Miami Herald - Monday, June 23, 2003
Andrea Robinson, arobinson@herald.com

Santos preferred street life, dealing and doping, over healthy living and common sense. The sweats, throat aches and nausea that struck during other jail stints in Miami-Dade and Monroe counties did little to dissuade her.

What turned her around, she says, was the nonjudgmental encouragement from a female jail employee. "She showed me something in myself. I saw I could do more than use drugs and die in the street," she said.

Today, Santos, 42, is clean, sober and a peer counselor at Sembrando Flores, a South Miami-Dade AIDS agency. She is one of a small but growing number of women striving to overcome the reluctance of many women to get tested and, if necessary, get treated.

That's one reason why Miami-Dade Commissioner Natacha Seijas and state Sen. Frederica Wilson are among those scheduled to take a public HIV test today as part of the prelude to National HIV Testing Day on Friday.

"You don't need to be afraid [to confront the] disease," Santos said. "We have to learn to live with it."

National and Florida data show there are good reasons for women to be concerned. The number of women in the United States with HIV and AIDS has climbed steadily since the mid-1980s, according to the U.S. Centers for Disease Control and Prevention. From 1985 to 2001, the proportion of reported AIDS cases among women jumped from seven percent to 26 percent. HIV infection is now the third leading cause of death among women age 25 to 44, and the leading cause for black women in that age group.

In Florida, females represent about 30 percent of HIV cases, according to government figures. An overwhelming majority, 77 percent, contracted the virus while having sex with men.

In South Florida, the toll falls most heavily on minority women, with blacks and Hispanics accounting for about 94 percent of AIDS cases reported in Miami-Dade between 1999 and 2002.

Miami-Dade, which has the nation's second-highest AIDS rate among major metropolitan areas, was one of four U.S cities selected to kick off the annual campaign, started in 1995 by the National Association of People With AIDS. The goal is to destigmatize test-taking and enable those with the virus to take charge of their health.

Many women naively believe the virus can't affect them, AIDS activists say, and those who do have it are more reticent than men to join group counseling.

About half of U.S. women don't discuss HIV or other sexually transmitted diseases with their physicians or partners, according to a survey released recently by the San Francisco-based Kaiser Family Foundation.

REASONS FOR SILENCE

The reasons women gave for not speaking up, survey researchers said, included embarrassment or concern about being judged, not knowing how to raise the subject or believing their partner or health provider didn't need to know.

"Sexual health issues are a critical part of women's health, yet many women think STDs [sexually transmitted diseases] are something they just don't talk about -- even with their partners, healthcare providers or closest friends," Tina Hoff, a Kaiser vice president, said in a statement announcing the study. "The stigma associated with STDs silences women, making it more difficult for them to get the information and care they need to protect themselves."

And when the topic is raised, survey respondents believed the responsibility for initiating the discussion fell on them, not their partner.

Vanessa Mills, executive director at Empower U, a Liberty City outreach agency, says women are afraid to discuss the virus because of deep-seated fears of ostracism. "There's still that stigma. It's as strong as it was 10 to 15 years ago."

This week, Mills and an army of volunteers from her group will dress in camouflage pants, T-shirts and condom belts and hang posters trumpeting free HIV tests in the medians along bustling Northwest 79th Street. "This is our war on AIDS," Mills said.

Doralba Munoz, a former Massachusetts public health officer who now administers programs at Union Positiva, said much of the AIDS prevention literature is printed in English and does no good for women who only speak Spanish.

Still, more Latinas are trickling into Union Positiva's Little Havana office. In one recent month, four women in their 20s to early 30s took the test. Three of them were positive. "That freaked me out," Munoz said. "One of them had been raped by her boss."

SOBERING NEWS

Sheri Kaplan, 38, had a similar reaction in 1994 -- except she was the one getting the sobering news. After "a year of crying every day," the New York native formed a support group so she could meet other heterosexuals who were HIV positive. The Center for Positive Connections has grown into a counseling and case management agency that specializes in spiritual and alternative approaches to fighting the disease.

Women are more reluctant to participate in the monthly sessions for heterosexuals, Kaplan said. At a recent meeting, men outnumbered women.

'GIRL TALK'

That attitude hasn't stopped activists from trying. Last year, one nonprofit organization, DeltaCare, was formed to educate minority women about the virus. Participants hold frank, weekend "girl talk" sessions on how women can broach difficult discussions about condoms with boyfriends or husbands.

Anne T. Herriott, DeltaCare's president, said some women are ignorant that their partner may be involved in an extramarital affair or having sex with other men, a practice called "on the downlow."

"We want to make sure they get the message," Herriott said. "This is where the disease is growing."

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