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L.A. County Record Worst in HIV Detection Program : AIDS: Results are the lowest among seven urban areas given federal aid. Health officials challenge comparisons.


A Los Angeles County counseling and testing program for the AIDS virus requires more money per test and turns up a lower percentage of cases of HIV infection than other such programs in the country funded by the federal Centers for Disease Control.

Figures obtained by The Times from the CDC, which pays for most of the county's HIV counseling and testing program, show the county had the worst record of identifying HIV cases among the seven major urban centers receiving special CDC funding grants during 1992, the last full year for which results are available.

For example, New York City, which established the highest rate for finding cases of HIV infection, conducted 46,564 HIV tests during 1992, compared to 25,779 for Los Angeles County. New York identified 2,971 HIV positives, in contrast to 345 for the county--a "hit" rate of 6.4% versus 1.3%. New York achieved its results on a grant of $4.9 million; Los Angeles County received $4.5 million, according to the CDC.

Even Houston, which received about one-third as much money as Los Angeles County did in the same year, performed 25% more tests and identified three times as many cases of infection, according to the CDC figures.

Locally, where non-county health agencies receive a flat $35 from the state to do HIV tests, there are also sharp differences.

Full-year statistics are not available for 1993, but a partial-year analysis prepared for the county's HIV Health Services and Planning Council showed that the city of Long Beach, which has its own public health department, was discovering infections at a rate significantly higher than the county's--2.07% compared to 1.3%--at a much lower cost: $414,000 over a nine-month period for Long Beach compared to $2.2 million over an eight-month period for the county. Even though Long Beach spent substantially less and serves a much smaller geographic area than the county program, it conducted more tests--8,646 compared to 8,619.

The nonprofit Los Angeles Gay & Lesbian Community Services Center conducts about 1,000 tests a month and reports HIV-positive results about 9% of the time.

Los Angeles County health officials complain that such comparisons are simplistic and do not take into consideration the population the county deals with or the far-flung regions it must serve in the 4,000-square-mile region. They say the costs of their testing and counseling program are pushed up by the need to serve a wide-ranging clientele who are at high risk for infection but who often balk at taking the test when approached at county health centers.

But critics say that broad target population is part of the problem. The county, they contend, should concentrate primarily on those at high risk for HIV infection.

The county "isn't getting results," complained Michael Weinstein, president of the AIDS Healthcare Foundation and the spearhead of criticism of the county's testing program for the human immunodeficiency virus. "That's a tragedy because half the people in this county who are HIV-infected don't know it. To break the chain of infection, you need to find the infected person, get them into treatment, and educate them about safer sexual practices."

Recently, Weinstein and other members of the fiscal committee of the HIV planning council voted to recommend that the county be asked to take $1 million of its testing money and use it to give anonymous tests, which are considered less expensive and more likely to turn up positive results than the confidential tests the county currently gives.

Under confidential testing, the identity of the person receiving the test is known and the test results become a permanent part of his or her health record. County health authorities vow that they keep the results a strictly private matter between them and the patient.

Anonymous tests are considered far more attractive to people who believe they may be infected because they do not carry a risk of harmful repercussions, such as the loss of a job or health insurance. It is generally acknowledged that anonymous tests consistently turn up higher rates of positives than confidential tests.

Another recommendation by the planning council committee was that the county spend $35 per test, the same rate that other agencies receive from the state Department of Health Services for giving the HIV test, along with pre- and post-test counseling. The study undertaken for the HIV planning council disclosed that during the first eight months of 1993, the cost per HIV test at county health centers ranged from $77 to $300, depending on how many tests were performed by each clinic and how many hours were being spent by the staff doing counseling.

"If they can't do it for $35, then they should give the money to someone who can," said Steve Toth, an administrator with a private AIDS program in Long Beach and a member of the fiscal committee who voted for the change with Weinstein.

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