NEW YORK, OCT. 12 -- Overwhelmed by a surge of desperate patients with nowhere else to turn, the nation's oldest and largest AIDS service organization has decided for the first time to limit access to new clients.
Public-health officials nationwide said they regard the action, taken by the Gay Men's Health Crisis (GMHC) here, as an ominous sign of economic hard times that will become even tougher for the rising number of AIDS patients. Facing similar pressures, officials at clinics in the District, Boston, Los Angeles and other cities said they also may limit services.
"I would like to say this is only one group or one city," said Dan Bross, executive director of the District's AIDS Action Council. "But the only thing unique about GMHC is that they are the strongest, richest and most powerful of all AIDS organizations. At least they have services to limit."
Since it was founded in 1981 to care for about 100 gay men dying of a disease that few people understood and fewer cared about, Gay Men's Health Crisis has grown steadily each year into an agency with an annual budget of $15 million, 3,000 regular clients and thousands more who use its AIDS hotline and other services.
More than 83 percent of the organization's funds come from private donations and the rest from state and city sources. But the recession and the fear of worse times to come has taken a big cut out of charitable donations, forcing GMHC to handle increasing numbers of sick people with less money than ever.
"Believe me, this is not a choice we wanted to make," said Joy Tomchin, president of the GMHC board. "We don't want to see our quality damaged by handling more than we are capable of, and we certainly don't want to turn people away."
It is a dilemma that more and more health care providers will face as the growth of federal funds slows and they are forced to rely more heavily on voluntary contributions. Beginning Dec. 1, GMHC plans to accept only the first 100 new patients each month, about one-third of demand. In the District, where the Whitman Walker Clinic receives at least half of its funding from public sources, the issue has become highly sensitive.
"We are struggling with this same issue right now," said Jim Graham, administrator of the clinic, which serves as many as 2,000 people infected with human immunodeficiency virus (HIV) each month and has a budget of about $6 million. "How do you maintain quality in a recession with a rapidly rising caseload? It sounds trite, but we are all going to have to do much more with much less."
People infected with the AIDS virus often do not become sick for years, and many of those infected in the beginning of the 1980s are expected to need treatment for the first time in the next three years. Health experts say New York City will be hit particularly hard.
As the nature of the epidemic has changed, with more poor, minority and uninsured patients, GMHC has become almost a shadow version of a city Health Department staggered by the expense of more than 29,000 city residents diagnosed with AIDS.
As many as 10 times that number are infected with the AIDS virus but do not yet need medical care, and health officials estimate that, by the end of 1993, there will be 64,000 diagnosed cases in the city.
"This is very bad news for all of us," said Carmine Rivera, director of the Mayor's Office of Health Policy. "This and the federal government's refusal to fully fund their programs for AIDS will force us to make some extremely disturbing choices about how to treat this disease."
Earlier this year, Congress authorized more than $875 million for a package of AIDS treatment, counseling and education services such as those that GMHC offers. But after unanimous agreement that such spending, expensive as it is, would save money in the long run by preventing many new cases of HIV infection, which causes AIDS, the Senate this week cut the figure to $49 million.
"The federal budget-makers are acting as if the epidemic is over," said Henry A. Waxman (D-Calif.), chairman of the House subcommittee on health and the environment. "Someone will have to pay for the cost of treating tens of thousands of poor Americans with AIDS . . . the epidemic is just too big for voluntary groups to manage it all."