The New Dealers

They're poor, black, and HIV-positive. Their product? The AIDS medications intended to cure them.

There is a certain type of drug trafficker who doesn't fit the popular image. These dealers aren't rich and don't live large. They're underground outlaws who usually look more bedraggled than menacing. They are indigent AIDS patients who sell their sophisticated and costly HIV medications on the street for cash.

It's difficult to accept the notion of sick people selling the very medicine that can make them well, that could even save their lives. But many such traffickers do exist in Miami, though they are nearly invisible, because they live at the periphery of society and few are willing to expose the black-market network they believe provides them the means to survive.

These people, who are almost always addicted to other drugs and who subsist in the most precarious of circumstances, are at the lowest level of an efficient criminal system that is set up to rip off Medicaid, the federal program that finances most medical care for very low-income and disabled citizens.

Neupogen, an injectible immune-system builder, is the current rage on the street, where a month's supply (retail cost: $1700) brings a patient up to $300
Steve Satterwhite
Neupogen, an injectible immune-system builder, is the current rage on the street, where a month's supply (retail cost: $1700) brings a patient up to $300

Last month federal, state, and local law enforcement authorities arrested 75 people in Miami and charged them with cheating Medicaid of ten million dollars via schemes involving the sale of prescription drugs of all kinds, including AIDS medicines. It was Miami-Dade County's second round of mass arrests relating to illegal traffic in prescription drugs in just over a year, by far the largest yet in Florida, and an indication that Medicaid fraud has become a priority for law enforcement. The recent arrests resulted from investigations in and near the Little Havana area, and targeted almost exclusively Hispanic pharmacists, pharmacy employees, and clients.

This story explores only one aspect of Medicaid fraud -- that within the AIDS community -- and it takes place in the heavily African-American neighborhoods northwest of downtown Miami, such as Overtown, Allapattah, and Liberty City; almost all the AIDS patients interviewed are American blacks. It's true that white Hispanics and Caucasians sell their AIDS medicines in other drug-infested inner-city enclaves (Little Havana, for one), but demographics alone suggest that blacks, who suffer disproportionately from both poverty and AIDS, make up the majority of AIDS drug traffickers in Miami.

All AIDS patients in this story use aliases. Those who agreed to share some of their experiences or information are exceptional; simply raising the subject usually provokes denials and silence. Like any form of drug trafficking, this kind is highly profitable (although not so much for the AIDS patients themselves) and thus protected by secrecy. Perhaps by threats of violence, too; one woman, who sold not her AIDS medications but other prescription drugs on the street, said she was threatened with death from an "accidental" overdose of heroin if she continued talking to the press.

Regardless of the seriousness of that threat, selling AIDS drugs is its own death sentence. Even if the sellers are never arrested and jailed, they face consequences more dire, and with unique implications. By neglecting their prescribed drug regimens, they're clearly hastening their own demise. Less obviously, they are contributing to the increasingly ominous development of drug-resistant strains of HIV, a danger to all strata of society.

"Green and white, that's what it's all about. Green and white," intones Wayne, referring to the color of money. He is on the job early today, fortifying himself with a bottle of Bud Dry. At eleven o'clock in the morning he can't keep much else down. In fact beer is about all he can stomach at any given hour, with the help of some marijuana.

Gray clouds have begun to gather in the azure sky in preparation for Miami's usual afternoon downpour. Also collecting in Wayne's vicinity, which is outside the pink façade of the privately owned Metro-Dade Medical Center at 1521 NW 54th St., is a handful of men and women who could be considered his co-workers. They mill around an unshaded pay phone on the sidewalk and along a covered walkway leading to the clinic. Languidly exchanging news and views, they pause to take quick hard puffs on cigarettes, all the while watching with darting eyes to see who will arrive next. These Medicaid clients aren't here for medical treatment, exactly, despite the fact that all are infected with HIV and some have full-blown AIDS. No, they're working. Green and white.

Most are waiting to see the clinic's sole doctor, Marvin Isaacson, who will write them a few weeks' or a month's worth of prescriptions. These will quickly be filled (all paid for by the government) and the medicine sold (or not filled and the actual prescription sold), either to men waiting outside in cars or to some other prearranged contact. Dr. Isaacson is aware that some AIDS victims sell their medications for cash, but he isn't going to stop writing prescriptions. "This is a problem everywhere," Isaacson acknowledges. "I don't know how you can control it. But all we do is write prescriptions for medicine that's going to help them. After that it's out of our hands. We see people two times a month. What they do with the medication I don't know. I don't know how many doctors they go to. I cannot police 150 people coming in here with a variety of problems. I have a patient [who has improved markedly]. I assume, judging by the results, that she's taking the medication. But even if she's not getting better, that doesn't mean she's not taking it. Sometimes a drug doesn't work."

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