The Miami Herald, Inc.; Sunday, July 6, 1997
Peggy Rogers; Herald Staff Writer

"Sometimes I get so frustrated with the system, I feel sick," said Suarez, a prominent Miami Beach activist appointed to three government AIDS boards, which sprout countless committees.

Dade has two AIDS crises: One is the disease and the other the bureaucratic morass that hands out public HIV and AIDS dollars. Costing a small fortune, the system for overseeing actual services includes at least three consulting firms, four principal advisory boards, five pots of money, six governmental entities and dozens of subcommittees.

"It ends up being almost a dysfunctional system," said Florida's Health Secretary, Dr. Jim Howell.

For once, an issue has brought agreement within Dade's often-fractured AIDS community: Only one board, administered by only one governmental agency -- ideally, a newly created Dade County Office on AIDS -- should coordinate AIDS housing, treatment, food vouchers, social services and prevention, say the leaders of the four advisory boards, with support from community and state leaders.

"You just think about the waste of money," said Lillian Rivera, executive nursing director in Dade for Florida's Department of Health. "People have made a living out of administering HIV/AIDS money. You're going to have people lose their jobs, but in the end, it's going to mean more money for patients instead of for people pushing paper around."

Various federal, state, county and city of Miami agencies now distribute and monitor public AIDS dollars, most of which come from Washington and Tallahassee. It adds up to tens of millions of dollars a year, with a sizable chunk spent by local governments to administer it.

Miami, for instance, gets to keep close to $250,000 for distributing less than $9 million in housing money for people with HIV and AIDS, according to Suarez, chairman of Miami's Housing Opportunities for People With AIDS advisory board.

Yet the city has failed to disburse some money from the past three years, and once it picks agencies to provide the housing, negotiating the contracts can take an additional six months, critics say.

"I would love to see the function taken away from the city, and as fast as possible," said Suarez, whose criticism is echoed by leaders of other key advisory boards.

Critics of the present system also note that hospitals, medical clinics and other agencies that receive AIDS money must negotiate separate contracts with each governmental entity for each piece of money.

The agencies must meet differing regulations and, often, provide a separate accounting on how they spend each pot. All this leads to a profusion of programs doing the same thing, an emphasis on administrative chores and confusion among patients.

Hundreds of thousands of dollars could be saved if the boards are merged into one, and administrative jobs centralized in one agency, authorities believe.

"It makes perfect sense, conceptually," said Dan Wall, Metro-Dade project director, whose office of 13 workers oversees the spending of some $19 million in federal AIDS treatment and assistance money.

But Dade would need some of the administrative money now going to the state and city to assume all the extra work, Wall said. "The county just can't afford to absorb all those costs."

Top state health-care authorities are now studying the logistics of transferring programs. "We are absolutely supportive of Dade developing one comprehensive system," said state health chief Howell.

At least two other large U.S. cities -- Los Angeles and Seattle -- succeeded in merging AIDS functions and have advised Miami.

The stakes for a merger are higher in Dade than just about anywhere. Greater Miami now has the nation's second highest rate of AIDS, after New York City. It is also afflicted by battles for money and conflicts over who sits on what board.

"What we have in Dade County is the worst of all possible worlds," Bonnie Brower, a housing expert, said at a recent meeting.

Dade has entertained discussions of a merger since 1993. Previous efforts have withered or fallen apart. But the recent creation of Florida's Department of Health has brought renewed hope for a solution.

"I think we have a better opportunity now than we've ever had before," activist Gene Suarez said.

970706
MH970703

Always watch for outdated information. This article first appeared in 1997. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .