Activists Call for City Council to Declare an AIDS-related "State of Emergency"
Can political wordsmithing help Baltimore win the fight against HIV/AIDS? Activists and public-health workers hope so, which is why they are pressing the Baltimore City Council to pass a resolution declaring that the AIDS crisis in Baltimore City has become a "Public Health State of Emergency." If the resolution is passed, it will call for more money from the state and federal governments to fund city AIDS-prevention programs. The City Council held a hearing on the bill--titled Council Bill 02-0281--Oct. 9, and it is expected to go before the council for a vote later this month.
Those in favor of the resolution say the city is in the throes of one of the worst public-health predicaments ever. According to the most recent statistics from the Atlanta-based Centers for Disease Control and Prevention, Baltimore's AIDS incidence rate is the third highest of any major metropolitan area in the country. For every 100,000 people in the city, 50 have tested positive for HIV or AIDS. In comparison, Baltimore ranked higher in AIDS incidences than the Washington metropolitan area (32.8 per 100,000 people) but lower than the New York area (65.9 per 100,000) and Miami area (53.8 per 100,000). As of Dec. 31, 2000, more than 12,000 people in Baltimore City were known to be living with the disease, according to the City Council Commission on HIV and AIDS Prevention and Treatment, an independent body of activists, scholars, and public health workers convened by the council. The number of new cases increased at an average rate of 5 percent per year between 1995 to 2000. And the disease disproportionately affects African-Americans: Although blacks comprise slightly more than 60 percent of the city's population, they represent nearly 90 percent of the city's AIDS cases.
Though the death rate from AIDS complications is down, "there are three to five new infections a day in Baltimore City," says Dr. Donald Burke, a professor at the Johns Hopkins Bloomberg School of Public Health. Burke says treatment dollars are desperately needed, and much of the funding that comes to the city to fight the AIDS epidemic is used to keep afflicted patients alive. However, he laments, the fact that so much money must be spent on treatment means there's simply not enough to go around to prevent the spread of the disease.
"There hasn't been a comparable amount of money for prevention, and this isn't an either/or proposition," Burke says.
Baltimore City Health Commissioner Dr. Peter Beilenson says the city spends about $100 million on HIV/AIDS treatment and prevention (a figure which includes roughly $75 million spent on drug treatment), but he notes that the municipality "could always use more."
Supporters of the "state of emergency" resolution believe that, if passed, it could prompt state and federal agencies to pump more money into community organizations that spread the word about HIV/AIDS prevention. J. Lawrence Miller, executive director of the Baltimore-based Black Educational AIDS Project, says organizations like his that provide "quality prevention services" will not be able to survive if new money is not found immediately.
Two weeks ago at a hearing before the city council, Miller testified, "[Prevention and treatment] program dollars are not enough to continue to run an agency. They do not totally cover the rent or lights. They do not cover enough of the benefits. Most staff at these agencies make barely more then minimum wage."
Programs designed to keep people from becoming infected with HIV in the first place, known as "primary prevention," are really what's needed, says Darryl Kofi Kennon, director of the Park Heights-based African-American Health Alert.
Until fiscal year 2003, which began Oct. 1, the CDC gave the African-American Health Alert no money for primary-prevention programming, according to Paula Blackwell, a coordinator for the Park Heights Recovery Campaign. All of the money went toward "secondary prevention" programs, she says, which are designed to target those already infected with HIV. The programs educate those who carry the virus so that they do not infect others.
Blackwell, Kennon, and Miller say the lack of adequate funds for primary-prevention programs is painfully evident in the attitudes of many Baltimoreans--even those who live in areas where AIDS is concentrated.
"Park Heights is one of the areas hardest hit by the disease," Kennon says. "Part of the problem is that people think if they're not intravenous drug users or gay, then they're not at risk. Folks don't realize that the heterosexual population is also at risk."
Park Heights is in the city's fourth council district. More than 2 percent of that West/Northwest Baltimore district's population--2,987 people--are infected with HIV, according to a report released in April by the City Council Commission on HIV/AIDS. The commission's report revealed that District 2, in central and East Baltimore, has the largest infection rate in the city: Nearly 3 percent of the population--roughly 3,000 of 112,000 people--is infected with AIDS.
"If these statistics don't indicate an emergency status, then I don't know what [an emergency] is," Kennon says.
The "state of emergency" declaration now before the City Council was written about earlier this summer after a war of words between city officials and HIV/AIDS activists. Kennon, Miller, and other activists fought to get the city to declare a state of emergency in hopes that they might obtain more money to keep their programs alive. The Baltimore City Health Department, however, was not eager to embrace the language in the resolution.
Beilenson told a City Paper reporter this summer that declaring a state of emergency was simply "semantics" and "symbolic." Beilenson explained that chronic problems like HIV/AIDS, which has affected the city for more than two decades, should be treated with long-term initiatives. Beilenson said that "acute" public-health crises, such as West Nile virus, are the ones that require drastic and immediate action.
"You don't go to the emergency room for a chronic problem," Beilenson said. "An emergency is just that--emergent."
HIV/AIDS activists, including Miller, were astounded by Beilenson's message. "Simply because the disease has been with us for more than 20 years doesn't make it less than an emergency," Miller says. "Every day people continue to get infected with HIV. Over the previous years, more people have died of AIDS complications than were murdered in Baltimore City. So if it's just 'semantics,' then let's declare a state of emergency. But this is an important matter of semantics."
Beilenson has since changed his stance on the city's AIDS crisis. Following various meetings with activists over the summer, he acknowledged that passing the bill activists want will at the very least generate awareness of the city's AIDS problems. He now says that HIV/AIDS in Baltimore City has "fallen off the radar," which he attributes to three things: lack of media coverage, new treatments that help HIV/AIDS patients live longer, and the changing demographics of those afflicted by the disease (these days, it is mainly people of color and people from lower-income groups who are most at risk for contracting the AIDS virus).
However, Beilenson warns that the resolution won't guarantee increased funding from the state or federal government. "I think this is more symbolic," he says. "It doesn't bring more effort to bear on the problem."
Dr. Liza Solomon, director of the Maryland AIDS Administration, says Beilenson is right: "There's no special funds that are automatically released if a state of emergency is declared," she says.
However, activists and supporters of the resolution point out that cities such as Houston and Alameda County, Calif. (which includes Oakland), have both declared states of emergency to deal with growing numbers of AIDS cases. And both cities received increased funding as a result. Activists hope the same will happen in Baltimore.
"I don't think it's ever easy to get money, but it'll be a step in the right direction," says Councilwoman Pamela Carter (D-2nd District).
Right now the bill sits in the City Council's Housing, Health, and Human Services Committee, chaired by Councilman Edward Reisinger (D-6th). Supporters of the bill, including City Council President Sheila Dixon and Reisinger are confident it will pass. This week, the committee will meet to plan how to obtain the mayor's support for the resolution. Once that is accomplished, they say, the next hurdle is to fight for more money to help Baltimore shake the disease.
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