WHERE ALL THAT AIDS MONEY IS GOING Yes, there's a lot of it. But AIDS is not getting more than its fair share -- and devoted grassroots organizations are making almost every penny count.
By Peter Nulty REPORTER ASSOCIATE Jane Furth

(FORTUNE Magazine) – THE CAMPAIGN against AIDS may be simultaneously the most visible charity in search of private donations and the noisiest lobby in search of government funding. In major cities like Los Angeles and New York, money-raising galas -- auctions, dances, dinners, walks, concerts, and parties -- occur almost daily. Smaller cities and towns far from the center of the epidemic are beginning to sponsor their own events. In Washington and in some state capitals, AIDS activists have been winning double-digit annual increases to fight the disease, despite government austerity drives. Is AIDS hogging more than its fair share of resources, as a few critics suggest? And what is happening to all that money? Whether you are giving to the cause as a corporation, a committed individual, or indirectly as a taxpayer, you can feel good about your donation. AIDS is not pigging out on the resources of others. Rather, it is getting a lot of money because it is deadly, communicable, and as Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases, says, ''out of control.'' Despite a decade of research on AIDS, the medical community has no remedy for it or defense against it. Condoms and abstinence are effective as long as discipline doesn't erode. But no doctor worth the name wants a disease hanging around that can spread death with impunity the minute society lets down its guard. Just how much money does the AIDS cause get? The top three research priorities of the Public Health Service last year were cancer, with $2 billion in funding; AIDS, with $1.3 billion; and heart disease, with $770,000. Some people grumble that the figures represent a bias toward AIDS, because only 34,000 died from the disease last year, vs. 700,000 who died from heart disease and 500,000 from cancer. Looking at it another way, the amount of research money spent on each life lost to AIDS was about $38,500, vs. $3,700 for cancer and $1,000 for heart disease. ''The blunt fact is that people will die of these other diseases because of the overemphasis on AIDS,'' writes Michael Fumento in his controversial book The Myth of Heterosexual AIDS. That's blunt all right, but it's more hunch than fact. No one can possibly know which research funds will save lives because no one can predict where or when breakthroughs might come on any of these diseases. Cancer research has been going on for decades with no magic bullets in sight (something AIDS activists should keep in mind when they suggest that the AIDS budget should be a lot larger). Fauci, whose institute conducts or coordinates most AIDS research, defends his budget with a compelling argument. While AIDS takes many fewer lives than either cancer or heart disease, its victims are younger, usually adults in their 20s or 30s. To account for the different ages at which people die, statisticians use a measure called YPLL, for ''years of potential life lost.'' To arrive at YPLL, they multiply the number of deaths from a disease by the number of years victims could have expected to live had they not gotten ill. By that calculation, AIDS is at least as destructive as cancer, and worse than heart disease. The Centers for Disease Control in Atlanta (CDC) estimates that in 1993 cancer and AIDS each deprived Americans of 1.4 million years of life and heart disease, 1.2 million years. The government is surely not alone in throwing money into the battle against AIDS. Private philanthropies are major allies. Giving USA Update, a newsletter about philanthropy, estimates that charitable donations to AIDS causes in 1992 (the latest year with available figures) amounted to between $575 million and $850 million. It is difficult to calculate precise numbers because there are so many AIDS groups raising money. By contrast, most private donations to cancer and heart disease go to a single charity for each: The American Cancer Society, which received $355 million in 1992, and the American Heart Association, which took in $235 million. If you haven't already been solicited to contribute to the AIDS cause, be prepared. The movement may be unique in the annals of American health care for its grassroots origins. Campaigns against disease have traditionally been led by one or two big organizations endorsed by the government, as when President Franklin Roosevelt, a polio victim, lent support to the March of Dimes. ''But AIDS was an outcast,'' says Michael Seltzer, head of Funders Concerned About AIDS, a group that advises would-be AIDS philanthropists on where to put their money. Instead of one or two lead charities, thousands sprang up, perhaps as many as 18,000. The three largest fundraisers in 1992 were the American Foundation for AIDS Research, or AmFAR ($17.7 million), the Gay Men's Health Crisis ($16.7 million), and AIDS Project Los Angeles ($15.2 million). The charitable organizations focus mostly on services -- nursing, food, counseling, and education -- and leave research to the government; the best guess is that less than 10% of the $575 million-plus in charitable AIDS money goes to research. Still, the philanthropic groups are remarkably efficient, particularly given how quickly they were organized when the crisis struck. In New York City, God's Love We Deliver provides about 1,400 hot meals a day to the afflicted within a 30-mile radius, using 55 paid staff, 1,900 volunteers, and 11 delivery vans. Total budget: $5.5 million. Cost per meal, delivered: $5.40. Price of the blue-plate special at a local coffee shop: $10 and up, delivery not included. ''We view the AIDS groups as lean and efficient,'' concludes Len McNally, who directs philanthropic money into health care for New York Community Trust. ''Salary levels are low for charitable organizations, and the volunteers are highly motivated.''

AIDS groups have traditionally favored publicity-heavy events like celebrity receptions and concerts because government was doing so little to publicize the crisis. The trouble is that while celebrity events make a lot of news, they don't usually make much money. Veteran fundraisers say a celebrity affair that nets 50% of the total revenues is a success. So some AIDS groups are turning to events that generate both publicity and higher-than-usual returns. For example, the Gay Men's Health Crisis holds walkathons and concerts where opera stars like Luciano Pavarotti and Kathleen Battle donate their services; these can net up to 80% of revenues. By using tens of thousands of volunteers and by caring for the sick in their homes, private charities have actually helped drive down the cost of AIDS. George Washington University's intergovernmental health policy project says in a recent report that the average cost of treating patients from diagnosis of AIDS to death has fallen from $102,000 to $70,000 in the past three years. It is impossible to predict whether the cost of AIDS care will rise or fall in coming years. Although the CDC estimates that the number of cases reported annually will level off in the mid-1990s, the cost of treatment could rise as new medicines come along and patients live longer. But costs could just as easily fall as patients are increasingly treated in residential settings where the bill runs $500 a day or less, vs. $1,000 a day in a hospital. In either case, AIDS activists seem certain to keep up their tireless search for money. AIDS may be a disease without a cure, but the philanthropies that have formed to fight it deserve a clean bill of health.

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