Now the case manager at Baltimore's Health Education Resource Organization (HERO) finds herself telling people that she no longer can assist them.
"No more appointments?" asks one homeless man visiting her office.
"Not for now," Ms. Feldman says. She gives him a hug and arms him with a letter to help ease his way through the bureaucracy of city agencies.
Until last month, HERO, a nonprofit agency, offered referrals and support of many kinds -- financial,emotional, administrative -- to anyone who tested positive for the human immunodeficiency virus (HIV) that causes AIDS. But on June 1, overwhelmed by a crushing workload and squeezed by a tight budget, the organization stopped accepting new clients.
The decision is a reflection of the ever-increasing numbers of infected people. About 3,000 residents of Baltimore have been diagnosed with AIDS; as have another 3,000 Marylanders living in other parts of the state. Public health officials say those numbers will grow dramatically: an estimated 30,000 Marylanders are HIV-positive. HERO's eight caseworkers are swamped by nearly 2,000 clients -- nearly 150 active cases for each of the six who handle clients full time. Even so, the decision to stop accepting newcomers was painful and long overdue, says Peggy Waggoner, coordinator of case management services.
HERO faced a cruel choice: Having ever-lessening amounts of time and resources to offer an ever-increasing number of people, or closing the door to new clients to be able to offer meaningful help to those already on its rolls. Even now, rather than refuse new clients altogether, caseworkers perform quick-hit help and referrals two days a week for people who are not on their caseloads. "Everyone here knew that they were seriously overloaded. We were reluctant. But there is a point at which it becomes unethical: You are no longer helping even the ones you can get to," says Ms. Waggoner, who, after four months on the job, is setting up a stress-management workshop for employees.
The organization's decision comes as no surprise to leaders of other agencies, who are familiar with the crunch that comes with increasing workload and decreasing dollars.
"It's a pretty brave decision on their part -- it is the only way they could continue to do good work without going into overload," says Richard Dunning, director of the bureau of disease control in the city's department of health.
HERO is by no means the only area agency trying to meet the specialized needs of people with AIDS. Others include local departments of social services, the Johns Hopkins Hospital Moore Clinic and Francis Scott Key Hospital. But HERO, which receives federal, state, city and private funding, is the only agency that, until now, placed no restrictions on whom it helped.
To qualify for help at some agencies, for example, a person must have full-blown AIDS and be receiving certain types of financial assistance, or be HIV-positive and receiving medical care through a particular clinic, or have no other needs beyond those that are medical.
Many of HERO's clients face the toughest of problems: homelessness, substance abuse and poverty. For example, 15 percent of Baltimore's estimated 20,000 homeless people are HIV positive, says Jeff Singer, director of community relations for Healthcare for the Homeless.
"For the majority of people with HIV, [the virus] is the least of their problems. Getting medicine is wonderful, but when you are living on the streets it's practically meaningless," says Susan Rucker, manager of the diagnostic evaluation unit at the Moore Clinic.
Karen Feldman's goal is to help people field the maze of paperwork,clinics, appointments, insurance forms, crises that come hand in hand with HIV. The job description could easily read: shepherd, paper-pusher, counselor, mother, referral agent and advocate.
On a typical work day, as many as 25 people stream through her Read street office. One is a homeless man with HIV, who is still using heroin. He has been on the public housing waiting list for months, he says, and wonders when he'll have a place to stay. From a battered wallet, he pulls a crumpled identification card to prove his story.
Ms. Feldman places calls to the mayor's office and to the public housing department on his behalf. She also lectures him: If he's using, he is to clean the needles. She urges him to stop by the drop-in center run by HERO in North Baltimore where substance abuse counseling is offered. By day's end, Ms. Feldman has found him a bed at a shelter, although the long-term housing problem is still unresolved; she tells him to come back.
A 47-year-old woman arrives next. She has mood swings, perhaps a physiological result of her disease. Recently she threw her kids out of the house. Today she has been notified that her food stamps are being cut off next month.
Ms. Feldman places three phone calls and gets transferred seven times before reaching the appropriate person at the city Department of Social Services. The food stamp problem, the result of confusion on both sides, is resolved. "I knew you could do it. I've been calling for three days and look, you fixed it. I knew you could do it," says the woman.
Ms. Feldman greets some clients with an easy banter that comes from long acquaintance. Others pop into HERO once only -- for referrals. Still others come faithfully for weeks then drop out of sight for months. And many die.
To put this continual grind of emotions and needs in perspective, says Ms. Feldman, "I tell myself that before I came here, people were getting sick. After I leave here, people will get sick. In the meantime, I might be the one to make the difference to one person on that one day. It's the only way to think of it."