Miami Herald - July 7, 2002
Fred Tasker, ftasker@herald.com

The reasons are as myriad as they are ominous. And in deadly irony, many of them are directly related to successes in fighting the serious, often fatal, condition:

ò Because new antiretroviral drugs have held AIDS at bay, a new generation has grown up never having seen the devastation of AIDS. "People aren't scared of AIDS anymore," said David Trussell, board member of the People With AIDS Coalition of Dade County. "They let their guard down."

ò Because of the drugs, people are living longer with AIDS. But they still carry the virus -- and potentially can infect others. More than 300,000 Americans are in this category, says the U.S. Centers for Disease Control and Prevention.

ò Young people are increasingly engaging in risky behaviors: bisexual men who don't think they need to take precautions, and infect both men and women; young men and women engaged in unprotected sex; younger gay men trying to become infected on purpose.

'I talk to infected people and they say, 'How insane is that?' " said Lisa Agate, director of the Broward County Health Department. These scenarios are increasingly being played out in South Florida, where Miami, Fort Lauderdale and West Palm Beach were first, third and fourth among U.S. cities in the rate of new AIDS cases in 2000, the CDC says.

"South Florida has a very large community . . . with low education, poor access to healthcare," said Dr. Toye Brewer, director of the Sexually Transmitted Diseases clinic at the Miami-Dade Health Department. "And we have an immigrant population that comes from countries with high rates of HIV -- Haiti, the Bahamas, Honduras, Nicaragua. And we have a large gay population."

AIDS will be the topic of discussion in Barcelona, Spain, this week as 10,000 scientists, researchers and others involved in the battle against AIDS gather for a week of scientific presentations. The conference will examine new strategies for battling AIDS, as well as look at AIDS trends around the world. The researchers will include Dr. Corklin R. Steinhart, director of the Florida AIDS Education Training Center in Miami.

AIDS compromises the immune system, leaving the body defenseless against serious infections.

OUT OF PROPORTION

Blacks in South Florida heavily affected by AIDS

In South Florida, the black population is one of the hardest hit by AIDS. Blacks make up 19 percent of Miami-Dade's population but 49 percent of its AIDS cases; in Broward, they make up 21 percent of the population and 45 percent of the AIDS cases.

One of those cases is that of Justin Bradford. Eleven years ago, the Florida City packinghouse lifter and street-court basketball player learned that he had HIV, the virus that causes AIDS. He had contracted it through a woman.

He sat down and cried. "I thought I was going to die."

Today, at 40, he's on an eight-pill-a-day anti-HIV regimen.

Women, however, make up a disproportionate share of the cases among blacks.

"In some parts of the country . . . there's a shortage of black men relative to women," Dr. Brewer said. "It means one may have multiple female sex partners."

Studies have shown that men infect women more easily than women infect men.

Blacks also have not had the same access to HIV treatment as white non-Hispanics. A California study published in May in the New England Journal of Medicine detailed that blacks accounted for 33 percent of patients receiving HIV treatment but represented only 23 percent of adults in trials of AIDS drugs. By contrast, whites accounted for slightly less than half of the patients, but more than three-fifths of those in medication trials.

The rate of AIDS cases is greater among Haitians. In Florida in 2000, Haitians had an AIDS rate of 439.8 per 100,000 of population, more than 13 times the state's overall rate of 32 per 100,000.

"It's a real crisis of education," said Maria Flore Lindor, who represents the South Florida AIDS Network in Miami's Haitian community. "Even if you print health warnings in Creole, so many of them don't know how to read. That's the biggest reason for so much unprotected sex."

But illiteracy isn't the only problem. One educated Haitian with HIV is Edmonde Benony. Born in Haiti and living now in Miami, she contracted it here, then got into a peer program that instilled in her a new sense of hope. She now teaches Creole in the same program, at Jackson Memorial Hospital.

The gay population also is a major part of the AIDS crisis. Across America, one-third of all new AIDS cases involve gay men, the CDC reports.

Many of them have been living with HIV or AIDS for decades, trying to live a healthy lifestyle and not endanger others.

"I think most people with HIV are responsible, use condoms, only seek other positive people," said Joey Wynn, 37, of Fort Lauderdale, who learned in the 1980s that he had AIDS.

But, experts say, many younger gay men believe that AIDS can't affect them or that it isn't that bad.

"I go back to the first wave in the '80s, when you'd see people with HIV looking like they came from a concentration camp," said Trussell, of the AIDS Coalition. "Now they don't even look visibly ill."

In addition, some bisexual men don't consider themselves gay and therefore don't think they have to take precautions.

"It's a big machismo thing," said Agate, of the Broward County Health Department. "They're very secretive, very closeted. They don't go to gay bars. They go to house parties. It's a closed community."

Perhaps the most irrational and risky practice is the "conversion party," in which men, particularly gay white men, have unprotected sex to try to contract the virus, Agate says.

"It doesn't sound logical to you or me," she said. "But they say it can be a relief from the fear of getting infected, the fear of the unknown."

HISPANICS HIT LESS

S. Florida group does better than national average

A South Florida group that fares better than the national average is Hispanics. Nationally, Hispanics make up 12 percent of the U.S. population but 18 percent of its AIDS cases.

In South Florida, however, they make up 60 percent of Miami-Dade's population but only 33 percent of its AIDS cases. In Broward, they make up 20 percent of the population but only 8 percent of its AIDS cases.

Hispanics in South Florida tend to be more affluent and educated than those in other regions of the country.

One South Florida Hispanic who contracted HIV -- and says it was from a girlfriend -- is Lucio Amado, 34, who arrived in Miami from Brazil in 1981. Learning in 1990 that he had HIV, he avoided anti-HIV drugs for five years, dealing with his increasingly poor health with marijuana and cocaine.

"I was in denial," he said. "I didn't want to face it."

Drug use in general is a major risk factor for HIV. Users account for only 15 percent of all U.S. cases but 34 percent of cases among black men, 41 percent among black women, 35 percent among Hispanic men and 47 percent among Hispanic women.

It's more than sharing needles.

"A lot of it is not just intravenous drugs, but other things like crack cocaine, which leads to high-risk sex practices and multiple partners," Brewer said. "When you're high, you feel invulnerable."

When drugs are involved, HIV treatment becomes even chancier, according to a 2000 study of 327 HIV-positive crack cocaine and other drug users from Miami's inner city by Lisa Metsch, director of the University of Miami Drug Abuse and AIDS Research Center.

Such users often didn't seek medical care for as long as five years, until their symptoms reached "moderate to severe pain."

"They had medical problems, legal problems," Metsch said. "Being HIV-positive was the least of their worries."

Getting such people into treatment -- and keeping them there -- has become a major thrust of the fight against AIDS.

REGIMENS RESISTED

Many unable to tolerate pills that combat HIV

Many HIV patients who start drug regimens quickly drop out. The pills taste bad, they say. They have to take 10 to 15 pills a day, sometimes more, at precise times of the day -- some with water or food, some without. Side effects include everything from diarrhea to kidney damage.

"And you can't miss a single dose or HIV will penalize you," said Dr. Steinhart, of the Florida AIDS Education Training Center.

The treatment issues are compounded by the resilience of AIDS. Some experts fear that the nation's HIV and AIDS rates might rise again because of the virus' ability to become resistant to the most powerful antiretroviral drugs.

"More than 75 percent of all HIV patients have resistance to at least one of the three major classes of drugs," Steinhart said.

"These drugs seem to have finite periods of effectiveness."

In the end, of course, making it all work will be up to those with the most at stake: the patients.

"You've got a life," Bradford said. "You've got to keep it intact."

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