THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, August 18, 1996 TAG: 9608170004
SECTION: COMMENTARY PAGE: J4 EDITION: FINAL
TYPE: Opinion
SOURCE: By ALAN D. WILSON, M.D.
LENGTH: 84 lines
In medicine, an avoided problem saves money, time, disability and lives. However, much of our training focuses on waiting for a failed system before we intervene.
Physicians learn that to experience the exhilaration of healing you must find a reparable situation (something broken but fixable) and then assume the role of rescuer. If done well, you then accept all the praise and rewards that follow.
In contrast, a long-ignored aspect of medicine is preventive care. There is little praise directed toward controlling coronary-artery-disease risk factors (hypertension, elevated cholesterol, etc.) and thus preventing heart attacks.
To be a healer, an illness must exist. Yet if we successfully prevent or avoid problems, what is our title? Where is our reward?
A serious illness is spreading across Hampton Roads - a disease of our culture with manifestations of self-perpetuation symptoms. As with many pathologic problems, prevention is absolutely the best ``cure.'' But in order to avoid falling victim to the full expression of a sickness, one must be able to recognize the early warning signs. This is difficult since the disease is apathy.
AIDS has been present in Hampton Roads for more than 14 years. Southeastern Virginia now has 5,089 documented HIV-infected citizens of every known exposure risk. HIV is the No. 1 cause of death for adults ages 25 to 44 in Virginia and America as a whole. Newly diagnosed Virginians increased by 36 percent last year. The majority of these people are in their late teens and 20s.
Since the beginning of the HIV epidemic, the vast weight of preventive education has been shouldered by volunteer, not-for-profit AIDS service organizations - ASOs. Approximately four years ago, a limited HIV-education program was introduced into some of the area's public-school systems via the Family Life Program. The local public-health departments use a portion of their tight resources for HIV prevention. A few churches have also recognized the urgent need for community education and have started HIV-focused programs. Notice no mention of the local city governments or major hospital corporations.
The U.S. Bureau of Statistics estimates that we spent $15.2 billion on HIV health care in 1995. This is expected to rise by 15 percent for 1996. In addition, the cost of any illness includes the loss of valuable work time and cost to employers. The estimated five-year cost to a business for an HIV-infected employee is $17,000 to $32,000. Also, presently 50 percent of HIV/AIDS cases are supported by the Medicaid system (increased from 42 percent last year).
What have local governments done? Eight to 10 years ago, several city governments organized ad hoc committees to address the problem. There have been no communications or recommendations for many years. What else have they done?
There has been fair support for case management for those already infected. The city of Virginia Beach allotted $25,419 for fiscal years 1995-1996 to the Tidewater AIDS Crisis Taskforce, while the city of Norfolk gave $34,350. Compare this with the support of projects such as Nauticus and the Virginia Beach Amphitheater. One could deduce that the cities value entertainment over health and preventive care.
Not a single hospital in Hampton Roads has a dedicated area for HIV-infected patients while hospitalized. The largest Norfolk-based health-care corporation listed HIV as one of its top two priorities at an annual board of directors meeting years ago. The only attempts to support its pledge have been planning and aborting an HIV-dedicated wing in one hospital and initiating an HIV/AIDS clinic twice a month. This clinic is staffed by volunteer physician experts, not employees of the corporation. Even still, there was talk of closing it just this past year.
Why does one of the gravest threats to our future and our children's future continue to be ignored? My diagnosis is apathy.
I challenge our local governments to recognize the current and worsening devastation of HIV in Hampton Roads and act upon it immediately. I challenge the health-care corporations to stop ignoring HIV in Hampton Roads and admit that AIDS deserves the same respect as other illnesses. The ASOs can no longer carry the burden alone and, indeed, it should not be up to volunteer forces to protect our citizens from illness and death.
In any crisis, there are never enough resources or supporters. But when we balance the impact of this health crisis against local plans and actions, I see no valid excuses for the past. I ask that my challenges be met with acknowledgment and an urgent, aggressive response. The system has failed; it is broken. This is an opportunity for our government and hospitals to become healers. MEMO: Dr. Wilson is assistant professor of medicine at Eastern Virginia
Medical School. by CNB