Reporting of AIDS questioned

State officials believe Baltimore's Health Department has failed to track accurately the AIDS epidemic.

Unless the number of AIDS cases is recorded, the city and the state stand to lose federal money for treatment and care programs, Maryland AIDS Administration officials said yesterday.


"You never really know what is happening with the epidemic until after it happens and you track it, but we think they are a little low in the numbers they are reporting to us," said Dr. Joseph $H Horman, acting director of the state AIDS Administration.

For the past few months the state agency, which has overall responsibility for AIDS case reporting in Maryland, has been conducting an evaluation of the city's surveillance methods. The evaluation won't be completed for several months.


It is the responsibility of state and local health departments to make sure AIDS cases are being counted, Dr. Horman said.

City officials confirm that during the first part of the year, the recorded number of new AIDS cases was low. The reporting foul-up was caused in part by job vacancies in the AIDS surveillance division that went unfilled for up to eight months.

"We admit our numbers were down for that first quarter," said Dr. Peter Beilenson, city health commissioner. "But we are comfortable that we are moving in the right direction."

City officials also say that doctors and other health care workers are not consistently alerting the Health Department to new AIDS diagnoses. State law requires health professionals to notify the local health department if a patient has AIDS or symptoms considered indicative of AIDS.

Nearly 4,000 Marylanders have AIDS. In the last two years, 2,060 new cases of AIDS have been diagnosed statewide, but state officials said that number may be low. AIDS cases diagnosed in Baltimore have historically accounted for about 50 percent of new AIDS cases statewide.

Although the last job position was filled Thursday, state officials and leaders of the AIDS community are concerned that the city will not be able to catch up on its recordkeeping in time to meet a federal reporting deadline next month.

State officials began to suspect that the city's figures were inaccurate when, in the period from Jan. 1 to March 31, the city recorded only 14 new AIDS diagnoses, Dr. Horman said. It is difficult to estimate what the true number should have been; however, state officials expected about double that number.

March 31 was one of two deadlines for metropolitan areas and states to report new AIDS diagnoses to the Centers for Disease Control in Atlanta for federal money used for AIDS treatment and care.


How much the lag in reporting will cost Maryland is difficult to estimate. The formulas used to decide each region's share include factors other than new cases, said Bob Soliz of the HIV division of the U.S. Department of Health and Resource.

Since three of the largest AIDS treatment centers in the state -- the Moore Clinic at the Johns Hopkins University, the Chase-Brexton Clinic and the AIDS program at the University of Maryland Medical Center -- are in Baltimore, failure to record AIDS diagnoses could have wide-reaching effects.

Any reduction in grant money would hurt the AIDS community, said Garey Lambert, head of AIDS Action Baltimore, a community organization that is partially funded by federal grants.

"Virtually every AIDS program is dependent on government support in one way or another -- everything from primary care to social services. And the formulas for funding those grants are based on numbers of AIDS cases," he said.

The next deadline for reporting new AIDS cases to the federal government is Sept. 30.

As that deadline approaches, city and state surveillance workers as well as personnel in AIDS clinics citywide are scrutinizing new patient work-ups for AIDS symptoms and re-examining mountains of old patient records for diagnoses that went overlooked.


"There has been an extraordinary effort on the part of some people to find new cases. We've gone through the records in the Moore Clinic and through all the back cases to see if there were any we missed," said Dr. John Bartlett, chief of the infectious disease division at Johns Hopkins Medical Institutions.

Dr. Bartlett has ordered Hopkins' staff to send duplicate copies of all reports of new AIDS diagnoses to the city and to the state.

"What this is about is getting Baltimore's fair share of federal money," Dr. Bartlett said.