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Slowly, in many cases too slowly, state and local health officials around the country are taking a cue from the volunteer organizations and mounting their own efforts to deal with the epidemic. During the past two years New York State, where more than a third of the U.S. cases have been reported, has funneled $13 million into research, education and service programs. California has taken the lead in protecting the rights of patients with laws forbidding the misuse of blood tests for the purpose of discrimination.
Local governments are also beginning to put resources directly into the care of AIDS patients, many of whom no longer have medical insurance. In New York City, a day-care program, staffed with doctors, nurses and social workers, is being set up for infants and children with AIDS. Because many AIDS patients are evicted from their homes and have no place to go, the city is providing funds for shelters.
Although the Federal Government has put $200 million into AIDS research in the past four years, it has been criticized in many quarters for moving much too slowly. "When President Reagan called Rock Hudson in Paris, it was the first contact he has made with AIDS," says Larry Kramer, a novelist and playwright whose latest dramatic work, The Normal Heart, depicts the politics of AIDS. Sloan-Kettering's Krim charges that Washington has treated AIDS like a "ghetto disease. They didn't think the public would be too concerned or caring."
Responding to the criticism, Secretary Heckler last month announced a request for a 47% increase in research funds. She insists that "the important research into education, treatment and vaccines is being funded," but Congressman Henry Waxman of California disagrees. "The new request for more money is helpful, but very inadequate," he says. "The Administration should be putting together a Manhattan Project to push research as fast as possible."
Experts think that the Federal Government will inevitably have to take a more active role. As the AIDS toll mounts, the sheer cost of caring for patients, ranging from $50,000 to $150,000 each, will overwhelm local resources. By this time next year there will be twice as many cases of AIDS as there are now, says Lange of New York City's St. Luke's-Roosevelt, and "I can already see the whole hospital system coming apart at the edges." Some doctors believe that special medical centers similar to cancer centers may have to be established to care for AIDS and ARC patients. Public health experts are calling for wide-reaching educational programs to teach Americans about the disease and how to avoid exposure.
Meanwhile, clinical and molecular researchers are launching a biological attack on the virus. Their objective: the development of vaccines to prevent its spread and drugs to treat those already infected. But the AIDS virus is a formidable adversary. Because it can reproduce so rapidly, says Harvard's Haseltine, it can mutate frequently, changing its outer coat (the essential ingredient in making a vaccine) 100 to 1,000 times as fast as quick-changing flu viruses. As a result, he says, "trying to develop a vaccine for AIDS is like trying to hit a rapidly moving target." Scientists are now searching for segments of the coat that seem to resist change, hoping to use them to create a vaccine that would remain effective against more than one strain of AIDS. But even the most optimistic experts think that an effective vaccine is still five years off.
Progress in the treatment of AIDS has also been frustratingly slow. "We are no more effective today in prolonging survival than we were four years ago," says San Francisco's Volberding. Some potent antiviral substances are being tested, and several seem to stop or slow the reproduction of the AIDS virus at least temporarily. But they produce debilitating side effects, like kidney damage, which make them unsuitable for prolonged treatment. Among these drugs are HPA-23, a compound developed at the Pasteur Institute in Paris, where Rock Hudson sought treatment; Suramin, originally used to treat such parasitic disorders as African sleeping sickness; and Foscarnet, a drug being tested in Sweden and Canada.
For AIDS victims, the still unproven antiviral drugs represent the only chance, a reminder that the battle for their lives is not yet over. "So many people accept the diagnosis as a death sentence," says one 33-year-old patient. "They just don't want to fight anymore." The chance of being admitted to an experimental drug program, he says, "gives me a little extra hope. Hope is something I don't want to lose." —Reported by Patricia Delaney / Washington, Joyce Leviton/Atlanta and Melissa Ludtke/Los Angeles
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