Miami Herald - Friday, March 29, 2002
Andrea Robinson, arobinson@herald.com

"This is a serious problem we're having now. Everyone who deals with HIV/AIDS in our community knows this," said Dr. Michael Kolber, director of adult HIV services for University of Miami School of Medicine.

A report issued last month by the U.S. Centers for Disease Control and Prevention in Atlanta shows the Miami area has the nation's highest AIDS rate -- about 60 cases per 100,000 people as of June 2001.

Nationally, the rate of new AIDS cases has decreased. That was the trend in the Fort Lauderdale area, where the rate dropped from about 57 per 100,000 people to about 48, and in the West Palm Beach area, where it decreased from 50 to 44.

However, Miami's rate increased last year -- from about 58 to about 60 -- ending five consecutive years of declines.

Rounding out the top five in the report released in late February are New York, second; and Baltimore and San Juan, Puerto Rico, tied for fifth.

Tom Liberti, chief of the HIV/AIDS bureau for the Florida Department of Health in Tallahassee, said one reason the South Florida rates are so high is that aggressive outreach and testing of more than 500,000 Floridians over the past two years identified more people who previously had not been tested for AIDS and HIV, the virus that causes the disease.

Among the places health officials and community groups visited for tests were jails, substance-abuse facilities, clinics, pharmacies, parks, mobile vans, prisons, detention centers and maternity clinics.

"Any place where we thought there was a good facility to offer a test, we worked to get it done," Liberti said.

Evelyn Ullah, director of Miami-Dade's HIV/AIDS office, said that as outreach efforts continue, the number of cases will increase. But she and other experts said better reporting is not the sole cause of the increased rate in Miami.

"We still have individuals practicing unsafe sex behaviors," she said.

Dr. Margaret Fischl of the University of Miami, a leading researcher in HIV/AIDS since the beginning of the epidemic, said Miami tends to be a barometer of what will happen in the rest of the country. The figures, she said, are cause for concern.

"It tells me that people are still doing or practicing sexual behaviors or drug and substance abuse that put them at risk," Fischl said.

"Miami's epidemic continues to occur, and we have no indication that it's slowing down in this area. None."

She added that people still tend not to get tested for early detection. When a person finally is tested, she said, the diagnosis is more likely to be full-blown AIDS, not just HIV infection.

The increased rate comes as local AIDS agencies find themselves with less money to spend.

This year, Florida legislators have cut $5 million from the Medicaid Project AIDS Care Waiver program.

So far, the program has eliminated funding for about a dozen services, including physical and respirator therapy, substance-abuse treatment and home care services. Funding for other services was reduced.

Manuel Laureano-Vega, executive director of the League Against AIDS, said he had to lay off three workers -- half of his case management staff.

Remaining employees saw their caseloads rise by 25 clients each, and everyone took a 16 percent pay cut.

How are they getting by doing more with less?

"Everyone's asking themselves that question," he said.

Earlier this month, he and other AIDS advocates and patients went to Tallahassee to try to get the funding restored. He said he was hopeful that it would happen during next week's special legislative session.

David Trussell, spokesman for People With AIDS Coalition in Miami, said the organization was already feeling the pinch from higher caseloads. PWAC doesn't receive state or federal funding, and relies solely on private donations. He said those donations have declined significantly since the Sept. 11 attacks.

He said the agency would have to cut transportation and clothing assistance services to its 1,700 clients.

"With the cuts [at other agencies], people are coming to us. We get people who other agencies can't help, but we need cash to survive." One of PWAC's clients, Bobby Hamilton of Miami, said the organization's demise would be unfortunate.

"People living with HIV and AIDS are able to function and have normal lives. They can work," he said.

"This is going to hurt a lot of people."
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