By Terrence McCoy
By Allie Conti
By Chuck Strouse
By Scott Fishman
By Terrence McCoy
By Ryan Yousefi
By Ciara LaVelle, Kat Bein, Carolina Del Busto, and Liz Tracy
By Pepe Billete
It's not surprising that few mainstream AIDS activists -- mostly gay white men who have devoted much of their lives to working in the AIDS arena -- are familiar with the world of street-level traffic in AIDS meds. "I both make my living [in AIDS-related businesses] and play around people with HIV, and I don't see it," says Luigi Ferrer, a long-time community activist serving on the board of several national and local AIDS advocacy organizations. "I've seen a lot of abuses, but not with medications like this."
For years AIDS organizations locally and throughout the nation have collected medications to distribute to those who couldn't obtain or afford the drugs they needed -- working people, for example, who didn't qualify for Medicaid but didn't have insurance. The groups solicit donations of medicines, mainly from the estates of deceased AIDS victims and medical offices (pharmaceutical companies apparently never contribute), and some even conduct AIDS medication "drives." People involved in local AIDS service organizations say this so-called recycling has declined in Miami, but there are growing efforts in other parts of the United States and internationally to develop recycling networks on behalf of AIDS victims. Humanitarian recycling, however, is worlds apart from the subsistence trade in AIDS medications.
Florida is a stingy state when it comes to public assistance, so a single mother who may receive $40 worth of free food and food stamps each month might justify selling her AIDS drugs to feed her family. That pitiful story, however, is just another mental trap that people with substance-abuse problems fall into, social service workers say. "They may not own up to it," says Karen Gilbert, supervisor of case management for MOVERS, a nonprofit AIDS service agency in Liberty City, "but there's only one thing responsible for them selling their medication, and that is drugs. Most of them live in the moment, and it's the choice they make at the moment. It's a real problem because clients don't understand that if they do sell their medication, it's going to throw their whole immune system off track."
It's also a dilemma for doctors, who have recently been reminded by several published studies of the dangers of haphazard administration of AIDS drugs. If the medications aren't taken according to a strict regimen, not only are the drugs' effects minimized or canceled, but resistant strains of HIV that don't respond to any drug are increasingly likely to develop. "HIV medications have to be taken every day, on a consistent program, and there's not much room for error, to be honest," says Dr. Ernesto Scerpella, a physician who treats AIDS patients at Jackson Memorial Hospital's Special Immunology Clinic and works at the University of Miami's respected AIDS research program. "But there's another problem for society. You could even have a doomsday point of view on this." When the mutant viruses keep multiplying, Scerpella explains, they attack not just new and defenseless victims but render defenseless those already infected with other strains who may be doing well on existing medicine.
Thus it could be disastrous to keep placing AIDS drugs in the hands of people who are going to take them only occasionally and sell them the rest of the time. "I do believe treatment should be offered to every patient," Scerpella reasons. "Obviously the key thing for me is whether he is going to be able to make all the changes in his lifestyle necessary to adhere [to the proper regimen]. If I can't convince him to take the medicine seriously, if he'll end up selling it or whatever, sometimes we decide to withhold therapy and continue educating him. You have to understand it's a difficult decision. When I have patients who openly admit to using crack, I usually prefer not to start therapy until the drug problem is solved, because at this point his priority is crack. When you have a very advanced condition and they're approaching the end, but they're using drugs, you'll usually just [prescribe AIDS medications] because you don't have six months. But when a patient goes on a drug or alcohol binge, he will forgo his HIV medication, and that brings a resistance problem for the patient and also eventually for the public."
Wayne is feeling fine, other than being tired and thirsty and annoyed that he still hasn't got the tires for his car. He's back at the Metro-Dade Medical Center the afternoon after visiting the Viko pharmacy in Overtown, and he's anxious to return to collect his $100. He smokes a little weed and it mellows him out. A vague feeling of goodwill steals over him and he looks around, almost affectionately, at the assortment of feet-dragging, heat-numbed men and women hanging out, just like him, looking to make a buck.
"Hey, man, I need a ride to Overtown," he urges the driver of a rattletrap black Buick that's just pulled into the clinic parking lot. The driver agrees to take him, and they're off, down sun-dappled residential streets Wayne has known all his life. He says his four sons grew up around here too, and continued a family tradition of survival on the criminal edges, dealing in the usual drugs and stolen goods. A few of the sons, Wayne hints, are in prison. "I'm a gangster," he says flatly, not posturing. "Retired gangster. I been around too long to bullshit. I don't stick a gun in your face, but I will do what's necessary for me to live."