MAYOR SCHMOKE appointed a first-rate AIDS Coordinating Council to tell him what the city was already doing about the disease -- and what it ought to do.
After more than a year of work, the council has presented its report. It is a complete report, a competent and reasonable one and one that paints a grim picture. Implicit throughout is the sad conclusion that Baltimore has failed to respond adequately to the challenges posed by AIDS.
Statistically, the report is discouragingly bleak. Baltimore accounts for 44 percent of all AIDS cases in Maryland. A person with AIDS in Baltimore is less likely to receive the only drug known to be effective in treating the disease and "lives a significantly shorter period from the date of diagnosis" than does an AIDS sufferer elsewhere in the state.
Over half of all AIDS cases in Baltimore are the result of IV drug abuse, and most people with AIDS here are minorities. Increasingly, they are also women, adolescents, children and infants. More than half depend on Medicaid for health care.
Despite these desperate figures, Baltimore has spent no city money on AIDS and is completely dependent on state and federal grants to provide its meager AIDS services. Yet, the Baltimore city Health Department has assigned no one to develop and write grant proposals or to manage grants when they are received. As a result, a great deal of money has been lost, especially from grants requiring matching funds. A $1 million grant for sexually transmitted disease clinics was "categorically rejected due to the absence of city support," according to the report.
City-run clinics are often the places where an HIV-infected person makes his or her first contact with the health care system. But the clinics offer virtually no medical care. Instead, patients are referred elsewhere -- to privately run clinics or hospitals.
Because most city AIDS patients depend on Medicaid, which covers less than 20 percent of actual cost, the hospitals and clinics that do offer AIDS care lose money on their services. The few private doctors willing to care for AIDS patients on Medicaid consider them "pro bono" cases -- that is, cases that are treated without charge. To aggravate matters, under current federal legislation the number of AIDS sufferers here falls just short of the minimum required for Baltimore to receive federal AIDS treatment money.
To address these problems and others, the council recommends that the city continue to offer anonymous HIV testing so people at risk will seek help without fear of exposure. AIDS cases, the council advises, should nevertheless be reported to the state health department for epidemiological purposes -- and to justify requests for funding. The council supports legislation to end AIDS discrimination. It expresses "concern that existing law does not provide adequate protection against the improper disclosure of medical information."
Further, the council urges the city to spend some of its own money to staff the office of AIDS coordinator in the city Health Department and provide primary health care at Health Department clinics and the City Jail. The city should provide more services for women and children, including day care and respite care programs for families, and better housing services. Adequate drug rehabilitation programs should also be provided.
The council wants Mayor Schmoke to take an active, public role in fighting AIDS. It wants to see more private money raised. "Both the mayor and the commissioner of health," the report says, "should . . . make every effort to attend major AIDS fund-raisers when invited." It also advocates increasing involvement of Baltimore's black community in fighting AIDS.
Clearly, the city cannot accomplish all this by itself. It doesn't have the money. It needs more private help and more money from both the state and federal governments. But with a faltering national economy, the state budget crisis and the enormous federal deficit, Baltimore can expect less help than it needs.
The council offers no suggestions on how to overcome the financial or political obstacles. That was not its charge. Those challenges are the responsibility of Mayor Schmoke and the City Council, and they loom very large indeed.
Baltimore suffers now from the consequences of its failure to deal with AIDS. Though the council's report avoids direct criticism of the city's AIDS policy, its predictions are dire. Were it possible to implement all of the recommendations today, the AIDS epidemic would still grow, claim victims and drain Baltimore's resources and vitality. If the recommendations are ignored or sabotaged by politics, the calamity Baltimore faces is incalculable.
Garey Lambert writes from Baltimore.