Notes from the Dead Zone

From the beginning of the epidemic in the early Eighties, people of color in general have had higher infection rates than whites. Nevertheless the greater number of AIDS cases initially was among white, middle-class gay men, who quickly mobilized to form strong advocacy, treatment, and education networks. It wasn't until the mid-Nineties that the public began to learn about the severity of the crisis among heterosexual minorities. Yet the overall amount of money spent on HIV-AIDS treatment and prevention, $14.7 billion nationwide (according to government figures), has remained stable for the past several years (and this year the Florida Legislature reduced AIDS spending). Thus in many areas competition for funding, always highly political, inevitably has pitted ethnic groups against each other. Meanwhile more minority-sensitive efforts and billions of dollars have barely slowed the HIV infection rate, which in many areas continues to rise among blacks and Hispanics. (On South Beach, the rate of new infections among young white men is as high as in Liberty City, according to the nonprofit South Beach AIDS Project.)

The picture is complicated in racially polarized Miami-Dade, where white Hispanics predominate numerically, politically, and economically. Here an ethnic group that is disadvantaged and often disenfranchised in the rest of the nation is a well-organized ruling elite. As such Hispanics hold a political advantage when it comes to soliciting AIDS funding. For example, according to the 2002 Miami-Dade HIV/AIDS Partnership Needs Assessment by the consulting firm Williams, Stern & Associates, Hispanic clients last year received 37 percent of medical services paid for by a major federal program, Ryan White Title I. The needs assessment noted Hispanics made up 29 percent of the county's reported AIDS cases in 2001. At the same time both black and white nonHispanic AIDS patients received relatively smaller percentages of Ryan White Title I benefits: African Americans and Haitians, 55 percent of 2001 AIDS cases, received 49 percent of the services; whites, 16 percent of cases, got 13 percent of the services.

On the other hand, under a different funding category, Ryan White Title II, black organizations in Miami-Dade received almost twice as much money as white and Hispanic service providers. (Apart from Medicare and Medicaid, which pay for the majority of AIDS treatment and prescription medicines, $6.3 billion annually, the Ryan White CARE Act passed by Congress in 1990 provides the largest portion of public funding -- $1.9 billion -- under four different categories, or titles.)

By all accounts the distribution of AIDS assistance in Miami-Dade is far more equitable than just a few years ago. Changing attitudes and increased publicity highlighting the severity of the epidemic in black communities have improved the lot of black AIDS activists and organizations. Still blacks working for parity in the AIDS arena also have to build what they've historically lacked -- political clout.

"It's always the squeakiest wheel that gets the most grease," points out Philip A. Hilton, a senior vice president at the National Black Leadership Commission on AIDS in New York. "If you have a vocal population that votes cohesively, you have the greatest ability to come together to utilize the political process in a way most advantageous for your community, especially if you have people in positions of power who look like you, who know where the skeletons are buried, who can ask the right questions and get the proper responses [during competition for grants] -- that makes all the difference. Many [black] communities just aren't there yet."