Iowa Press; 1505; Aids

Tony this is for Nancy. But if I were crash show 15 0 5 it was recorded October 30th. Eighty seven is twenty eight fifteen and airs November 1st 87 and all that good stuff. Oh. A major funding for this program was provided by friends of Iowa Public Television. When thousands of gay rights activist marks on Washington this month one of their demands was more federal money to fight the battle against AIDS. But progress on all fronts federal and local has been slow and cautious. I think we have to be very careful not to create a hysteria about it I think it was some thoughtful leadership is always important and it's not just an AIDS it's an everything.

Tonight we'll talk with two Iowans confronting the social and economic problems caused by AIDS. This is the Sunday November 1st edition of violent crimes. Here is. Good evening. Item public health experts say it does not appear that hospitals will have the facilities and staff to help the increasing number of AIDS patients that will need care. Just four years from now. Item three New York congressman stepping in where the White House has declined to tread. Well male the Surgeon General's report on AIDS to every household in their districts. Item. The DuPont company has warned the neighbors of its Glasgow Delaware plant that it will build a biologically secure lab to grow and study the AIDS virus. So from health care providers to the seats of government to the leaders of business and industry AIDS is high on the public agenda these days. AIDS or Acquired Immune Deficiency Syndrome is

the name given to a wide away of health problems that begin with vague symptoms like weight loss and fever and then quickly develop into chronic pneumonia and a rare form of cancer. To date the populations most affected by that disease have been homosexual and bisexual men and intravenous drug users. The spread of AIDS has created not just a medical quandary but a social economic and political dilemma as well. And though the reported number of cases in Iowa is still relatively small compared to other parts of the country there are problems that Iowa lawmakers and industry leaders must begin to face. Sid Spector reports. An overflow crowd at last week's central Iowa AIDS Project conference in Des Moines underscored the growing concern over the spread of AIDS. Organizers had expected about two hundred fifty people to attend but a crowd estimated at more than twice that arrived to learn about the impact of AIDS on caregiving health education and business and industry. Well I think it has an impact on economic planning.

If you're planning budgets either state budgets or private industry budgets I think you will have to know how much the impact has been on the cost of it and the cost of services and anything that surrounds that area so that you can plan for that. But how do governments and private industry plan for what some people are calling a billion dollar epidemic. The U.S. Public Health Service says that by 1991 there will be some 270000 AIDS patients in the U.S. and 1 to 1.5 million carriers of the AIDS virus. The cost for diagnosis and care of those patients will be staggering by some estimates as high as thirty seven point six billion dollars. Steven Kessler is a vice president for one of New York City's largest insurance companies which since 1992 has provided coverage to about 8 percent of the nation's AIDS patients. With a large data base from which to work more than 30 400 AIDS patients to date

Kessler's company has been busy researching costs on a per patient basis the cost of these cases according to our plenary results seem to be in the $40000 range. Now this is only hospital insurance we're talking about the institutional costs the inpatient the outpatient settings. We have not completed our work looking at the medical costs the ancillary medical costs for providers doctors those types of costs which certainly will add significantly to that $40000 number. I always share the reported number of AIDS cases thus far has been fractional from 1983 when the first AIDS patient was diagnosed in Iowa this month. There were a total of but 70 reported cases. That compares with the thousands of cases reported in New York California Texas and Florida state spending on the problem followed suit. Nationwide state government spent one hundred seventeen million on AIDS from 1983 to 1986.

But according to the intergovernmental Health Policy Project is one of 17 states that will spend less than a million dollars in fiscal 1087 aid on AIDS and other 900 states will spend no money at all. But Kessler warns that calling the AIDS epidemic a problem only in places like California and New York is a mistake by 1901. He predicts the share of AIDS cases in those two states will drop from 50 percent of the nation's total to 20 percent. Some say the unwillingness to confront the growing cost of AIDS stems not only from complacency but a lack of leadership on a national level. Earlier this month thousands of homosexuals and their supporters from across the nation marched in Washington. Among their demands was more federal money to fight AIDS. But the greatest political challenge is how we are going to pay for the care of those with AIDS. The private and public sectors the federal and state governments all seem to be waiting in the hope that the other will resolve the problem.

More than half the states in the nation have now passed some kind of legislation to deal with AIDS. Lawmakers attempting to contain both the spread of the disease and the rapidly escalating cost of AIDS in Iowa last year for example legislation was approved that mandates the Department of Health to compile a central registry of diagnosed AIDS cases and maintain the confidentiality of those cases and also provide education constantly and blood testing. But what else needs to be done what about the cost of state and local governments if the number of AIDS cases in Iowa continues to grow. Well those are some of the questions that we're going to be asking tonight of our guests their State Representative Ralph Rosenberg who co-chairs a legislative Interim Committee on AIDS and Rosemary Hilman chair of the central Iowa AIDS Coalition She's the former director of Hospice of Iowa with a big question by David Epstein of the Des Moines Register and by Judy Dobbin Meier of the Cedar Rapids Gazette. Representative Rosenberg how big a deal is this and I want 70 cases. Doesn't sound like a lot. So let's put this in perspective. How big a deal is the age problem and I'll well though it's not as big as the New York or San Francisco.

It's still significant. Talking with legislators and public health experts from places like San Francisco northern New Jersey they feel it's critical for I would take steps because now is the time to put efforts in to put resources into prevention and education to really stop the spread of AIDS. Whose home when are we getting panicky in Iowa about this situation. Well I think that there's a rational fears around the issue of AIDS everywhere and I would hope that given some lead time until it becomes an epidemic proportions here that we can provide good educational program that would eliminate some of that hysteria. Representative Rosenberg is there a climate for calm reasoned response to this. There's a feeling among some people evangelical Christians for example that homosexuals and drug users are sinners and they're they're getting what they deserved. From God for this disease how do you respond to that. Well I think and I just have to flatly reject those kind of comments. I don't think that kind of argument is is responsible is anything to do with the life and death matter such as this.

And again it's not just homosexuals and I.V. users it's also heterosexual people. It's also little kids who receive blood transfusions as hemophiliacs. So I just simply reject that kind of out of it. Well but wait a minute it's. Relatively few AIDS cases are little children right. The the predominant people who get AIDS are homosexual men and bisexual men and intravenous drug users and whether you or I may like that line of reasoning there are a lot of taxpayers in this society who say those people are getting what they deserve. Julian I hear that out there on the road covering these candidates for office. So how do you deal that what do you say to somebody who has that attitude even to say OK let's see if they're right let's agree with that moral sense let's put it where we put our resources to prevent the spread. Please we can agree saying regardless of what you think it's a moral problem or not. Let's prevent the spread we can get some agreements on how to prevent the spread of AIDS. We can get some agreements is the only known antidote today. You're only really in a sense no cure is

education in preventing the spread. Oh yes he said. There is no risk group anymore is risk behaviors and that's what we need to educate their risk behaviors that put anyone at risk whether they're in a so-called identified group or not what do you mean by that because what I hear you saying is I have one sex partner and there are some other things too. He will feel like who needs a blood transfusion can change his or her lifestyle for example. No that's right that a percentage of those are small compared to those who participate in risky behaviors which would include multiple sex partners or using drugs and injecting. But that seems to just reinforce what Dave was contending here all along that that is the segment of our population or lifestyle population if you will. And so people who say I don't indulge in those things I'm not going to be affected can still point and say those are the people who are at risk.

Well I disagree in that we all participate in sex. There's hardly an adult that does not. And that risk of having AIDS be transmitted through sex is higher depending on the practices that you use and protection that you have. And so it crosses across. The boundaries of society and groups there was a reason what is the state doing about this problem now. You've got a committee where we have a carrier task force and last year we passed House file 310 which dealt with education and counseling pre and post tests counseling provided for some confidentiality protection for people whose names become on the registry. What the state's going to have to do is we have limited resources in state government we've got to do is decide how we're going to spend our resources. To what extent are we going to get into the area of research and there is some research I guess that is being done in numerous environ I genocide or what extent we're going to put resources into successful public health matters. You borrowing from what traditionally has worked with public health and with other types of sexually transmitted diseases. And then realizing this is a little different.

What do you think the state should be doing that it's not doing now. And how would you grade the state for what it's done so far. Well I guess I'd give it a C. You know the State Government doesn't change quickly and it's a very traditional kind of elephant that's hard to define and hard to move forward. I think that everyone has agreed that it's a priority is just how to approach it that has been the difficulty. And I hope that they work with local groups and people who are involved in providing services to AIDS patients and families so that there can be a partnership established. I think that the state has to look at the private sector as well as government sector. Devising some mechanisms for providing care and the economics of providing good medical care for people who have the virus and develop the disease. Representative Rosenberg. You're a political animal. You're in politics and I characterize you as being able to analyze and understand the politics of this right. Is it a bipartisan issue or can this become a partisan issue.

Liberal conservative for example. Voters on one segment saying don't spend the education dollars that would provide a better education for my child or lower tuitions at state universities to put into the AIDS fight. That's not our problem. We have maintained a clean lifestyle. You liberal. And if that is if it can be characterized liberal don't we spending our money for that and can some candidates come out and say that it was a politically suicide just do that. Well you know that any kind of money that comes from state government competes with our other limited resources. So in that sense any effort to expend our limited resources on AIDS is going to be part of the political spectrum. However I think our task force is going to do everything it can to avoid entering into the partisan arena because I don't think issues like prevention and education. I don't think some of the steps that the state can do to to reduce the cost of health care for AIDS by looking towards our alternatives to hospital care have to get into a Democrat versus Republican or conservative

versus liberal so I think we're going to do everything we can to avoid that sort of characterization. Representative Rosenberg How much would you like to see the states spent on AIDS education health care. Well I don't have a figure right now I know that the state of Iowa has been described as. Take a piece of swiss cheese and that there are some resources that are available in some areas in the state and other areas it's just a vacuum of resources so I think one of the things responsiblities or task force can do is identify where those needs are. But I think the state's going to have to commit itself. Let's get back to a question Judy asked her and that is what should i will be doing that it's not doing. Specifically why don't we put in the mandatory testing requirements and I will let's assume this is a problem and the prevention is the way to deal with it. So how do we get tough in Iowa about it. What about mandatory testing. Well I support routine patient testing and I think I think that's definitely a responsible way to go at it. One of the things we have in this one of these our task force is going to

look at as well. But we have to look at our resources and we have to look at mandatory testing requires a commitment of resources and who are you going to mandatory test what are going to do with the test results and those are the kinds of questions you have to ask. There's been a recent article in journal American Medical Association that says if you test all premarital applicants which is a that's a proposal that's been around many states but your chest all those you only identify one half of one percent of all the AIDS victims because the large pool of Merril applicants just heart wants. What about mandatory testing of people convicted of sexual crimes something of prostitution for example. Again look at the research the probabilities would be much higher of finding AIDS carriers if you required mandatory testing of prostitutes and what you going to do with the results and we have what will you your the but here the not yet you know what do you do it step but what do you brand someone. No I think what you have to do what it would mean to a brand someone what he would do with the result.

I think what you do is when you identified people not only through the mandatory testing but when you identify people as having a serial positive the HIV virus has shown up in their blood test you have to do something. And I agree I think we have to look at changing their behavior. That could be their I.V. use that could be their sexual behavior. The types of sexual behavior we have to convince people to go to safer sex. It's my understanding that in the one state in our country there is legal prostitution for the last several years. There is mandatory condom use and there's mandatory testing I believe all the prostitutes in that state you know race a political question I mean getting into these areas is very sensitive politically and if the mandatory testing of prostitutes you talk about dirty needles you know the solution there is to provide free needles to people. Mandatory condom use. Do you think these things are in the realm of possibility for the legislature to to to do. In Iowa it's difficult in other states it's already happened. They are now providing free needles in several states. They are now providing free

condoms in other states and are in the should we do that now. I think we should look at it. We're going to I think we have to ask our Department of Corrections to come before a committee. I believe earlier they said they were not going to do I think they asked them to re-evaluate that as well represented Rosen where you said we should counsel people to change your behavior. What about people that don't want to change their behavior there have been cases of individuals intentionally wanting to infect others with age. How do we handle those those types of people that are sort of malicious a lot that's right other states have looked at the same sions which most people would view as some sort of criminal sanctions. That is the general way that our government responds to certain types of anti-social behavior and that's one way. That is one thing I let our task force has to look at his home and what get real. I want to ask what about the private sector I mean we constantly look at government. You're a volunteer. A citizens group. What can ordinary citizens do while they're waiting around for the politicians to do something.

Well first of all they can inform themselves they can inform their families about the facts of AIDS and you can't talk about is without talking about sex. I'm a parent of teenagers and we have to get real. It's like teaching them to drive safely we have to teach them the facts of AIDS and its transmission and we have to realize that our values will be transferred to them through our family activities and give them the information that they need to protect themselves and then we have to go and protect others. I want to form an abberation Maybe it's wrong but sort of get the impression that various groups are out here flailing away and I know that you have you're a central Iowa AIDS Coalition leader. So there's a correlation there. But somebody has to lead. We're doing research. We haven't got the leadership yet. Then I was going to ask is that something that we need to do not all areas of the state have a coalition our coalition is very poorly funded we have far more to do than we have resources to do. Goals come in daily for programs to be presented for resources to be shared with schools with providers and

they want the education and we don't have it to give them should leave the state. Why shouldn't the federal government lead if this is a national problem. You know that it doesn't stop at the border. Why shouldn't the federal government. Well they have taken a position of leadership and that money is flowing through the states through the Center of Disease Control and we've been the recipients of some of that money for our testing programs. And in fact our coalition is operating on a very small sum of money that trickle down to us it's four thousand five hundred dollars for a year for all of our activities was. Basically it just simply isn't enough we need to have a staff person with that we pay for our hotline we pay for our resources we pay for training we've developed a volunteer program for a buddy system to help with AIDS patients and families who need that kind of support. But we need to get real about this as a major health issue and we need to put the resources to it that it deserves. I thought to question earlier how much resources as much as we can afford.

You know that's a difficult question what every time you have a budget you have to compromise and anything that we can divert into state monies that should be done for education reporter that was right and I agree I mean you look to the federal government to meet certain resources I think we're going to look to federal gun for a lot of the research dollars but a lot of these issues like they were raised and been raised tonight are going to be dealt with by state government. The issues of testing that is a state and state issue discrimination laws are to what extent should we implement anti-discrimination laws. To what extent should people who test positive are actually been diagnosed I mean it's perceived protection Republic education or schools is negotiated what timebomb out there though on this. Maybe this is what you're going to ask today. I can see children for example in fact with maybe having to set up separate schools for children as we do for some handicapped not necessary once you know the facts and the way the virus is transmitted is not necessary to segregate people they can be productive citizens.

You know the AIDS test does not tell you that they have the disease it only tells you that they have the virus and that their body has developed antibodies to it is not a diagnosis when you say when you say represent Rhodri when you say anti discrimination laws we are talking about. Other states have considered and I believe we will at least debate in our task force issues of discrimination against people who've been diagnosed as having the virus or not have been tested as having a virus or die saving age discrimination could be in the areas of employment housing credit insurance insurance and were not well look at those. What about the implications of this you mention insurance people in the insurance industry say there's there are some real horror stories actuarially of people that have sold life insurance to die early. Let's go through some of the what do you consider the most important implications of this disease. Here in Iowa. I think the most important implication of this diseases for peace is for us to have two things compassionate treatment towards people that are positive or have AIDS. And the second thing is to protect the uninfected individual to avoid any

transmission of it. I think those are the two most important things which includes working with the media to getting out the education in a sense part of the goal of our task force is the actual education the actual dissemination information that our task force can of what can provide. But I think the two most important things is getting that out and I think for both the infected individual compassionate treatment and avoid transmission to the uninfected and that's really what education that means education in classrooms in the boardrooms and church rooms and family rooms that is Hilman. We've seen what's happened in Florida where three school boys that didn't have AIDS but had the AIDS virus were allowed to go to school their homes were burned. Is it too late for people to be talking about not discriminating against AIDS on people already even though it's not medically necessary isn't it politically necessary. We have time I think people in Iowa are very highly educated and pride themselves on their compassion toward each other and working together in a community. And I think it is possible to do that

now so that we don't reach the point where community size is a family because of three children who are afflicted with an illness. I'm told that a number of the AIDS patients in Iowa are people who have literally come home to die. Is that correct. That is correct what sort of obligation to the rest of us have to pay for these people who are who decided to come back to Iowa after having contracted AIDS elsewhere and at a cost of thousands of dollars to take care of them until they die. Well I think again as I mentioned I think you have to examine the compassionate treatment of people with a couple other things one of these are task forces going to look at is that very question of cost who is paying for the health care of aides. Victims people with the AIDS disease instead of out is that Medicare is a private insurance. Is it a philanthropist. We're going to look at that then we also look at ways to avoid the cost looking at things like hospice rather than health care. The other thing is that people with other diseases come back to Iowa

because one thing that our state is known for is its compassion. And I think people from other with other diseases come back to Iowa if you may to die. Well but the state treasury is not a bottomless pit. And this disease unlike most others that we deal with we don't have a cure yet and there are very very spooky scenarios out there that we've all seen heard from where this thing can head I mean some people say it will shift the geo political balance of the world to Eastern nations where this isn't a problem I mean at what point does Iowa's compassion have a limit represent room. OK well we can talk about dollars and cents. AIDS is is an expensive disease. However it's also comparable to other expenses disease that our state already addresses. I guess that's maybe my best response for example. Its cost is comparable to treating people with myocardial infections stomach cancers. Those are also horrible diseases horrible problems but we have already devoted the resources through private insurance through Medicare through philanthropy through some state dollars to deal with people with those

diseases in our state. So in a sense that's not totally answering your question but we already do this with a disease that's a magnitude though that is predicted or we haven't really talked about what what you anticipate for Iowa four fold increase here in the next X number of years. Do you have that sort of a projection as to both what the cases might be and what our cost might be. I think that's one of the things our task force has to look at. Some people have predicted that will be a four fold increase within the next 10 years. But I think one of the things you can do is I'm going to hit at it again it's is prevention and education. You know people need to understand you don't get AIDS from door knobs nor do you get AIDS from talking about it but you can prevent the spread of AIDS by talking about it. Representative Rosenberg is there one state that you've selected sort of as a model for I when it's really done a good job that we could look to for ideas and guidance on how to respond either of you.

I think every state every little bit if you can look at some of the successful public health efforts for example in San Francisco where there's been a dramatic reduction in the number of new HIV positive cases in San Francisco and the other hand we have to look beyond that because our state just doesn't have the level of of homosexuals that San Francisco does our populations a little different. So I think we also have to look at some of the more rural states and see what they have done to me Tell me what specifically what should the legislature do we don't want to talk about the private sector but what I want is some of the single most effective things two or three things that you think of at the next session the legislature should do to deal with this problem which I gather is a prevention one as in and as well as care but I'm trying to get it to just a couple of points I think OK well first I would say appropriate some money for education and have it be an environmental approach local. Kinds of programming for education in schools and businesses and providers of care and everyone to be educated. Secondly I would think they need to investigate the waivers for the partnerships to come into play that

will help pay for the disease. Home care is better than hospital care is also cheaper. A substitution of state funds in under Medicaid to pay for some of those things and would eliminate some of the larger costs of the disease. And I also think that they need to look at the mandatory testing and to resolve that. My feeling is that it is not appropriate to enforce mandatory testing that our researchers are better spent elsewhere and that that again we need to work together with whoever is involved at this point to develop those partnerships. Our risk pool for instance in the insurance and in the state to provide insurance coverage and to share the cost of that. Will the legislature do this. We're going to look at it I think there's several good ideas I'm not sure I agree with everything. Well there's about I think she has some several good ideas particularly at risk insurance but we have to look at providing resources. Representative Rosenberg is Hilda thank you very much for being our guest tonight in my one class and

discussing this most important subject one that we're going to be hearing a lot more about. We invite you to join us again next week and I will press at that time. We're going to discuss among other things what he thought presidential candidates debates have on Iowa voters were panelists tonight they've been why are ID in Bourg. Thanks for joining us. Morgan helden has take one next. Good night. Major funding for Iowa press was provided by friends of

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