Peak near for S.F. in AIDS cases Disease's cost to city is soaring

December 02, 1992|By Knight-Ridder News Service

SAN FRANCISCO -- The number of new AIDS cases in this epicenter of the epidemic is expected to peak this year after more than a decade of spiraling increase.

That's the good news.

The bad news is that financial costs of acquired immune deficiency syndrome will continue to mushroom at a time the city can least afford it. Without a huge infusion of federal money, the epidemic soon may overwhelm local health agencies and trigger an ugly tug-of-war among the many who compete for shrinking city funds.

"It's almost catastrophic now, and we're just beginning to see the peak of this epidemic -- we haven't seen the worst part of it at all," said Supervisor Angela Alioto, who chairs the committee that oversees health budgets. "Clearly we're in dire straits."

The financial crisis has been a long time coming. It represents a convergence of factors that have pushed health care costs to the stratosphere and burdened San Francisco taxpayers with what proportionally may be the biggest health-care budget of any American city.

A historical commitment to a high level of health services, a population mix of numerous needy groups, a reluctance by political leaders to spend within their means, a deep and intransigent recession all served as kindling for the crisis.

The lighted match was a virus.

AIDS cases in San Francisco have soared from two in 1980 to a cumulative total of 12,579 at the end of last year. This year, according to projections by the city's Health Department, the number of new cases will peak at 2,173 and then gradually decline to 2,007 in 1997.

But as the number of new cases levels off, the cumulative number of cases will continue to grow. An estimated 28,000 San Francisco residents are infected with HIV and expected to develop AIDS. By the end of 1997, the cumulative number of AIDS cases is expected to exceed 25,000.

As the number of AIDS cases climbs, so does the public cost of the epidemic, in part because a large percentage of AIDS patients are uninsured. In fiscal year 1982-1983, San Francisco spent a total of $180,447 on AIDS programs. By fiscal year 1991-1992, the amount had soared to $73.3 million.

Most of that $73.3 million came from state and federal sources. But nearly $22 million for AIDS education, prevention and treatment came directly from city coffers. And the burden on San Francisco's beleaguered general fund seems destined to grow.

Last month, to loud applause from local officials, Rep. Nancy Pelosi, D-San Francisco, held a news conference at City Hall to announce that she, as a member of the powerful House Appropriations Committee, had helped secure an estimated $110 million for local HIV-related programs.

It was a record-breaking appropriation. However, Ms. Pelosi also warned that future federal AIDS spending would increase only "incrementally" unless there was a major restructuring of priorities.

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