The Miami Herald, Inc.; Sunday, December 1, 1991
Carl Goldfarb, Herald Staff Writer

A considerable number of men also said they had intercourse with partners who used drugs intravenously, compounding their chance of being exposed to the AIDS virus.

The survey found that about one in nine homeless men acknowledged having tested HIV positive.

A 1988 study, based on blood samples of 126 homeless people who sought treatment at Camillus Health Concern, also found one in nine of the homeless tested were HIV positive.

A third study, which is still in progress, paints a bleaker picture. It suggests as many as 20 percent of the homeless could be HIV positive.

The newly released study is based on a series of interviews with homeless black men under Interstate 395. Most of the men who participated said they had taken an HIV test. One in nine acknowledged having tested positive.

About 70 percent said they were sexually active. Half of those men said they had had intercourse in the previous 30 days without a condom, some just once, others repeatedly.

"More than anything else, the study gives quantitative documentation of how big the problem is," said James Shultz, an assistant professor at the University of Miami medical school.

"In the context of a high rate of HIV infection and in the context of survival behaviors -- sex for drugs, sex for money, sex for food -- the risks for HIV infection are substantial."

Some experts suspect Shultz's study underestimates the rates of HIV infection because it relies on self-reporting.

"If about 10 percent of the men admit testing HIV positive, my guess is that it is really probably twice that number," said Barry University Professor Andrew Cherry, who works extensively with the homeless. "We're talking about an epidemic."

Even if one in nine homeless people test HIV positive, that is much higher than the rate for most other groups.

A statewide study of nearly 60,000 new mothers found that about half of 1 percent, or five women in 1,000, tested HIV positive. That is one of the lowest levels for any group.

Roughly 12 percent of the people who visited a Dade County public health clinic last year tested positive for HIV while being treated or checked for other sexually transmitted diseases. The study did not include people who specifically came in seeking an AIDS test.

A 12 percent infection rate is one of the highest for any group in the state. But one ongoing study of the homeless in Dade indicates their infection rate could exceed even that high number.

"My study is going to show you a much higher rate than 12 percent, I can tell you that," said Marlene LaLota, the state's coordinator for HIV studies.

In that study, the state and Camillus Health Concern are analyzing blood samples of patients who visit Camillus House. LaLota hopes to test as many as 2,000 homeless men and women. More than 600 blood samples have been analyzed already, she said.

Asked if her study would show exposure rates as high as 20 percent, LaLota replied: "It might."

Dr. Pedro Joe Greer, medical director of Camillus Health Concern, cautioned that it was too early to draw conclusions from the study.

He plans to start yet another study next month, taking blood samples from about 100 homeless people on the streets of Miami. The purpose of that study is to see whether the homeless people who visit Camillus for treatment are representative of the overall homeless population.

Greer said homeless AIDS patients regularly turn up at Jackson Memorial Hospital, Dade's public hospital. While making his rounds on the streets this week, Greer examined a homeless woman with AIDS who was just discharged from Jackson because her condition was under control -- for the moment.

She looked "like death warmed over," he said.

Greer predicted more and more homeless people would become infected with AIDS. 'It's going to get worse," he said. "It's going to spread. What we're going to see is people dying under I-395. Whatever you think, these are human souls and they're going to die. That's the bottom line."

Despite the high rates of exposure for homeless men and women, homeless advocates say they know of no AIDS prevention group that focuses on the homeless. Some homeless men and women are given free condoms or taught about safe sexual practices through outreach efforts targeted at drug abusers or other groups.

HIV exposure is not the only serious health problem faced by homeless men and women. National studies also show they suffer from disproportionately high rates of tuberculosis, hepatitis and diabetes, among other diseases.

Shultz's study will be published Dec. 20 by the National Centers for Disease Control as part of a special AIDS publication.

More than 100 men were interviewed for the study. The men went to the homeless encampment under I-395 during the late summer or early fall to seek help from social workers stationed there. Shultz limited his study to black men because they were the largest group among the homeless, and he wanted as uniform a study group as possible.

But the 1988 Camillus Health Concern study found no significant difference in rates of HIV infection among blacks, Hispanics and non-Latin whites. Greer was one of the authors of that study, and he's also working with Shultz and LaLota on their studies.

Shultz's study questioned the men about a broad range of behaviors.

One in every nine men acknowledged having sexual relations in the previous 30 days with at least one person who used a needle to inject drugs. One in eight said they had sexual relations with another man.

More than half the men said they smoked crack while having sex. Although not an AIDS risk in itself, crack makes people less discriminating about their sexual partners and less likely to think about using condoms, experts say.

Three in 10 men said they had just one sexual partner in the previous 30 days. Four in 10 said they had two or more partners. The rest said they had not engaged in sexual activity.

"The street is not conducive to a large number of sexual partners and activities," Shultz said.

Of the people who acknowledged being sexually active, only half said they used condoms.

Cherry, the Barry professor who has interviewed the homeless extensively, said some homeless men and women are unusually active sexually, even working frequently as prostitutes.

He estimated about 10 people now living under I-395 regularly sell their bodies. He said that in the past month, about 20 people he knows from the streets have told him they had recently contracted HIV, mostly through prostitution.

"The guys who are prostituting get it from the johns," Cherry said. "The women who are prostituting get it from the johns. And they all pass it on to their partners."

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