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Latest estimates aside, AIDS clinics overflow


Fifty-four patients and two doctors.

The ultimate in packed waiting rooms is what greeted anyone who wandered into the Chase-Brexton Clinic on Wednesday evening -- only hours after state health officials estimated that the number of Marylanders infected with the AIDS virus was one-quarter to one-half as large as expected.

It was just a typical night, according to Carol Hilton, the clinic's acting director.

"We're not taking any new patients -- we just can't," Ms. Hilton said yesterday.

The free clinic, located in the Medical Arts Building on Read Street, treats people who are infected with the human immunodeficiency virus. And these days, the clinic is following more than 700 patients -- triple the number of 19 months ago.

In hospitals and health clinics that see the epidemic up close, it was difficult to hear a single sigh of relief amid the new projections by the state health department that 16,000 to 28,000 state residents carry HIV.

Those numbers pale in comparison with the department's earlier projection that 60,000 people were infected. And while many professionals said their crowded waiting rooms gave them a gut feeling that the new estimates were too low, they conceded that they lacked a scientific basis to insist the figures were wrong. But even if the figures are accurate, many said, Maryland still faces a critical shortage of services for AIDS patients -- and with an epidemic that only promises to get larger.

Dr. Jonathan Cohn, chief of AIDS services at University Hospital, said a conservative estimate of 20,000 HIV-infected people means that at least 10,000 people will come down with full-blown AIDS in the 1990s -- triple the number of people diagnosed in the past decade.

"I don't think we're prepared for these cases. In order to be prepared for this, HIV needs to be better integrated into the health-care system as a whole," Dr. Cohn said, noting that very few private doctors outside major teaching hospitals treat patients infected with the virus.

The Moore Clinic at Johns Hopkins Hospital greets 40 to 60 new patients with HIV every month, according to Dr. Richard Chaisson, chief of the AIDS service at Hopkins. Only one thing has kept the hospital's 21-bed inpatient unit from overflowing -- recent medical advances that have allowed doctors to manage patients on an outpatient basis.

Experts following the epidemic's progression in Baltimore say they are seeing fewer new infections among gay men than they did several years ago, but more among intravenous drug users.

Johns Hopkins scientists who have monitored more than 2,000 addicts since 1988 have discovered that 5 percent contract the virus each year -- suggesting a spiraling epidemic among people who shoot drugs.

Dr. David Vlahov, who heads the study, said one-quarter of the addicts are infected. This would suggest that at least 8,000 of the 32,000 addicts who are estimated to live in Baltimore carry the virus -- and more are being infected each year.

Epidemiologists -- including those at the health department -- agree that estimating the number of people infected with HIV is only a "best guess" affair. And Dr. Vlahov cautioned against reading too much into anyone's numbers.

"It's one thing to be reassuring," he said. "It's another thing to provide a false sense of security."

Some 1,984 people in Maryland have died of AIDS since the epidemic began. In Baltimore, it is the leading cause of death among black males between the ages of 25 and 44 and the third leading cause among women in that age bracket, according to a December report by the Baltimore Health Department. Overall, AIDS is the second leading cause of death for blacks and whites in the age group.

Some observers said they feared that Gov. William Donald Schaefer would use the lower estimates to justify spending less money on programs aimed at containing the AIDS epidemic. This year, the state AIDS Administration is spending $12.4 million -- $8 million of which comes from federal grants.

Kathleen Edwards, who directs the AIDS Administration, said the estimates would be used to gauge how much money is needed to fight the epidemic. But she denied that the figures were crafted to justify a lower budget and agreed that Maryland is still fighting a growing epidemic that has no vaccine and no cure.

The governor is to release his budget today.

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