AIDS, the deadly disease, today moves relentlessly into its second decade and those who combat it in Baltimore and Maryland find themselves facing cuts in funding, a critical shortage of acute medical care for children and a dearth of innovative programs for hard-to-reach victims such as women, intravenous drug users and adolescents.
Doctors, people with AIDS and activists battling the spread of the epidemic also say that key advisory groups are stalled and mute on controversial issues such as wider AIDS testing programs.
There is no end in sight to the suffering caused by acquired immune deficiency syndrome, a disease that destroys the immune system. But while the disease, which is most often sexually transmitted, is not abating, experts say it is not spreading as quickly as it once did.
Federal Centers for Disease Control officials in Atlanta say that by the end of the year, AIDS deaths since 1981 will top 150,000, and that more than 250,000 cases will have been diagnosed. It is estimated another 1 million to 1.5 million people carry the human immunodeficiency virus, or HIV, which develops into AIDS after an average 10-year incubation period.
In Maryland, state AIDS Administration officials are girding for about 750 to 825 cases in the year ahead.
At the start of the second decade of AIDS there is still no vaccine or cure. But patients are living longer and better thanks to improved drugs and treatments.
The predominance of homosexual sex as the method of infection is also changing. Homosexual men still make up the largest percentage of new cases. But in Maryland, the percentage of new cases of those infected through intravenous drug use or through sex with intravenous drug abusers has nearly caught up with homosexual sex as the leading cause.
Increasingly, AIDS is an epidemic of poor blacks and Hispanics, particularly IV drug users, their sex partners and their children.
This year, AIDS is expected to become the fifth leading cause of death among women, according to the CDC, making women the fastest growing segment of the population infected with AIDS.
The state AIDS Administration will be forced to operate with $1.4 million less in fiscal 1992 than in fiscal 1991, down to $11.3 million from $12.7 million.
Of that, $4 million will come from state general funds, which is $400,000 less than last year, and $7.2 million in federal funds, which is $1 million less than last year. Grants and gifts add about $100,000.
The Ryan White Care Act of 1990, which is designed to improve care of persons with HIV, will change the way the state gets some of its money, says Dr. Eric Fine, deputy director of the AIDS Administration.
In October, Baltimore will become one of two cities that will qualify for this special assistance to cities that have an unusual number of AIDS cases. Sixteen cities across the nation, including San Francisco, Los Angeles and New York, already get this federal support.
"At this point, they're talking in terms of roughly $1 million to $2 million," said Fine. "The money will go directly to Mayor [Kurt L.] Schmoke's office and is earmarked for programs that will benefit minorities and women."
The kinds of things the Ryan White Act requires are central medical services, which includes case management, and central support services, which in the case of women and children have to do with day care, respite care, foster care and residential care.
Although at first blush this sounds like good news, Dr. Kathleen Edwards, director of the AIDS Administration warns, "We don't want people to think we have new money because we really don't. It's not totally all good news."
She said that while the government was adding money under this new program, it was taking money away from other programs.
"Money continues to be a critical factor," Edwards says. "We can't be discouraged about these money problems. We have to stay up and we have to keep working hard."
"We're facing a crisis in the acute medical care of children with HIV infection or at risk for the infection," says Dr. John P. Johnson, the head of pediatric AIDS at the University of Maryland Medical Center.
"Our numbers have swelled tremendously in our clinical operation. We now have gone from operating the clinic a half-day week to three days a week. We're following close to 250 children who are at risk, have HIV disease or AIDS. That is close to a four-fold increase in the last couple of years."
Johnson expects the figures to keep rising. UM data show a steady increase of children on a monthly basis, he says.
The only way hospitals are going to be able to cope with this problem in the future, he believes, is to train general pediatricians to take care of children with HIV disease.