Miami Herald - July 26, 2001
Christine Morris and Stephen Smith, cmorris@herald.com

On Saturday, just as they did in July 1999, hundreds of people will meet in downtown Miami for an AIDS summit, driven by the same quest: stopping the virus before it can steal more lives. And although the state has expanded education campaigns at the same time black churches have embraced prevention efforts, there is less optimism and more anger about the ability to contain a virus that 58,146 Floridians are known to be living with.

"We're really in a crisis here," said John Muhammad, chairman of the Miami-Dade HIV/AIDS Partnership. "People really want to forget about it, and that denial is what's killing us."

Two decades since the dawn of the epidemic, thousands of people become infected with HIV each year in Florida. The reasons are complex, everything from the youthful sense of invincibility that leads to risky behavior to the misguided belief that powerful drugs can make controlling the disease as easy as swallowing a few pills. "It is easy to get discouraged because we don't see how all the individual efforts move things forward," said Dr. Helene Gayle, chief of the AIDS division at the U.S. Centers for Disease Control and Prevention. "What I am encouraged by is that people are not letting go of this effort -- in fact, they are upping the volume."

Dr. Margaret Fischl has been involved in the war on AIDS since its earliest days in the 1980s. There has been tremendous progress in refining treatments, helping people live longer than was ever thought possible. While the science has advanced, attitudes have often remained frozen in time, causing the University of Miami researcher to confront many of the same issues she saw a decade ago. Today, the vast number of patients she sees -- as high as 80 percent -- are 25 or younger.

"If we see, for example, a young gay man, he doesn't know what AIDS is, he's never seen it," she said. "He doesn't know what this epidemic was 10 years ago. He has no sense of what he's facing. "Death and dying and being sick is not something you want to worry about when you're young."

During the past 20 years, the course of the epidemic has shifted significantly, with the onslaught borne increasingly -- in Florida and nationally -- by blacks, said state AIDS epidemiologist Spencer Lieb. Although blacks make up 15 percent of the state's population, they constituted 58 percent of the reported HIV infections since July 1997.

HIV infection statistics provide the best snapshot of the recent course of the epidemic -- better than AIDS rates because it can take years for infection to progress to full-blown disease. HIV is the virus that causes AIDS whereas AIDS is an affliction that destroys the immune system.

Broward provides an especially sobering tableau: Since the start of the epidemic, white non-Hispanics and blacks have constituted an equal percentage of AIDS cases, 46 percent each.

But in the four years that HIV infection data have been collected, the epidemic's path has bisected the heart of black communities in Broward: Blacks accounted for 63 percent of new infections, more than double the percentage for white non-Hispanics.

In Miami-Dade, Hispanics make up 30 percent of HIV infections, while blacks account for 56 percent.

"In the lower socioeconomic groups, the disease is really percolating," said Dr. Michael Kolber, director of adult HIV services in the UM Department of Medicine.

"There are much higher percentages of heterosexual infection than we saw before. It's frightening, and people's habits haven't changed."

Since a 1999 Herald investigation of the widening AIDS divide in Florida, the state health department has expanded efforts to reach out to black communities, with regional coordinators leading the charge.

Education campaigns have aired on TV and radio, appeared on billboards and the Internet.

A pivotal component has been the increased involvement of churches, a bedrock of social movements for decades in black neighborhoods.

"Early on in the epidemic, they saw this as people getting this disease because they were doing things that the Bible says they shouldn't do," said Ronald Henderson, statewide minority HIV/AIDS coordinator for the Department of Health.

"It's gotten to the point where churches have realized this is a significant crisis in our community, and I have seen a tremendous increase in the churches wanting to get involved."

There are more frequent calls for people to be tested for the virus, more widespread distribution of condoms. Still, denial remains a lethal enemy.

"James Baldwin wrote that `you cannot fix what you will not face,' " Henderson said.

"If we as a community don't face the fact that HIV/AIDS is killing our children, our families, our neighbors, our entire community, there's nothing the health department or any government agency can do."

People living with HIV can be the most effective educators in their own neighborhoods, Kolber said.

"Each community is very different. Overtown is very different from Homestead," he said. "We're trying to get the people who work in those communities to meld us in. We must infiltrate."

Eliminating the racial and ethnic disparities in HIV infection is a major focus for the Miami-Dade Health Department, said Evelyn Ullah, director of the department's Office of HIV/AIDS.

"I firmly believe that we all are doing the best job we've ever done, but there are many gaps," Ullah said.

Sheri Kaplan was at the summit two years ago, and she plans on attending the summit Saturday. She is the founder and executive director of the Center for Positive Connections, a resource, support and healing center in North Miami.

Agencies such as hers are struggling today -- not from lack of need but from a dearth of resources.

After so many years of giving to AIDS causes, individuals and foundations are channeling their money to other needs.

That doesn't mean new clients have stopped walking through Kaplan's door. "Nothing has changed," she said. "People are still getting infected, people are still not getting the message."

And people are still revealing their ignorance. A few weeks ago, Kaplan was at a networking session for a chamber of commerce, and she distributed business cards. A man at the meeting assumed -- correctly, it turned out -- that Kaplan is infected.

The man flung the card on the table, afraid that he would contract the virus from the business card. It turned out that the man had not used condoms with the three women he had most recently been intimate with.

"I really set him straight, and I let him know how much he's at risk," Kaplan said. "I put a face on the disease. It is not over till it's over. The only thing we can do is prevent it."

That is why U.S. Rep. Carrie Meek and other leaders called for a summit. The Miami Democrat has lost friends and acquaintances to AIDS and has watched the disease march through her district.

"We knew we couldn't legislate this disease away, so we had the idea for a community-based summit," said Tola Thompson, spokesman for Meek.

"We want to put together a strategy to make sure we're doing all we can to attack this terrible, terrible disease that has killed so many of our people in South Florida."

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