Local policy responses to the AIDS epidemic: New York and San Francisco

Abstract

The epidemic of acquired immunodeficiency syndrome (AIDS) has been concentrated in a few large cities. Thus far, New York City and San Francisco have reported more AIDS cases than any other cities in the world. Together they account for 40% of the total number of cases reported in the United States through the end of 1986. Both cities have expended an enormous amount of local resources in dealing with the epidemic, although the public policy response has been markedly different in each city. Although historically New York has had three times the AIDS caseload as San Francisco, it has consistently spent less money on public health education and other nonhospital-related health care services. The varied policy responses in each city can be attributed to several factors: differences in the magnitude of the epidemic; the patient mix; the role of risk groups in the political and economic life of each community; the scale of public health care systems, including the number of medical schools; the impact of local media; and the institutional roles of the respective health departments. With the prospect of other cities facing an increasing number of AIDS cases, the New York and San Francisco experiences may prove useful. They indicate that each community's response to AIDS will probably reflect the underlying social, economic, and political characteristics of AIDS victims and the existing structure and organizational roles of traditional health care and community-based service providers.