also enlarges the population at
risk for HIV infection and those currently infected. This
increase in numbers will cause heavy demands on existing and
newly created services. We need to plan ahead.

Sacramento is a less expensive area to live than San Francisco,
Los Angeles, and New York. Therefore, people with HIV infection
and who are symptomatic move here when their incomes are reduced
because the cost of living is lower here than in other large
cities. For example, 70% or more of the clients with AIDS served
by the Bay Area Legal Referral Services Foundation have incomes
of less than $7,000.

Specifically, listed below are current services that need
expanding and a list of new programs and services which need to
be developed in Sacramento.

Current Services Needing Expansions:

- Acute hospital beds.

- Expanded (non ambulance) patient transportation services.

- Home delivered meal services.

- Social work case management services.

- Clinical social work for assessment, patient and patient
"family" therapy.

- I.V. drug abuse prevention and education.

- Volunteer, "buddy" services for both emotional (look in on
and talk to patients) and practical (shop, clean, food
preparation) support.

- Network of support groups for patients, patient family and
children (eg., women I.V. drug users with children).
- Home health nursing and attendant care.

- Legal defence and advocacy (eg., Job and housing
discrimination, Office of Human Rights).

- Legal assistance and planning (eg., wills, Power of Attorney
for health care).

New Programs and Services needing to be developed

- Residential Skilled Nursing Facility (SNF).

- Licenced board and care and group homes.

- Residential Intermediate Care Facility (ICF).

- An AIDS out-patient clinic with mobile outreach.
- Street out-reach for I.V. drug users.

- In-patient psychiatric services.

 

 
 

 

- 24 hour AIDS patient emergency services.
- Outreach in minority community for I.V. drug users.
- Development of ethnic specific education, outreach and

prevention information services for minority patients (i.e.,
language - modes of services).

Sacramento has done exceedingly well to meet the demands of the
HIV epidemic. More must be done but the financial support of the
federal government is needed to meet this crisis head on. We
must 4% educate the high risk individuals and the general
population. We must 4% provide funding for this now so that we
can end the spread of this deadly disease and reduce both the
financial costs and needless loss of lives. What will the next
generation think about those of us who had the knowledge in the
1980's to virtually stop the HIV epidemic dead in its tracks, but
Gid not apply that knowledge? They are going to wonder what kind
of fools we were to let this virus spread to the point where the
next generation would not be able to eradicate it.

Thank you for inviting me to speak before the commission. It has
been a privilege.

 

 
 

MAUREEN O'CONNOR
MAYOR OF THE CITY OF SAN DIEGO

TESTIMONY BEFORE THE PRESIDENTIAL COMMISSION

ON THE HUMAN IMMUNODEFICIENCY EPIDEMIC
MARCH 25, 1988

ADMIRAL WATKINS AND MEMBERS OF THE PRESIDENTIAL COMMISSION. I AM
MAUREEN O'CONNOR, MAYOR OF THE CITY OF SAN DIEGO. I AM GRATEFUL
FOR THIS OPPORTUNITY TO DISCUSS THE AIDS EPIDEMIC AS IT IMPACTS
SAN DIEGO. OUR AREA IS ILL-PREPARED TO DEAL WITH THE SCOPE OF
THE IMPENDING CRISIS LACKING A COORDINATED EFFORT AND REALISTIC
FUNDING TO DEAL WITH THE MOUNTING TIDE OF AIDS AND ARC CASES,
WHICH ARE ESTIMATED TO NUMBER AROUND 10,000 TODAY AND WILL

APPROACH 50,000 ACCORDING TO PROJECTIONS BY 1991.

AS AIDS RAISES NATIONAL AND SOCIAL CONCERNS AND HAS CAUSED A
PROFOUND LOCAL AND INDIVIDUAL IMPACT, WE APPLAUD THE STEPS
OUTLINED IN YOUR INTERIM REPORT AS NECESSARY IN ADDRESSING THE
WHOLE FABRIC THAT MUST CONSTITUTE THE NATIONAL EFFORT. WE MUST

HAVE A NATIONAL APPROACH TO AIDS WHICH:

°STOPS THE SPREAD OF THE DISEASE

°PROTECTS THE CIVIL RIGHTS OF THE AFFLICTED

°PROVIDES FOR MEDICAL CARE. PWA'S/PWARC'S SHOULD BE GIVEN
EXPEDITED COVERAGE UNDER MEDICARE AND BE PROVIDED WITH

HOSPITALIZATION, OUTPATIENT, AND PRESCRIPTION SERVICES.

°ADDRESSES THE ECONOMIC CONCERNS OF MEDICAL INSURERS AND
THOSE WHO NEED INSURANCE

°PROVIDES FOR THE SOCIAL SERVICE REQUIREMENTS OF PWA'S AND
PWARC'S

 

 
 

 

°COMMUNICATES EFFECTIVELY TO ALL SEGMENTS OF THE POPULATION
ABOUT RISK AND BEHAVIOR

STATES AND LOCALITIES NEED CLEAR DIRECTION. IN CALIFORNIA, WE
FACE OVER 120 BILLS ON AIDS PENDING BEFORE THE LEGISLATURE GOING
IN EVERY CONCEIVABLE DIRECTION AND THE CITIZENRY MUST ADDRESS
PROPOSITION 69 (LA ROUCHE AIDS QUARANTINE INITIATIVE) ON THE JUNE

BALLOT.

LET ME NOW BRIEFLY SPEAK TO IMMEDIATE LOCAL NEEDS FROM A MAYOR'S

PERSPECTIVE IN COMING TO GRIPS WITH AIDS PROBLEMS.

CITY AND COUNTY GOVERNMENTS ARE SEPARATE ENTITIES IN SAN DIEGO.
RESPONSIBILITY FOR HEALTH ISSUES RESTS WITH THE COUNTY. AS MAYOR
OF THE CITY, I HAVE NO CONTROL, BEYOND PERSUASION, OVER THE
MARSHALLING OF RESOURCES TO COMBAT THIS DISEASE. BECAUSE AIDS
HAS SIGNIFICANT IMPACT ON ONLY ONE OF THE FIVE COUNTY
SUPERVISORIAL DISTRICTS, THE COUNTY IS UNRESPONSIVE TO THE
BURGEONING CRISIS. DR. COX, THE COUNTY HEALTH DIRECTOR, AS
RECENTLY AS TUESDAY, FLATLY DECLARED THAT THERE WAS NO AIDS
EMERGENCY IN SAN DIEGO AND THAT AIDS MERITED NO SPECIAL
CONSIDERATION IN RELATION TO OTHER HEALTH ISSUES. DUE TO A LACK
OF RESOURCES, THERE IS NO ACTION PLAN IN PLACE FOR DEALING WITH
THE DISEASE, NO PRIORITIZATION OF PROGRAMS, AND NO CASELOAD
PROJECTION BEYOND 1991. WHILE STATE AND FEDERAL PROGRAMS PROVIDE
FOR BASIC MEDICAL CARE AND EDUCATIONAL PROGRAMS, THE MAJOR BURDEN
FOR SOCIAL SERVICES AND OUTREACH CONTINUES TO BE CARRIED BY THE

PRIVATE SECTOR, WHICH BY AND LARGE MEANS THE GAY COMMUNITY.

 

 
 

 

THE CITY HAS BEGUN TO ASSIST THE VARIOUS SOCIAL SERVICE ORGANIZA-
TIONS IN PROVIDING AIDS/ARC SUFFERERS WITH THE MOST ESSENTIAL
FOOD, SHELTER, AND COUNSELING NEEDS AS THE DEMAND OVERWHELMS THE

ABILITY OF PRIVATE DONATIONS TO KEEP PACE.

eTHE CITY SUBSIDIZES APPROXIMATELY 60% OF FOOD BANK COSTS
FOR PWA'S AND PWARC'S EARNING LESS THAN $850 PER MONTH.

°THE CITY FUNDS A VAN FOR PWA/PWARC TRANSPORTATION.

°THROUGH ITS HOUSING COMMISSION, THE CITY IS PROVIDING A
HOUSE FOR PWA/PWARC LOW COST HOUSING. THE CITY SUBSIDIZES
THE RENT ON ANOTHER HOUSE USED FOR LOW INCOME HOUSING BY AN
AIDS AGENCY.

oTHE CITY ASSISTS IN PROVIDING EDUCATION/COUNSELING FOR
THOSE AT RISK AND WHO TEST HIV POSITIVE.

THE CITY FUNDS ITS VERY MODEST EFFORT, ASSISTING PERHAPS 5% OF
PWA'S/PWARC'S, THROUGH ALLOCATION OF 10% OF COMMUNITY DEVELOPMENT
BLOCK GRANT (CDBG) FUNDS AVAILABLE FOR SOCIAL SERVICES. ONLY
$1.5 MILLION OF SUCH FUNDS WERE AVAILABLE TO THE CITY IN 1988 FOR
ALL CITY SOCIAL SERVICE PROGRAMS. CDBG FUNDS WERE FULLY
SUBSCRIBED BEFORE THE ADDITION OF AIDS PROGRAMS. THE RAPID
GROWTH OF AIDS REQUIREMENTS WILL QUICKLY DISPLACE ALL OTHER
SOCIAL PROGRAMS, EVERY ONE OF WHICH IS ESSENTIAL TO SOME SEGMENT
OF THE COMMUNITY. COMPOUNDING THE PROBLEM IS THE FACT THAT THE
FEDERAL GOVERNMENT IS REDUCING CDBG FUNDING TO THE CITIES EACH
YEAR. FEDERAL CUTS ARE ALSO THREATENED IN OTHER AREAS SUCH AS
PUBLIC TRANSPORTATION. SUCH CUTS HAVE A DIRECT IMPACT ON THE

SERVICES NEEDED BY THE AIDS/ARC POPULATION. CITIES CANNOT

 
 

 

COMPENSATE FOR DIMINISHED FEDERAL PROGRAMS AND FUND AN INCREASING

AIDS DEMAND.

CITIES SUCH AS SAN DIEGO ARE JURISDICTIONALLY CONSTRAINED IN
THEIR ABILITY TO RESPOND TO A HEALTH CRISIS AND ARE FISCALLY:
POWERLESS TO ADDRESS NEEDS. WHERE THE POPULATION AFFECTED IS
CURRENTLY CONCENTRATED IN THE MAJOR URBAN AREAS, THE TOOLS MUST
BE PROVIDED TO THE CITY GOVERNMENTS TO ACT WHERE OTHERS FAIL TO
STEP IN AND WHERE THE PRIVATE SECTORS' WILLINGNESS TO PARTICIPATE

IS OVERCOME BY THE NEED FOR SERVICES.

THE REQUIREMENTS OF VARIOUS URBAN AREAS WILL VARY BASED ON THE
MAKEUP AND SIZE OF THE IMMEDIATELY AT RISK POPULATION, EXISTING
LOCAL MEDICAL AND SOCIAL AGENCY RESOURCES AND VARIOUS PECULIARITIES
IN THE LOCAL POLITICAL AND SOCIAL ENVIRONMENTS. SAN DIEGO FOR
INSTANCE MUST DEAL WITH NAVY AND MARINE CORPS RECRUITS DISCHARGED

AS HIV POSITIVE.

WE URGE THE IMMEDIATE ENACTMENT OF FEDERAL LEGISLATION SUCH AS
S1220 (SENATOR KENNEDY'S AIDS RESEARCH, CARE, AND TREATMENT BILL)
WHICH WILL GIVE DIRECTION, SCOPE, AND FUNDING IN SUFFICIENT SCALE
TO FORMULATE A NATIONAL AIDS POLICY. FUNDING PROVIDED SHOULD

GO DIRECTLY TO THE LEVEL OF GOVERNMENT BEST POSITIONED TO

ADMINISTER PROGRAMS.

SPECIFICALLY, WE NEED DIRECT ASSISTANCE TO THE CITIES THROUGH
PROGRAMS SUCH AS THOSE CONTAINED IN $1220, THE INCREASE IN SOCIAL

SERVICE FUNDS AVAILABLE THROUGH EXISTING PROGRAMS SUCH AS CDBG,

 

 
 

 

OR OTHER PASS THROUGH MECHANISMS. SAN DIEGO NEEDS SUCH FUNDS NOW

TO PROVIDE THE FUNDAMENTAL STRUCTURE TO SUSTAIN HUMAN EXISTENCE

WITHIN THE BOUNDS OF DECENCY. EXAMPLES OF OUR SPECIFIC

REQUIREMENTS ARE:

°A PWA/PWARC LICENSED ADULT SOCIALIZATION (DAY CARE)
FACILITY

°LOW INCOME HOUSING

°FACILITIES FOR AIDS AGENCIES TO ALLOW FOR ADEQUATE
CLIENT SERVICING

°MEALS ON WHEELS IN THE TRIPLE A (AREA AGENCY ON AGING)
MODEL

°FOOD BANK FUNDING

°VISITING NURSE/HEALTH CARE CAPABILITY

°COUNSELING SERVICES

°CLEAN NEEDLE (BLEACH AND NEEDLE EXCHANGE) PROGRAMS

THANK YOU FOR THE COURTESY EXTENDED TO ME TODAY AND FOR YOUR

INTEREST AND CONCERN.

BFD:evs
a:watkins
3/24/88

 

 
 

Office of the Mayor

SaN FRANCISCO ART AGNOS

 

STATEMENT BY MAYOR ART AGNOS
PRESIDENTIAL COMMISSION ON THE HIV EPIDEMIC
SAN FRANCISCO HEARING
March 25, 1988

Admiral Watkins...Members of the Commission.
As Mayor of San Francisco, I welcome you to our City.

We want you to know about AIDS in San Francisco...and
what needs to be done.

San Francisco already has lost more young men to
AIDS...than all the San Franciscans who died in World War
I...World War II...Korea...and Vietnam...combined and
doubled.

The word "decimate" literally means one out of ten.

In San Francisco...by the end of this year...one out of
ten gay men in our City will have been diagnosed with full
AIDS...or died of AIDS.

Within five years...it will be one out of four in our
city.

They are San Franciscans in the prime of their
lives...hardworking...good citizens...whose contribution to
our City is without question.

But the pain and suffering that you hear from those of us
who have lost friends and loved ones in this City to
AIDS...is not just a San Francisco story.

Today there are perhaps 30 American cities who have the
same level of AIDS cases that San Francisco had three years
ago.

While the level of new infections is almost leveling off in

San Francisco's gay community...that isn't happening to the
same extent elsewhere.

1

200 CITY HALL, SAN FRANCISCO, CALIFORNIA 94102
(415) 554-614]

 

 
 

Mayor Agnos
Presidential AIDS Commission
March 25, 1988

We did it alone in California...because there was no
federal help.

In 1984, I doubled the funding to $1 million...and we
still had no federal AIDS education funding.

In 1985 I authored California's.law setting public health
standards for use of the AIDS antibody test...including
consent and confidentiality provisions.

The federal government did not provide leadership.

Finally, in March, 1987, I requested and won approval for
a Special Joint Session of the California State Legislature
on the AIDS Epidemic.

The U.S. Surgeon General, Dr. C. Everett Koop, and a
Nobel laureate, Dr. David Baltimore, co-chair of the
National Academy of Science Institute of Medicine panel on
AIDS...came to the California State Capitol and spoke at
that highly unusual Joint Session.

I was dismayed then that Dr. Koop, our nation's top
public health officer, had not been invited to bring his
message to the President of the United States who appointed
him.

I am still dismayed, a year later, that Dr. Koop has not
been invited to fully brief the President of the United
States on our nation's most serious health crisis...nor has
he been invited to play the lead role in setting our
nation's policy.

I urge this Commission, without delay, to recommend to
the President that he meet with his Surgeon General and that
they appear together publicly to end the impass that public
health officials face from those who hold political office.

I understand that impass.

As a state legislator, I worked with public health
officials on every AIDS bill that I authored.

Without exception, those bills had the support and
enthusiasm of public health leaders and AIDS care providers.

But time after time, what the public saw was a partisan
political line being drawn.

 
 

Mayor Agnos
Presidential AIDS Commission
March 25, 1988

That was an artificial line...drawn for artifical
reasons...but the delay results in deaths which are not
artificial.

Working with the U.S. Surgeon General, I drafted an
omnibus AIDS bill that incorporated the recommendations in
his 1986 report.

I also worked with the National Academy of Sciences
Institute of Medicine.

The bill was hailed by health officials as a model for
the nation...a measure that could save lives.

While Dr. Koop does not endorse state legislation, he
confirmed that he had worked on each draft and said the bill
was the most compassionate he had ever had presented to hin.

In the California State Assembly, only one Republican
would vote for it.

He is the only physician in the Legislature.

In the California State Senate, not even one Republican
voted for the bill.

The centerpiece of that legislation was the creation of a
California Commission on AIDS.

It would bring together the public sector and the private
sector, the many agencies of the state, local governments,
and a range of individuals who are affected as employers,
police, insurance executives, physicians, nurses and people
with AIDS themselves.

That same approach has been recommended by every major
public health association for the nation...but it has yet to
happen.

This Commission is a temporary stop-gap...not the
national body we need to oversee all the parts of our policy
on AIDS.

It is overdue...and it shouldn't wait on an election to
happen.

 
 

Mayor Agnos
Presidential AIDS Commission
March 25, 1988

In the interim, I urge you as a Commission to call for
the establishment of a powerful body that can review
existing programs of every kind...to see whether they might
be put to work to help us combat AIDS...and to provide the
assistance we need for demonstration programs and rule
changes where the need is already evident.

In San Francisco we have a model program called Open
Hand.

Volunteers, including professional chefs from some of our
city's finest restaurants, prepare meals that are taken to
people with AIDS who are still able to live at home...but
unable to prepare nutritious meals for themselves.

It is very like the Meals on Wheels program...except that
the Meals on Wheels program is barred from helping people
under 65.

We have no nursing home facility for people with AIDS in
San Francisco...indeed, we have virtually no facility in all
of Northern California.

The reimbursements are too low.

The fear of other patients and their families is too
high.

We are seeking to have the Public Health Service Hospital
in San Francisco converted into a facility that can help
meet that need...particularly for those who face the dual
diagnosis of AIDS dementia.

But the process of winning the federal approvals for such
an innovation...and the help we need for operating
costs...will take years before the project is complete.

Those who need it this year...or next...likely will never
live long enough to find it of service.

Too often, federal rules prohibit demonstration project
funds from going to programs that already have been
launched.

We call that the San Francisco penalty.
Our city begins a program...proves its

effectiveness...using our own funds...and then a federal
demonstration program is created...but only for new efforts.

 

 
 

 

Mayor Agnos
Presidential AIDS Commission
March 25, 1988

When the Commission proposed a $1.5 billion program for
AIDS and substance abuse, you called for a local and federal
match.

San Francisco wants and needs such a program.

We have less than a dozen beds for women who have child
care needs who require residential substance abuse prograns.

We have an aggressive street outreach program to IV
needle users...informing them of detox programs...counseling
programs...and how to clean needles with bleach.

I helped start those programs with a state pilot that is
being expanded.

But the federal component comes from a block grant that
was a one-time appropriation from the War on Drugs.

Your proposal could help us put in the residential
treatment program we need...while keeping families intact.

We could continue our model street outreach programs.

But unless you make clear that there will be no penalty
for programs like ours that are already started...the
announcement you made intending to encourage us all...will
be an incentive for further delay.

Cities will simply stop the innovations...stop bridging
the gap...and wait for the pipeline which may never open.

San Francisco won't do that...but you can remove the
issue from the table simply by including an ability for
programs like ours to be grandfathered in.

The burden on cities such as San Francisco is going to
grow greater...even though the new infections level off.

The incubation period guarantees that the pipeline will
continue to bring new cases.

But beyond that, a major shift is taking place in meeting
AIDS costs.

Two years ago, about 30% of San Francisco's caseload were
public-funded cases, including through our state Medi-Cal.

Today it is almost 50% whose costs must be borne by the
public sector.

 

 
 

 

Mayor Agnos
Presidential AIDS Commission
March 25, 1988

As insurance redlining increases...as employers feel free
to limit health benefits so that AIDS is not covered...or
worse, discriminate aginst those with AIDS...the costs are
going to fall straight on the cities.

This will continue to be particularly true in states like
California and about 35 others where no risk-pool program
exists for those unable to obtain health care.

They drop straight to the public rolls.

The federal government has an opportunity to play a major
role in creating federal incentives to states to create risk
pool or stop-loss programs, including case management, that
can spread the costs of AIDS care sensibly and equitably
between employers, insurers and the public sector.

I particularly want to call your attention to the fact
that one out of every two dollars paid by California
employers for health care comes from a self-insured plan
that they underwrite on their own.

The state and cities have no authority over such
programs.

The conditions of benefits, whether home care and hospice
is reimburseable...even whether certain diseases such as
AIDS could be red-lined out...are issues reviewed at the
U.S. Department of Labor.

I have yet to see policy guidelines to employers on AIDS
in ERISA plans.

The federal-state share of AIDS care, according to the
Health Care Financing Administration, is only 53 cents on
the dollar.

The other 47 cents is absorbed by the doctors, hospitals
and charities.

For us, that means the San Francisco taxpayer, because
our major hospital is San Francisco General, a part of our
City's health Department.

The specifics of our needs are long.

We need help for the homeless with AIDS.

In San Francisco, we estimate that number at between 200
and 600.

 

 
 

 

Mayor Agnos
Presidential AIDS Commission
March 25, 1988

We have fewer than 80 beds.

We need significant funding for case
management...including money management...and eligibility
workers for those who should receive veteran's benefits or
SSI.

We need to create health centers capable of monitoring
and possibly providing early intervention for those who are
antibody positive...something many San Franciscans with
independent incomes are doing through the private
sector...but which is still out of reach for those who rely
on the public sector for help.

We need better coordination of new drugs...and better
access to investigational drug opportunities.

We need a federal consumer protection program to halt
AIDS fraud...just as we are doing through an Attorney
General AIDS Fraud Task Force started by Attorney General
John van de Kamp in California.

Most of all, we need committed leadership at the White
House itself.

Cities like San Francisco show what can be done.

But what threatens to overwhelm San Francisco is not the
increased case load of AIDS...but the continued lack of
leadership from the federal government.

Thank you.

#U,5, GOVERNMENT PRINTING CFF ICE 11968-617-929293515 8